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In this episode, we sit down with Amaka Nnamani, a pediatrician who shares her powerful story of starting her residency while four months pregnant. Amaka discusses the unique challenges she faced balancing her medical training with motherhood, the shortcomings of maternal leave policies in the United States, and the broader implications for women in medicine. Join us as we explore the disparities in paid maternal leave, the lessons the U.S. can learn from other countries, and the long-term impact of these policies on both health care professionals and society at large.

Amaka Nnamani is a pediatrician.

She discusses the KevinMD article, “It’s time to pass federally mandated paid parental leave.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we have Amaka Nnamani. She’s a pediatrician, and today’s KevinMD article is “It’s time to pass federally mandated paid parental leave.” Amaka, welcome to the show.

Amaka Nnamani: Thank you, such an honor to be here. Thanks, Kevin.

Kevin Pho: So you are a pediatrician. Tell us a little bit about your story and journey.

Amaka Nnamani: Fantastic. Yes, I am a pediatrician, the best job in the universe. Don’t argue with that.

So my journey has been quite interesting. I trained as a pediatrician, been a pediatrician for over ten years now, but a few years ago, actually about three years ago, I made a very difficult decision to leave full-time clinical outpatient care. And to be quite honest, at the time I didn’t have a plan. Did not quite have a plan. I just knew I needed a break. We just had our third child in the midst of a pandemic. He was born 4th of July 2020, you know, what a better, that’s not a better time to be born I guess. And there was a lot going on in our personal lives, but I just had to make that decision.

And in my time away I decided to explore other non-clinical aspects of my life, and for me that included writing. I’ve always enjoyed writing and so it’s always been an outlet for me, more therapeutic than anything. And so I decided to take a few writing classes, and I just woke up one day and said I was going to write a picture book on breastfeeding. Well, that journey lasted several months, and I ended up self-publishing a picture book titled Z’s Quest: Mommy’s Milk Rocks. And that has actually opened up a whole new path for me into public health advocacy and a lot of other exciting things.

So that’s kind of my background. Still a pediatrician, always will be. I just do more contract and locums type things, but continue to feed other interests that include public speaking, advocacy, and all that fun stuff.

Kevin Pho: Oh, I love that story so much, because I talk to a lot of doctors whose identity is just being a doctor. And then you said that you paused clinical medicine a bit, you didn’t have a plan, but then eventually just opened up a whole new world, publishing, speaking, that you initially didn’t have a plan for. And now that’s your professional life and identity.

Amaka Nnamani: Yes, you couldn’t have said that any better, Kevin. You’re spot on. It’s quite serendipitous I would say, but I’m glad for it. Really grateful.

Kevin Pho: So one of your articles is on KevinMD. It’s titled “It’s time to pass federally mandated paid parental leave.” For those of you who didn’t get a chance to read your article, tell us what led up to it and what it’s about.

Amaka Nnamani: Absolutely. So my personal experiences led to that. So I’m a breastfeeding advocate, and that just means that with that I don’t just advocate for mothers, or birthing people, to breastfeed, but also to have laws and legislations that support that choice, right? Because it’s one thing to say I’m a mom, I want to give my child the best nutrition I possibly can. It’s one thing to make that decision, but it’s a whole different thing to have the support system around you. And so that was kind of detailing my personal experiences.

So for those of us that haven’t read the article, I was one of those crazy people. I started residency pregnant. I was the intern who showed up pregnant, four months pregnant to be exact. At the time that I interviewed I was not pregnant, so I would say it was a bit of a, I wouldn’t say a shock, it was definitely a blessing, but it wasn’t something that the residency program had been aware of prior to me just starting.

And so I remember being told by an attending, basically who made it quite clear, that that was not a good decision, especially because my husband lived in Nigeria at the time, so he was thousands of miles away. So I was a single married mom, if you will. But I had made that decision to exclusively breastfeed our daughter, primarily because I’d seen a really, really good friend of mine do it, and she was a single mom at the time working in corporate America. And I saw her do it and I said, you know, if India can do it, I can do it. And she was so supportive.

But what I didn’t have was the workplace support, right? Like I said, I started residency pregnant, and so I already felt like I was the weak link, especially because my husband wasn’t there. So I felt like I needed to overcompensate for just my condition, if you will.

And so I remember, I hadn’t qualified for FMLA because I hadn’t worked a year, but I had a residency coordinator, Ketta, God bless her. I don’t know what I would have done without that woman. We’re still very good friends. But she advocated for me to get time off, which ended up being about five weeks or so. That was largely unpaid because, again, I didn’t even qualify for FMLA. So this is me feeling grateful that I actually did have some time, that I could actually get some time off. And this was like Thanksgiving. Amara was born two days before Thanksgiving, so this was like wintertime, right?

But then after coming back I realized I also didn’t know how to advocate for myself with regards to pumping, because I was scared to ask. There was just a lot of insecurity, if you will, that was there just because of so many things, like not having a husband even though I was married, but feeling like I wish someone would speak up for me, because I really couldn’t speak up for myself.

But yeah, that article just basically details the importance of us as a country having a nationally mandated federal paid leave, because the U.S. is really one of seven countries in the universe that does not have that. Also, it’s a hot topic in my state, Pennsylvania, where we are advocating for paid parental leave. So that kind of is the summary of that article.

Kevin Pho: Now tell me the interactions that you had with the residency program. On one hand you said the residency director said that it wasn’t a good decision, but on the other hand you had some allies within the program that helped you out. So in general, was it an even support depending on who you talk to within that program?

Amaka Nnamani: Yeah, so to clarify, it was a residency coordinator. So she was like the program manager. She was a non-clinical member of the team, so she was responsible for helping to make schedules and things like that. So she advocated for me to do that.

Well, in terms of, I don’t know that I had a lot of attendings that supported that. I remember one of them besides, it was a different attending who said, you know, you showed up four months pregnant with a husband thousands of miles away, this is residency, what were you thinking? And then I had another attending tell me, well, I didn’t breastfeed my children, I formula fed them, they turned out OK. This is a pediatrics residency program, right?

But it wasn’t, so I wouldn’t say it was toxic. I wouldn’t term it that way. But there was not extra effort made, or I would say barely any effort made, to support me.

The full circle moment though happened earlier this year, I believe in March, when I was invited to speak on a topic of breastfeeding as a health equity issue. And I went there and I found out there’s a lactation pod where residents who are nursing can go and have dedicated space to pump. That definitely made me cry, because I remember several days, pretty much all the time, it wasn’t several days, it was every day, where I would need to pump and I just couldn’t find a room. And I would find one, sit, and then my pager goes off. So for me it was definitely a full circle moment. But yes, I would say that was uneven support, and maybe not toxic but definitely not a lot of support.

Kevin Pho: And just to be clear, what is the current policy as it relates to parental leave?

Amaka Nnamani: So on a national level we don’t have a federally mandated policy with regards to parental leave in the United States, right? So it tends to be, so a lot of it’s almost segmented. So some states, California is one, New Jersey I believe, New York is one of a few states in the U.S. that actually have state-mandated parental leave or maternal leave.

And then there are other companies, like I live in Hershey, Pennsylvania. I know the Hershey Entertainment and Resorts has a really good package for parents. I believe the mom’s maternal leave, I believe they get up to twelve weeks of paid maternal leave after you’ve worked for at least a year, and I’m almost certain that dads get about the same thing.

So it becomes a thing of, if you have a good job and you’re lucky to live in a state that has that, then maybe you will get that. So it’s not federally mandated at this time, but in the state of Pennsylvania we’re pushing for the state to pass that law of having paid parental leave.

Kevin Pho: So it sounds like it’s entirely employer dependent or state dependent. And when it comes to medical institutions and residency programs, to your knowledge, what is the standard when it comes to paid parental leave?

Amaka Nnamani: That’s a great question. I’m not sure that I know. Again, just like we talked about it being state dependent or insurance dependent, it’s again residency dependent. So it’s up to the woman to advocate for herself and say, hey, I’m about to go and leave, so when I come back, or maybe the week before, can I do an elective where it’s like a research elective and maybe I can be at home for a month? So it’s been a lot of those types of things.

To the best of my knowledge, I don’t know that there are a lot of, now there are a few residency programs, and I think it’s again dependent on who your residency director is. If you have a residency director that is supportive of it, or who had her own personal experiences and really wants to pass that on, then it just becomes a matter of you’re lucky, you have a good residency director. So that, to the best of my knowledge, is what we currently have.

Kevin Pho: So it sounds like how easy or difficult it is on the mother who just gave birth is completely at the whim of the residency program itself.

Amaka Nnamani: Yes.

Kevin Pho: So in terms of an ideal situation, let’s say you were to replay the first few months of residency, or your first year of residency while pregnant, in an ideal situation what would you have liked to have seen?

Amaka Nnamani: I would definitely have liked to see a more supportive environment where I think colleagues that are understanding of motherhood. Of course I made the decision to be a mother, so I don’t expect pity, that is not what I expect, right? But a support system where, and I had one or two of them to be completely honest, who would say, hey, what can I help you with? Are you rounding on patients? Maybe I can see the last one so you can go back to your daughter. So things like that.

But also in terms of the transition back, I kind of alluded to having things like research electives. I think that’s a good way to phase back in after coming back from leave. So I think ideally, in an ideal world, I would definitely want to see paid leave, right? And there are programs who have actually worked around this. I know a residency program in Colorado, I believe it’s Children’s Hospital Colorado, Dr. Maya Bunik, who is the breastfeeding section chair. They have a parental elective where it’s parenting, right? Maybe you’re a first-time parent, and so that counts as an elective.

So kind of incorporating it into the already existing curriculum, so it’s not like you’re having to pay back time. So having that kind of structure where you can have that be a parenting elective, and maybe the next one be a research elective, after having had that time to bond with your child. Because it is a life experience, right? And I’m so grateful for it, because during that time I learned so much about myself. I learned about the strength that I had, that I, I mean up until then I looked at myself as weak in some sense. And so I found that I was able to do quite a few things and do them well.

But I think in the ideal situation I would see one program that’s supportive, but I think having a supportive program also has to do with education. And so for some people they might just be nonchalant, not because they want to be mean, but just because they might not know what to do. And I think that’s why it becomes important to have embedded in a residency curriculum breastfeeding, right? We talk about, as physicians we get almost no education on this.

I think regardless of what specialty you are, whether it’s family medicine, anesthesiology, plastic surgery, whatever it is, one way or another you’re going to have to deal with it. Not even if it’s not you personally, even if it might be your patient. If you’re a pediatrician, that’s all you’re dealing with in the first at least three months, those types of questions around nutrition. Or your family doctor. But also if you’re an ophthalmologist. I mean, I’ll give an example. I went to my eye doctor several months ago and I was getting ready to have drops in my eye, and the tech asked me, she said, are you pregnant or are you nursing? And I said, oh, I’m nursing. And she said, oh, then I can’t put these drops in your eyes. And I said, why not? She said, oh, because I don’t want to risk getting it in the milk for the baby.

And so that was for me a time to educate, and thankfully I had someone who was willing to listen, and I spoke to the ophthalmologist, and then they created a policy around that. But I say that to say, including that in the curriculum is something that we need to be aware of, not just from a clinical side but also from a community standpoint of being better physicians and being better advocates for our patients. So hopefully that kind of answers, kind of a complicated answer there, but hopefully that makes some sense.

Kevin Pho: One of the things that you said while you’re telling your story is that you felt that you weren’t able to advocate for yourself. Now, as you said, there’s relatively uneven support in different residency programs when it comes to pregnant mothers, or a mother who just gave birth. Now for women in those situations, what kind of tips can you share with them on how they can better advocate for themselves in a perhaps less than ideal supportive environment?

Amaka Nnamani: Yes, 100 percent, and it’s a lot of what I do now. So a big part of it is communication, right? And I think that’s something I wish I did. I can’t just expect people to save me. Sometimes people want to save you but I don’t know what to do, right?

So I usually say communicate, depending on your level of comfort. If you’re in a workplace where you feel like you can share as early as four, five months when you’re pregnant, and then have a plan when you come back. Like, let your manager or HR know, well, this is how much I plan on taking off, when I come back I plan on breastfeeding, I will need a lactation room to pump, I will need this amount of time during the day to do that. There are policies. The PUMP Act actually stipulates that women have a right to a private place to pump that is not a bathroom, right? So making HR aware of these things, because for some employers they may not know. So communication is a big part of that.

But also having a support system, like a tribe almost. And that may look like your spouse, but I think that’s not enough, that a lot of times for a lot of women means a support group. There’s a lot of information and there’s a lot that you can learn from other women who’ve done it. And I will say that even for me the third time around, I had a colleague who went out the same time as I did and I learned a lot from her. She had a plan, she communicated it, and she had a plan when she came back. And then she had tips on how to go about it, and she was part of a support group, and she shared that she learned some of these things in her support group. So knowing about that.

But also a big population that I work with now is the women who qualify for and participate in the WIC program. WIC stands for Women, Infants, and Children, the supplemental nutrition program for women, infants, and children. And usually you have to be within a certain poverty level to get that. So these are women who are marginalized, who several times are women who do not know how to advocate for themselves. So teaching them about their rights.

But also a lot of times even when they know their rights they’re still scared, because you think, if I’m a single woman with three children and I have two jobs, and one of them is I’m a cashier at the dollar store, I work at McDonald’s, I may not know how to ask my manager for time, right? And so it may look like simulating time with her. Or even, several of these women have Medicaid, and some of them work with MCOs that work with community health care organizations that use community health workers. So that means that some of the appointments they have, people who go with them. And so even training the trainer, training these CHWs, or community health workers, to know how to advocate for their patients. So it’s a community effort.

But those are definitely two of the most important tips I will say. Communicate as early as you possibly can, as early as you feel comfortable doing. Join a support group. And if you’re a physician, because I know that’s a huge part of your audience, there is a Facebook group that’s exclusive to physicians, to female physicians or physicians who identify as female, called Dr. MILK. And MILK stands for Mothers Interested in Lactation Knowledge. And it’s an exclusive group because studies have shown that when female physicians meet their breastfeeding goals they’re more likely to pass that on and be supportive of not just their colleagues but also their patients. And so it’s a group where all sorts of questions are asked, and I know that helped me in my journey, and I’ve paid it forward.

And unfortunately the reverse is the case, and I know I was on the receiving side of this, where an attending says, well, I didn’t breastfeed my child and she turned out OK, so I mean, suck it up.

Kevin Pho: We’re talking to Amaka Nnamani. She’s a pediatrician. Today’s KevinMD article is “It’s time to pass federally mandated paid parental leave.” Amaka, we’ll end with some of your take-home messages that you want to leave with the KevinMD audience.

Amaka Nnamani: Absolutely. I would say, number one, if you’re a physician out there, number one, validate you. But number two, I think if you’ve had other interests that are not related directly to clinical medicine, it’s OK to explore, right? Because you don’t know what you’ll find. If I didn’t take this, as crazy as it was when I did it, I would not have found this part of me. And I’ve never felt this liberated and truly happy, being able to just nurture most of the different aspects of me, because I do have a lot of interests, right? So don’t be too, it’s a scary journey, right, but don’t be too scared to take that leap.

Definitely have a support system. I found, because now I’m an accidental entrepreneur now, so I’m doing a lot of things like speaking and my books and working with organizations, and I wish that I had some business skills. That is one thing I wish I had, and I’m learning the hard way. But there are support groups and systems out there. Like a big one I definitely want to shout out is Dr. O. She’s a female physician who’s a pediatrician as well, but she supports physicians in their journey to becoming entrepreneurs. So find groups like that.

But definitely, it’s OK to explore other, because you are not just one thing. You don’t have to be one thing. There can be different aspects of you, and you can find ways to intertwine them. And if you decide to stay in clinical medicine it could probably make you all the better and happier, right, because you’re able to fulfill these other parts of you.

Kevin Pho: Well, thank you so much for sharing your story, time, and perspective, and thanks again for coming on the show.

Amaka Nnamani: It was an absolute pleasure. Thank you so much for having me, Kevin, and thanks for all you do for the physician community.