As I sit breastfeeding a newborn and hastily switch to pump while the newborn (my fourth child) dozes, I have some thoughts that I think are particularly timely given concerns that are facing millions of families of young children in our country. Maternal and infant mortality continue to be worryingly high in the U.S., especially for women and children of color and in socially vulnerable areas of our country. The cost of private childcare is commensurate with higher education and inaccessible to millions of families. There are not enough high-quality, federally funded childcare programs. There are concerns regarding declining birth rates. There continues to be a lack of paid parental leave in many areas of the country, and there is no universal paid federal leave policy for families. Threats and actual cuts to federal funding of these programs will only worsen these problems and place the burdens on the backs of parents.

As I reflect on these concerns, I think back to the birth of my own children. My first daughter was born between my third and fourth years of medical school. I cobbled together vacation time and finished a required rotation (pediatrics, which is what I would eventually choose as a residency and area of practice). I had a difficult delivery and had challenges with establishing breastfeeding due to a special care nursery stay for my daughter but ultimately was able to have a successful breastfeeding relationship due to a lot of trial and error and dedicated research on my part. I took my pediatric shelf exam when my daughter was a week old and went back on an elective rotation when she was a week and a half old. I completed a licensing exam when she was two months old and had to pump with a manual pump in a bathroom stall (due to exam security concerns, you were not allowed to leave the building during testing). All of this was only possible with the support of my family.

My second pregnancy with my son occurred during my second year of residency. I regularly worked 24-hour shifts as a pediatrics resident and had an episode of threatened preterm labor, which resulted in a four-week medical leave. Ultimately, I went back to work at 36 weeks and completed an elective rotation until delivery. I had saved vacation time for when the baby would be born and had spoken with my program director about developing objectives for a newborn elective (which I had read that other pediatrics programs permitted) to allow me to be at home with my newborn son for four weeks (with ample hands-on experience with said newborn) and to complete by finishing the month with an essay on my perspectives on parenthood and newborn care. As a resident, I still had expectations of providing coverage over the holiday block and had to pump accordingly to accommodate this (four weeks after my baby was born).

I went back to work as a resident full-time when my baby was two months old and had a NICU rotation when my baby was three months old (resulting in routine 10- to 12-hour shifts, six days a week). I will never forget the moment I found out that my freezer stash of milk that I had so carefully pumped during my limited time off had all thawed due to a refrigerator malfunction and was ruined. While I was rounding with our team in the NICU, I shared my visceral reaction following my husband’s earlier text message about the lost milk with the neonatologist, and she shared my grief and frustration over all of that milk (and time) that was now down the drain. The constantly alternating schedule with nights on call and ICU coverage disrupted my pumping routine and made me hypersensitive to my milk supply, in addition to all the stresses associated with life during a global pandemic. Again, I only got through any of this with a supportive spouse and family who could help whenever I needed it.

My third child was born during fellowship, with a maternity leave of six weeks of paid leave (due to my fellowship program participating in the institution’s House Officers’ Union). My program director also offered me a four-week research month without any in-person clinic as well as using two weeks of my vacation time. This permitted me to have the most time home to date with my new baby and my other two children and was an absolute blessing.

My experience thus far with my fourth baby as an attending has been positive. I have the most time off that I have ever had with ten weeks of paid leave and my banked PTO to use. Because I have been with my employer for less than 12 months, I am not eligible to use any unpaid leave through the Family Medical Leave Act.

My point of all of this is that it is incredibly hard to have babies and young children in this country, especially for working parents. I have had the extreme good fortune to train and work where my family resides (and have a family who has been willing to help with childcare when I am not able to because of the demands of medical training and practice). I am well aware that this is a luxury that most do not have. Throughout all phases of my medical training, I have spent many hours pumping in call rooms, locker rooms, my car, airports, and at home to ensure that I can feed my babies. I have looked up power pumping and supplements to try and sustain milk supply when away from the baby. It just should not have to be this hard.

I have friends in the corporate sector who have had multiple months of paid leave for both parents, allowing the family to get through almost the first year without having to outsource any childcare. I have another friend who lives abroad with her spouse, and they have had years of paid leave with their young family (and then had access to government-funded, high-quality childcare). We know that the provision of human milk is beneficial for both mother and baby and is more than just a lifestyle choice but rather a shared medical decision that should be optimized and supported (and is definitely facilitated by having time with the baby). We know that supporting parental leave promotes more optimal breastfeeding outcomes. We know postpartum depression and anxiety are real and affect both maternal and child health. We know that the first three years of life are critical to supporting development. We know all of this and yet we are still not providing the ample support that young families need. We can do better. We can do better in pediatrics, in medical training, and in this country. Other industries and countries have found ways to support families. We can and need to do better for our patients, our families, and ourselves.

Julie Zaituna is a developmental-behavioral pediatrician.