This week, in honor of National Women Physicians Day, I bring you part two of my pregnancy journey. In case you missed part one, you can read it here. As I gestated month after month, I had to figure out how maternity leave worked, and who (aside from my husband) would care for my child when I went back to work. Looking back, it’s a blessing we got through that period of change. I’m grateful that in the end, I survived human resources (HR) and natural childbirth.

Unanswerable questions like: will I retain my health insurance coverage?

I say survive because it was not a seamless experience. Please note, this is my experience with a former radiology company that no longer exists. While I was on leave, I wanted to confirm my health benefits would remain intact. Seems like an obvious “yes” over a 2-minute phone call, right? Nope. My HR contact, the head of the HR, in fact, and a mother of three herself, could not give me a straight answer. It was pretty stressful. To make matters worse, she repeatedly used the word “terminated” to refer to my employment as I transitioned to leave. “I’m not quitting,” I assured her. “I’m the breadwinner of the family. There’s no question about whether I’m coming back.” I clarified this point, hoping she’d stop talking about my termination.

But on she went. “Are you f@#&-ng kidding me, lady?” I wanted to yell at her. But she was so nice… just oblivious. She seemed to be well-meaning but some of the terms she used were just tone-deaf. She droned on about how I might need to pay for COBRA, depending on the length of my leave, though I told her the amount of time I intended to take. It was bewildering. And not comforting. My husband and my new baby would be relying on that health coverage. Not to mention me, the pregnant person, staring down the largest medical event of her life thus far. In the end, there was no interruption of my health insurance, and no need to buy expensive COBRA coverage. But there was uncertainty. 

Uncertainty meets frustration with human resources

As I prepared for my medical leave, I felt confident in my place as a valued and respected doctor in the practice. I’d pulled more than my weight in the years leading up to my pregnancy. So I was not bashful about asking, “Is there a maternity leave policy?” No. There wasn’t. A nationwide radiology practice had no parental leave policy. And I’m not talking about paid maternity leave. They didn’t have any written policy on how it would work, whether a pregnancy worker would retain her health insurance coverage during leave, for example. Apparently, I had 5 sick days to use before my state disability went into effect. I didn’t realize we even had sick days up to that moment (apparently, they are required by law). I had to figure these logistics out as I went, getting mealy-mouthed answers along the way. 

Lame excuses from human resources…

States have different pregnancy laws, and this was my former group’s excuse for not having a parental leave policy. So despite my intimations that they should create one for the next individual affected, they never bothered. As I mentioned, this company I speak of no longer exists. Maybe it wasn’t forward-thinking enough. One thing I’m sure of is that in 2021, companies are operating in a world where more women are breadwinning than ever. They must have these policies in place. And FMLA is not enough. 

FMLA is a loosely constructed federal protection, which holds a woman’s job for 12 weeks if she and her employer meet certain criteria. A company must have a certain number of employees and a worker must have worked at that company for at least a year. Well, since my radiology company had taken over from my last employer less than a year prior, I wasn’t even technically protected by FMLA. 

Thankfully (?) it’s a huge cost and pain to recruit doctors, and my job was not in jeopardy. In fact, they needed multiple locum docs to cover what I’d previously done. I’m certain that coverage cost a pretty penny. Let’s just say everyone was eager to welcome me back. 

A pleasant surprise following maternity leave

Prior to becoming a parent, I’d worried that my becoming pregnant might be a liability to my career, how I was perceived, or how I was valued. But I must say, it had a paradoxical effect. As I prepared to return from leave, my Department Chair asked me to step into a new leadership role. I became Chief of Interventional Radiology.

It goes to show that there are places that value the contributions of women, even if they don’t do everything right. This felt truly deserved, as I’d been largely leading the section through my early career. Despite that, it was certainly the largest title I’d held up to that point. So I became “mama” and “chief” in the same season. 

One thing I want to share, in case you’re planning a future pregnancy, is the concept of short term disability. If you work in certain states as an employee, you’ll automatically pay into a state disability fund. But if you don’t live in one of those states, and you’re planning a pregnancy, you should buy your own SDI policy.  

Disability Insurance

Calling pregnancy a “disability” may be objectionable to some, but it is the current manner in which pregnant workers may qualify for partial income replacement in the period surrounding pregnancy and childbirth. 

Two types of disability insurance are pertinent to the pregnant worker:  state disability insurance (SDI) and/ or a purchased short term disability insurance policy.  

No federal disability insurance or benefit is available to those giving birth or adopting at this time. 

State Disability Insurance (SDI)

Employees working in California, Hawaii, New Jersey, New York, Rhode Island, and the Commonwealth of Puerto Rico may be eligible for state disability benefits related to pregnancy and birth. In some states, this benefit is called temporary disability insurance or “TDI.” Workers in these states contribute to the state disability fund during each pay period. 

To qualify for SDI, short term disability benefits, a medical practitioner must certify a disability is present.  A pregnant worker or new mother must meet an income threshold in the year prior to qualify for state disability payments. The monetary benefit she receives will reflect a percentage of weekly pay, based on a sample period during the previous year, with a ceiling. For example, in California, the maximum weekly benefit in 2018 was approximately $1170.  There is a waiting period of 7 days before one may claim SDI benefits. Refer to your own state’s department of labor webpage for further details. 

A warning about approaching human resources!

An employer may have their own requirements for initiation of a medical leave (like taking sick days before leave is initiated).  Ideally, parental leave parameters should be outlined in the employment contract.  If not clarified at the time of contract negotiation, this kind of inquiry may be perceived as an announcement of a pregnancy.  Be prepared to clarify this point.  

Short Term Disability Policies

If a worker does not qualify for a state disability benefit, or if this benefit is insufficient, short term disability insurance may be purchased.  An employee or self-employed individual may purchase short term disability insurance for this purpose only before she becomes pregnant.  The option to purchase such a policy will usually occur during the enrollment period for other employee benefits, such as medical, dental, and life insurance plans. Speak to your benefits coordinator or human resources department to find out more about the options available.  Short term disabilities start after different amounts of time which is important to consider when purchasing if one is planning on using this for maternity leave.

For more pregnancy and post-partum resources, head to the SIR’s Pregnancy Toolkit, where you’ll find information about radiation safety, general tips and tricks from those who have been there, and other resources. 

And about the birth. More surprises!

Oh, and I mentioned that I almost had an accidental home birth! It’s true. After a week of riding waves of nausea and misery, I was feeling pretty good one night, when I had a late-night snack. I wolfed down a tuna sandwich and Sun Chips, and within the hour, they were back again. I was in labor. Specifically, a stage of labor called transition. Most women transition in the hospital. I was transitioning at home.

I could hardly speak. “Call. Thunga.” That’s all I could utter, one staccato word at a time. My husband had no clue what I was saying. I was asking him to call my colleague in anesthesia. I needed an epidural, now. A freight train was moving through me, every few minutes. I’d been trained to record the interval between contractions, but I could hardly manage this myself. My husband quickly packed the car. It was the middle of the night, and it was time. 

These were telltale signs of the onset of active labor. We made it just in time to be leisurely greeted by the staff on L&D. I was a primipara, a first-time mom, so they didn’t take me too seriously. I began bleeding as I changed into my hospital gown for the nurse to check my dilatation. My cervix was fully dilated, and they rushed me to the delivery room. My water burst with a strong contraction, as though someone had pelted me with a water balloon. It was 2 am, and I was relieved my OB made it in time to catch the birth. 

Like a force of nature

I’d hoped for a natural birth, or natural-ish. Epidurals could slow labor, I’d heard, and I didn’t want to be in labor for days. As it turns out, I was way too late for an epidural. I’d planned to bounce on an exercise ball to pass the hours. But our suitcases never made it out of the car. The power of unmedicated birth felt like a freight train. It’s a power I’ll never forget.

I’d survived human resources… and natural childbirth.