Grappling and Grateful

I’m nesting.

No, I’m not pregnant, and I’m not sure when it started exactly, but with the start of residency looming and more free time on my hands right now than I’m used to, l have this strong desire to declutter and reorganize. Thanks in part to a nudge from Mommabee’s recent post on feeling stuck, I dove into Marie Kondo’s Netflix series.

I hoped that I would get some practical tips for decluttering, and I did, but I also found something much more enlightening. It clicked during the 4th episode, when a family of four was working to control the clutter after downsizing from a large house to a 2-bedroom apartment. The crux of the episode was when it became clear that the mother was responsible for essentially all of the “stuff”, both physically, cognitively and emotionally, to the point where her adolescent children and husband would call her throughout the day because they couldn’t find anything. She had taken on the role and implicitly assumed the responsibility while working a full-time job outside the home. I won’t dive into a full analysis of the show (although there’s a good one on the show’s gender dynamics here). The invisible labor of womanhood and motherhood becomes visible.

Suddenly, I saw my impulse to reorganize our home and life in stark clarity. While I’m grateful that my husband is committed to gender equality in our marriage, we’re still fighting generations of inequality and implicit assumptions about men and women’s roles at home and in managing family life. So while some things are straightforward, ie, if I make dinner, he cleans up, and vice versa, other forms of emotional labor are not. Looking back, we can both see the impacts of very unequal emotional labor on each of our mothers. And the “stuff” is just one example. We both moved at least 10 times throughout our childhoods, sometimes internationally, and usually lived in rented housing. While my father was the “packing expert”, my mother managed the bulk of the organizing and cleaning and knowing where everything was, on top of knowing who needed what doctor/dentist/chiropractor appointment or freshly laundered uniform and what we were going to eat for dinner. And I subconsciously still assume that’s my role too. I’ve been able to keep up (mostly) with this invisible work while keeping up in medical school, although it’s gotten a lot harder since my son was born. I’m actually pretty good at managing a lot of this in my head.

But here’s the thing - I know it’s taking energy away from other areas where I want to be excellent, like being really present with my son when I’m with him, and developing into an excellent physician, and building the career that I actually want, rather than just slogging along on a one-size-fits-all career treadmill. I know the other members of my medical-student-mom squad feel it too. We’re constantly exhausted and we’re not even in residency yet. And while decluttering is helpful, it’s not the answer. Delegating is definitely part of the answer, but first I have to list out all of the things that I’m trying to do and then figure out how to delegate them. So keep an eye out for my household organizing/delegating app once I actually figure out how to do all of this. (I'm kidding - this is way beyond the scope of any app.)

No, I put this out there not because I’m expecting someone has a magic answer, but because I’m grappling. And I’m also grateful. I’m grateful for my wonderful mother and mother-in-law, who managed two large, chaotic households with so much love and way more patience than we ever deserved. They fell into bed at the end of every day exhausted for reasons they couldn’t even name. I’m so grateful to them for managing all of our “stuff”, both physical and emotional. And I hope to honor them by finding a way to both love and care for my own little family while letting go of some of those expectations and responsibilities. I hope to honor them by sharing some of the empathy and intuitiveness that I learned from them with my patients and colleagues too. And I’m grateful for the #momsquad that lets me vent without judgement about how hard all of this is, and the husband and toddler who love me just as I am.

Let’s be like Sweden...or Why doesn’t anyone talk about paternity leave?

Hi everyone, I’m Anna Plasia.  This is my inaugural post for MiM!   A brief introduction: I am a pathologist with a new baby, but I've been reading MiM since long before I became a mom.  I'm married to my best friend who also happens to be a father-in-medicine.  I'm honored and excited to be part of the MiM family!

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I have to admit that I was reluctant to get pregnant.  I was happy, and I didn’t want anything to disturb that balance.    My husband and I are both physicians, and our relationship up to that point had been that of equals.  Obviously there are things at home that one or the other of us has taken over due to interest or entropy, but overall our relationship was egalitarian.  And honestly, I didn’t really see examples around me of parenting relationships that were what I hoped for.    My own parents were both professionals, but it was my mom who stopped working for several years when I was born and it was my mom who managed all doctors appointments, birthdays, shopping, cooking, cleaning, etc.  I was sure that my parents’ relationship must have been similar to ours in the beginning -- but becoming parents made them became so...traditional.  So is having kids just inherently unequal?  Obviously men can’t actually have the baby, but are women really genetically better at managing doctors appointments and birthdays and cleaning, or is there something structural going on that makes things turn out this way….every time?

It turns out that the seeds of parenting inequality may be sown as soon as the baby comes home.   According to a report produced by Boston College Center for Work & Family in 2014:

When we ask why it is the case that most men aspire to be equal partners in caregiving but often fail to meet even their own expectations, there can be many possible explanations for this shortfall. One cause that seems clear from our work and that of other researchers is that this performance gap begins in the very first days following the birth or adoption of a new child, when the disparities between the experiences of mothers and fathers emerge immediately. In our research, the majority of fathers take only about one day of leave time to bond with their new children for every month the typical mother takes….During that time at home, fathers are seldom “flying solo” in caring for their newborns (Harrington et. al, 2011).  

It makes sense - - if mom is the only one home with the baby for the first three months then of course she is the one who knows the most about baby.  She knows what baby eats, what soothes baby, what baby wears.  When dad comes home from work he’s stepping into mommy territory.  When baby needs soothing it’s just easier for mom to do it because she already knows exactly what to do.  And if mom has been off of work for a few months then she’s definitely the one getting up at night with baby.  When she goes back to work she will continue being the one getting up with baby, leading to exhaustion, burnout, bitterness, and curtailment of professional duties.

So the question then obviously becomes what happens when men take off their own version of “postpartum” time? In several Scandinavian countries (see Iceland, Sweden, and Norway) fathers are provided with paid paternity leave that they must use or the time is lost.  In Germany and Portugal mothers get bonus time if dads take their allotted time.  It turns out when men take more time off with their new babies the benefits last for a long time.  A survey of parents in Iceland which looked at how childcare duties were divided both before and after a paternity leave policy was implemented found that “there is a direct correlation between the length of leave taken by the father and his involvement in care afterwards.”

My husband and I both agreed that equality in parenting likely begins in the first weeks...so my husband decided that he would take two months of paternity leave.  We are lucky that both of our jobs were covered by FMLA, and we did not fear permanent professional repercussions from taking time off.  But this is definitely the exception, not the rule for physicians.  This decision came at a significant financial cost as both of us took unpaid leave, but we decided some things are priceless - money be damned.  Because it’s unusual for a man in the US to take off a significant amount of time for a new baby, no one could wrap their head around it.  The reaction was...confused.  “Wait, did you say two weeks - or two months???”  No one had ever heard of a father doing this...especially not a physician with an “important” job.  No one tried to dissuade him from doing it, but it was definitely seen as an unusual request.  I am so proud of him for sticking to his guns...honestly it takes courage for a man to buck the trend.

My husband’s extended leave was one of the best decisions we made about having a baby.  We spent the first month at home together.  I can’t imagine being left at home alone with a new baby a week or even a few days after giving birth.  That first month we woke up together for every nighttime diaper change and feed.  Those first nights are long, lonely, and dark, and I can’t imagine going through them without my best friend beside me.  At the end of my leave, my husband took his second month off, and it made the transition back to work so much easier.  Every morning I left our baby with my husband - who knew what to do since he spent that first month at home.  There was no mommy guilt about returning to work with a 10 week old.   And now I really don’t feel like one of us is the primary parent - we are both just parents.

Unfortunately, our experience is not the norm for physicians.  As a physician, unless you are employed by an academic center or a large hospital, your job is often not covered by FMLA.  Many physicians are employed by private practices with fewer than 50 employees or are self-employed and cannot afford to put their business on hold for an extended period of time.  I was told up-front at several (private practice) job interviews that I would only be able to take vacation time for maternity leave.  If it is this hard for physician moms to take medically necessary maternity leave, imagine how much harder it is for physician dads to take off extended paternity leave.  At the same time I am sometimes surprised when I hear of physician dads who take off less time than they would for a vacation when their partners have a baby.  Obviously there needs to be a shift in both the cultural expectations surrounding paternity leave as well as the law in the US before this becomes a more commonplace occurrence.

I also realize that we are very privileged that we could afford to both take off time from work.  The sad truth is that for many Americans this is not a choice they can afford to make.  Ours is the only developed country in the world whose government does not guarantee any paid leave to new parents (source).  Due to exclusions built into FMLA, only 60% of workers are eligible for the unpaid leave guaranteed by FMLA.   Only around 25% of US employers offer paid maternity leave, and even fewer offer any paid/partially paid gender neutral family leave (which includes paternity leave).  It is the lowest paid members of the workforce who generally have the least access to paid or unpaid leave.  And since family leave is usually unpaid, fathers are even less likely to avail themselves of it as they are often the higher earners (source).   Most families can barely scrape by on one salary for any amount of time, never mind three full months.  Having an egalitarian paid parental leave policy in the US would go a long way toward making parenting a more equitable experience.

Did anyone else’s partners take off extended paternity leave?  How was the request met?  Do you think this is viewed differently in medicine than in other fields?