The Surgical Mum’s Maternity Guide

Congratulations!

by Severn Women in Surgery

 

 

Authors

  • Rebecca Llewellyn-Bennett
  • Jayne Ward
  • Samantha Williams

Contact: severnwomeninsurgery@gmail.com

*This is an informal guide for the surgical mother. This is not intended to be prescriptive but informative and based on personal experiences. If you have any queries or suggestions, emails are gratefully received as this is a work in progress!

CONTENTS PAGE

 

1.Calendar of Important Dates

2.Occupational Health

3.Notifying work and the Deanery

4.Maternity Leave

5.KIT (Keeping in Touch) Days

6.Returning back to work

7.Breast feeding

8.Special circumstances in surgery

9.Additional information for financial

      implications

  1. 10.           Further reading

 

 

 

 

 

 

Severn Deanery Maternity Information

1. Calendar of important dates.

My advice would be to read your local hospital policy thoroughly before you inform work. Once you inform work, questions will commence!

Stage

Action

As soon as you know you are pregnant

  • Think about any potential issues-physical duties, on-calls, radiation exposure.
  • How are you feeling? If your symptoms worsen think about alternative measures needed
  • Inform your manager when you are ready- some wait until ready/symptoms occur. Hospital policy states to notify manager as soon as you know you are pregnant. (Check your local policy. Thoroughly read before decisions)
  • Once work is notified you must be assessed by occupational health/an elected surgical tutor. Either way, you must be reassessed every trimester/if symptoms change to make sure you are not struggling.

16th week-24th week before EDD (depends on local policy)

Notify work if you want to be part of childcare voucher scheme.

15th week before EDD (around 24th week of gestation)

Submit MATB1 form to manager (Midwife signs this). Also you need to provide written notification that you will be going on maternity leave and estimated date of starting mat leave

ASAP (at least 1 month before start of maternity leave)

Complete mat leave/pay plan and give to manager/HR

11 weeks prior to EDD

Can start mat leave from this time

Commencement of Maternity leave

If you need to change the start of your maternity leave you need to give at least 28 days notice.

Returning to work

Inform the deanery, hospital HR, and your educational supervisor your intention to start work at least 8 weeks prior to starting! If you need to change the date, you also need to give at least 8 weeks’ notice.

 

Before you start maternity leave, it is worth speaking to your educational supervisor about keeping in touch (KIT). Some doctors have found it useful to continue doing extra-curricular surgically-related work whilst on maternity leave to keep being involved. Also there are specified days called (KIT) days. You are entitled to up to 10 of these days whilst on maternity leave which can enable you to return to paid work whilst on mat leave. You need to inform HR and your educational supervisor if you feel you want to pursue this.

The training programme director also needs to be informed of your intentions to go on maternity leave, how long for, and if you want to go back LTFT/FT. That’s why it is important to fully read your hospital policy and decide for yourself what you would like to do before the entourage of questions!

2. Occupational health

Every woman experiences pregnancy in a very different way. Some women find the first trimester very difficult, and others the 3rd trimester. This is why it is important to get assessed every trimester/ when symptoms change. Remember to work safely. Your team, seniors and hospital staff want you to have a healthy and happy pregnancy. Don’t push yourself. This is not the time to be heroic and do extra duties if short-staffed or stay very late when not feeling well. If you are finding on-calls a struggle then speak to occupational health and keep your educational supervisor and training programme director in the loop.

Severn Surgical Mum’s experiences:

Case 1

“I knew of a reg who was pregnant and kept doing on-calls until she had severe Braxton-hicks contractions. She had to stop her on-calls as it was affecting her pregnancy.

 I got very tired during on-calls. When I was on nights, I couldn’t sleep during the day as the baby was kicking and I had such bad peripheral oedema that even TEDS couldn’t keep my oedema at bay! I stopped on-calls at 24 weeks. My seniors were extremely supportive of my decision.”

Case 2

“Each job, on-call rota and pregnancy is different. What worked for my uncomplicated pregnancy may not suit you if you are having bad morning sickness daily. It is a balance between looking after yourself but also providing a service and being trained. If you stop on call all together your time may not be counted towards your CCT, so get advice from the JCHST.”

My advice would be to swap your on-calls and do them early in your pregnancy. You will be too tired towards the latter end will be seen to be pulling your weight. Establish a good relationship with your GP who has your best interests at heart. If you can’t manage to work don’t rely on your colleagues to cover. Do things above board and be signed off sick or start your mat leave early.”

 

3. Notifying work and deanery

Notifying work www.nhsemployers.org.uk

You need to tell your employer by the end of the 15th week before expected week of childbirth (EWC). You need to state that you are pregnant, EWC and when you want maternity leave to start.

Notifying the Deanery

If you are in a training contract, you will be offered full-time employment or the opportunity to go less than full-time employment. You need to inform the Deanery and your training programme director of your pregnancy. Before you do this, decide or seek further information on the following so you can give the Deanery a clear plan so arrangements can be made:

  • When you want to start maternity leave
  • How long you want to have for maternity leave
  • If you want to go back full-time or less than full time training. (you need to also inform the associate dean for less than full-time training).

 

4. Maternity Leave

There is compulsory maternity leave from the first day the baby is born if it has not started before. This is a standard, compulsory 2 week leave by law.

All doctors are entitled to 52 weeks of maternity leave if you have worked continuously (without a break of more than 3 months) with 1 NHS employer or another by the time you are 28 weeks pregnant. Furthermore, you must want to return back to work either full-time or part-time. The length and amount of payment is dependent upon how long you have worked at your establishment.

You will accrue annual leave whilst on maternity leave. However, this will need to be checked if you are changing employer during this time.

Maternity leave can start from 11 weeks before the expected due date of the baby (e.g. 29th week.) However, you must inform your employer of your plans and give 28 days days notice.  If you want to change your return date to work, you must give 8 weeks notice to your employer.

Every hospital trust has their own maternity policy. Check your hospital policy for fine detail.

Training

If you are a core surgical trainee you will have to complete all of your training to be eligible for Spr national training number applications (24 months.) There is no exception made for maternity leave.

If you are a surgical registrar in training, you are entitled to a 3 month grace period of training i.e. you do not have to repeat your training for the 1st 3 months.

Maternity Pay

 There are 2 parts to maternity pay- Occupational maternity pay (OMP) and Statutory maternity pay (SMP). OMP depends on NHS service and SMP depends on continuity of employment.

OMP- you must have 12 months of continued employment with 1 or more NHS employer by the start the 11th week of the expected due date to qualify

SMP- you must have been employed by the same employer for a continuous period of 26 weeks by the 15th week of expected due date. Obviously there will be difficult complicated scenarios if moving between trusts etc. Please consult:

http://www.nhsemployers.org/Aboutus/Publications/Documents/Maternity%20issues%20for%20doctors%20in%20training.pdf

This gives detailed information and support for maternity pay.

5. During maternity leave- staying in contact/KIT days

Please contact the HR in your hospital about KIT (Keeping in touch) days and eligibility. These are paid work days which you can take whilst on maternity leave. You are usually entitled up to 10 days.

 

 

 

 

 

6. Returning back to work

Severn Surgical Mum’s experience:

“Even though I was loving being a mum and bonding with my child, I did find it very isolating being on maternity leave. Obviously I was nervous about going back to work, but by keeping in contact with my seniors during maternity leave, I felt I was more in control with training and not so isolated. In the lead-up to returning back to work, it took about 2 months to organise childcare, back-up childcare and resolve any work/training/ admin issues. It was a little bit frustrating, but in hindsight, I was very prepared and in work-mode when I returned”

 

a)    LTFT and full-time training

It is up to you if you want to go LTFT or full-time training. Full-time training will be exactly the same before pregnancy. Speak to your training programme director with advanced notice if you want to have your situation taken into account and be rotated to a nearer hospital. There is no guarantee that this could happen

LTFT

  • 50% and normally 60% of a normal working week.
  •  Day time working, on-call and out-of-hours duties pro rata to that worked by full time trainees in the same grade and speciality
  • 24-28 hours per week
  • A LTFT trainee’s programme should contain the same elements as that of a full-time trainee including departmental meetings, audit, research, teaching etc.
  • The duration of training (eg until Certificate of Completion of Training - CCT) will be extended according to the number of hours worked.

 

 

 

 

 

 

Below is a tabulated form of an informal comparison between the two types of training contracts tabulated by a LTFT surgical registrar:

LTFT

Pros

Cons

Spending time with your baby - you are with them more days than not, so you remain the main carer.

Salary reduced by 60% - may not reduce as much as you think though as you go down a tax bracket too eg. Can reduce from £2490 to £1790.

Enthusiasm - Work days are work days. You go back after 4 days at home and look forward to doing ward rounds, clinics and getting your teeth into anything other than childcare.

Pension - also reduced to 60%. I went to a financial advisor who advised taking out a personal pension plan to top up my reduced NHS pension whilst I was working LTFT

Work life balance - Feels better than working full time as even though your days not in the hospital are not ‘days off’ they are days which you can pursue hobbies e.g. swimming with your baby or when your husband gets home, going to the gym in the evening or meeting up with friends, which I don’t have the energy for after a day at work.

CCT date - will be delayed, potentially by 6 years if you have your baby early in your training! This can be an advantage as you get a more varied training in different hospitals and more life experience by the time you finish.

Cost of childcare is less, but so is your salary.

Continuity - for patients is interrupted so it can be difficult to stay up to date with a patients progress unless you have a good team that communicates with you, or a job-share with a seamless handover system.

More time for paperwork. Audit, research and other paperwork can be squeezed in around naps and once in bed.

Colleague Opinion - Seen as less dedicated than full time colleagues? Comments about ‘days off’, “long weekends’ and ‘never being around’ - need to maintain confidence in yourself and a sense of humour to  deal with the (jealous) jibes

Elective operative numbers can be kept similar to full time, meaning with extended training you will have larger numbers in your logbook. You can plan your working days around the operating lists, as long as you also include MDTs and clinics in your workload and make sure it is fair with the other trainees on your firm.

Emergency operative Competence - takes longer to achieve the learning curve with e.g. laparotomies when oncalls are few and far between and the number of emergency cases you do is greatly reduced.

 

b) Childcare

Childcare is expensive. Even nursery fees, full-time, are looking about £1000 per month! There are pros and cons for each type of childcare and the childcare which you will choose is a very personal decision. However, whatever you choose, plan in advance. You really need about 6-8 months notice.

Research into the different types of childcare which you can financially afford and are happy with. If you are thinking about nurseries or childminders, look into OFSTED reports. This is a government body that regulates and provide reports for nurseries and childminders.

http://www.ofsted.gov.uk/

 

c) Childcare vouchers

Childcare voucher schemes are dependent upon your employer. This is a scheme whereby part of your wage goes automatically into childcare vouchers which can be paid directly into the nursery/childminder (if they are part of this scheme.) The benefit of this scheme is that it’s tax-free. The maximum you can pay is £243 per wage (so both parents can elect to be part of this childcare voucher scheme- depending if both employers are part of this). You save approximately £70 per £243.

Contact your employer for further information

 

 

 

7. Breast feeding http://www.medicalwomensfederation.org.uk/new/breastfeeding.html)

“The World Health Organisation suggests babies should be having breast milk exclusively for the first six months; with further benefits after weaning until at least age 1.”

This is extremely difficult to achieve especially if you are returning to work. Only a small number of women achieve this and this should not be regarded as a failure if you are not able to achieve this. There are some mothers who do continue to breast-feed when they return to work, but careful organisation is required to be able to achieve this.

How can you achieve breastfeeding while working?

Some mothers continue with the late night breast feed and possible early morning feed (however this will be dependent on how far you need to travel for work.) If you want more flexibility in breast-feeding, you can express and then freeze the milk. You can then defrost and use when required. Storage life in the freezer is 6 months. In the fridge it can be up to 24 hours.

Your employer should provide time and space to be able to express breast milk in privacy. Your employer is required to have you risk assed and discuss with you any obstacles/ risks present at work which might prevent you from continuing to breast-feed.

The BMA has good information with regard to this, but is only available to members. As a trainee, it might be more stressful putting that extra stress on yourself.

Expressing breast milk

 

Medical Women’s Federation (MWF) Member Scarlett McNally, Consultant Orthopedic Surgeon & Director of Medical Education East Sussex Hospitals NHS Trust, Mother of four, all breast-fed till age 1, on-and-off

“If you want to breast feed more than just night and mornings or if you want to go away overnight to a conference you will need a breast pump. Your milk supply is dependent on regularly feeding or expressing. Your breasts will hurt if you do not feed or express as regularly as you get used to. Your baby can also have the benefit of real breast milk if stored and thawed later. There are electric (plug in and battery) or hand pumps. Both are easy to use. If you want to take the milk home, you need special freezer bags, an insulated bag and tablets (or another way) for sterilising the pump afterwards. (If you are only expressing once a day, you can take the pump home to sterilise again each day.) A quiet place to express should be identified with your manager.

You should also identify a freezer where you can store the milk. It is not easy to nip back to the residences or find a room to use your expressing machine between cases. I have always found the special care baby unit very helpful. They can keep the paraphernalia in a tub of Milton for you, and you can store labelled milk in their freezer to take home later. You don’t need bras with zips in (just loosen an ordinary bra strap). It takes about 20 minutes, and you can write up notes or read while expressing. You might want to tell people that you are going to another ward, as some men can’t cope with the thought of breasts and suction machines even if they approve of working mothers and female surgeons/doctors. “

Tips from MWF Scarlett McNally:

You MUST introduce the feel of a bottle before the baby is 6 weeks old (eg one bottle/day of expressed or formula milk), otherwise he/she will never take less than the real thing. (Midwives don’t tell you this, in case you convert completely.)

• Many babies can mix-and-match. Mum’s late home, I’ll have the plastic one now.

• You don’t need bras with zips in, just loosen an ordinary strap.

• It is very difficult to produce enough milk when you are working flat out. (I have always done night and morning feeds, and expressed when I was on call at those times, to keep the supply going.)

• There is no proven benefit in breastfeeding beyond a year.

• You do not need to feel guilty if you are not super-woman.

• If you have a breast pump and a baby who will take milk (either expressed breast milk or formula) from a bottle, you are no longer tied to the child, so you can go out occasionally.

Exclusive breast-feeding is very hard. No-one mentions this and this is probably why most women in the UK give up breast-feeding after a few days. Unicef found only 7% of UK women are breastfeeding exclusively at 4 months. For professional women it can be very hard to go from being an independent dynamic career-focused individual to being chronically sleep-deprived and breast-feeding. So until wet nurses come back into fashion, the breast pump, a babysitter and a freezer-full of expressed milk may be the best answer!

Severn Deanery Surgical Mum Experience: “I found breast feeding harder than I expected. I went from being independent career woman to being attached to a baby every 3 hours, with leaking boobs that were painful for the rest of the time. I lasted for 4 months of breast feeding and reduced down gradually. I know it was recommended to keep feeding until 6 months and I felt guilty when I stopped, but it was making me miserable and my baby was getting very hungry. I introduced a bottle early on (1st few weeks) to ensure the baby would take both bottle and breast. I expressed in the morning so my husband could give the 10pm feed. I did get thoroughly fed up of the expressing by about 3 months and started giving a bottle of formula for the early evening feed.

 It did reduce my milk supply a bit, but it meant I could get a break of at least 6 hours in the evening which was a godsend. As for breast feeding at work, I honestly cannot imagine being a surgical registrar and finding the time out to breast feed or expressing enough milk in the evenings to last all day. If I was determined to breast feed until a year, I think it’s easy to just stay on maternity leave until then (which I did anyway, just didn’t spend the whole year feeding). I did have a friend who managed to feed twins until a year, by expressing and buying a new freezer just for milk (!) so it is possible if you are determined.

 I think breastfeeding is a very personal decision, which people get very emotive about and I think you should just see how it goes and do what you feel is right.”

 

8. Special Circumstances in Surgery

www.hse.gov.uk/pubns/indg334.pdf

jbjs.org/data/Journals/JBJS/4367/e141.pdf

a)    Radiation exposure

Radiation exposure has been reported to be lethal and teratogenic for developing fetuses. The US National Commission on Radiation has recommended maximal permissible doses per year at 5 rem for whole body, gonads, lens of the eye, and bone marrow. The recommended limit during pregnancy is 0.5 rem per year. The most dangerous time for radiation exposure is following conception (preimplantation) up to the eighth week of pregnancy.

If you work with diagnostic X-rays, you should keep as far away as practicable from the patient and the X-ray tube while it is on, preferably behind the protective screen. If you have to be outside the protective screen during exposures, you must wear a lead apron which is easy to wear, fastened properly at the sides and covers your abdomen comfortably.

If you have to be inside the X-ray room itself and can move further away from the exposure, this could halve your radiation dose.

If you work in a radiotherapy ward with implant patients, you must use the bed shields provided to protect you, and not stay with the patient longer than is necessary. You may need to stop doing certain duties or caring for certain types of implant patients.

b)   Radionuclides

If you work with unsealed radionuclides, you may have to stop doing some jobs, such as giving certain diagnostic and therapy radionuclides, supporting patients during imaging, some radiopharmacy tasks and dealing with spills of radioactive materials.

Both the half-life of the isotope and the rate of biological elimination (if known) need to be considered. Risk assessment is frequently quite complicated, thereby requiring calculation by a radiologist or nuclear physicist. The nature of the isotope preparation may prevent its transfer across the placenta, so the dose will frequently be less than the maternal dose. In a majority of cases, the exposure will be too low to present a significant risk to the developing embryo or fetus (Brent et al. 1993).

 

Stephens and Gilmore made the following recommendations:

  • Minimize radiation exposure during pregnancy by wearing wrap around lead, limiting live fluoroscopy.
  • Avoid cases with cement use if possible, and if not, using fume control devices as well as double gloving.
  • Use universal blood precautions and avoid exposure to patients with active infections if possible.
  • Ensure that the operating room has effective scavenging systems for anaesthetic gases.
  • Use elastic stockings throughout pregnancy, limit or discontinue heavy lifting and prolonged standing after the 24th week of your pregnancy.
  • Limit case length to 4 hours in the third trimester and have backup for any case expected to last more than 4 hours.

Severn Surgical mum’s advice:

“Choose pregnancy appropriate jobs / rotations if possible. Now is not the time for big revision hip cases or multiple Image Intensifier screening in trauma. I chose a shoulder job, lots of short arthroscopy cases. Double lead gowns are heavy but a skirt and a vest lead gown gives double protection over the abdomen. Beware screening if you are sat down, your abdomen may be covered but x-rays can travel up so keep your legs closed.”

9. Additional Information on Financial Implications

All trusts have their own mat leave policies which are self explanatory. Usually it is around 2 months of full pay (including SMP) and 4 months of half pay plus SMP. If jobs on your rotation are banded differently it may be worth going for a higher banded job so that your maternity pay is higher.

You need to have worked for a trust for a minimum period in order to qualify for SMP. Other NHS trusts do not count. If you haven’t you will receive maternity allowance. This is the same amount but you need to fill in a form from the Job centre plus. Don’t forget you must return to work after mat leave otherwise you will need to pay back some money.

Severn Surgical Mum’s advice:

  • Continue to pay your NHS pension whilst on mat leave
  • You continue to accrue annual leave while on mat leave. Get this tagged on the end of your mat leave for more time with baby and make sure you are back on payroll and getting a full salary again
  • Before returning to work, join the hospital voucher scheme. Money is taken off before tax to help pay for childcare

 

  1. Further Reading
  1. RCS Women in surgery  http://surgicalcareers.rcseng.ac.uk/wins/guidance/pregnancy-and-maternity
  2. Medical women’s federation. Support information for female doctors. www.medicalwomensfederation.org.uk

 

  1. BMA- maternity, pay and leave. Restricted information to members only http://bma.org.uk/practical-support-at-work/working-parents/thinking-of-having-a-baby 
  2. www.directgov.uk on SMP pay
  3. “So you want to be a medical mum?” by Dr. Emma Hill Oxford University Press ISBN 978-0-19-923758-6 Interesting book on maternity-related issues