Becoming a Parent (12 Feb 2025)

SPEAKER_00 0:13

Hello and welcome to our episode in our Career Conversations podcast series. Today we are talking about becoming a parent in the context of training as a junior doctor. My name is Kirsty Crowe. I'm a Reno and General Internal Medicine Registrar in Scotland. And with me is Eva Daignan, who I'll let her introduce herself shortly. We've both become parents recently, and we thought it would be good to have a podcast that's centred on some of the areas that came up that we weren't necessarily expecting, or we had to do quite a lot of research around, and thought it'd be helpful to have a podcast that's centred on some of those areas. So Eva, I'll hand over to you to introduce yourself as well.

SPEAKER_01 0:53

My name is Eve Leitman, and I'm a geriatric stroke and general medicine registrar in Edinburgh. And like Kirstie, I become a parent in the last few years and have spent some time looking into some of the challenges that trainees and supervisors face when they're navigating maternity policies and processes, parental leave policies and processes, and have heard from some parents about some tips that they have found useful along the way to get back to work.

SPEAKER_00 1:24

I think that we were hoping to reflect a little bit on our experiences and also the information we found out along the way. And hopefully this podcast will be quite full of pragmatic tips and quite helpful. Obviously, neither of us are HR experts or BMA members, and so apologies if some of our information is maybe not quite so up to date, but we'll be signposting at the end of the podcast where a lot of the guidance is evolving in this area. But hopefully you'll find some of the things that we talk about useful. So I thought we would probably kick off at the beginning in terms of what is useful to know how to approach your employer or what things need to be done when you find out that you are expecting the child. The first thing to be aware of is that all in places of employment are expected to undertake a maternity work assessment by law. That's not unique to the NHS, that's that all employers must do so. My experience was that it's a little bit unclear who necessarily does that because really it's your line manager. But my experience certainly is that the line management of doctors and training is not necessarily clear who that is. And I know that some places it's been the educational supervisor that's undertaken it, in other places it's been the clinical director. In other places, I think it has been somebody from HR. In my situation, it was my educational supervisor who did it. And although they had not had experience in doing one before, they were very happy to find out from other colleagues how to undertake one, and we did it jointly as a conversation. I don't know about you, Eva, what your experience was.

SPEAKER_01 2:53

Mine was probably a little bit different because it was during COVID, so that probably sharpens minds a little bit about risk assessments in that I had to come up on calls pretty much immediately at the beginning of COVID or at the beginning of my pregnancy. In terms of telling your Ms. I suppose there's a few different people that you probably end up needing to tell about your pregnancy. But once you tell your department, they will be the people I see responsible for making sure that you have that risk assessment and the specialty that you're working in might influence that and also how your pregnancy is progressing. So some people obviously might feel very well during their pregnancy and be able to work on their normal rota right through until the time that they go on maternity leave if you're pregnant. But other people might have more challenging pregnancies, that's a bit unpredictable who it might affect or how it might affect you, whether that's physically or mentally. And so what has worked for previous people in department might not work for you, but it can be helpful to be aware of what reasonable adjustments have been put in place for other people. So, for example, when or if you might need to stop working on cold shifts or a night shift, whether if you're in a procedural specialty, whether it might become more physically challenging to undertake some of the procedures that you're doing, or if you're in an environment where you might have more exposure to infectious diseases, whether you might need to take more precautions. And in some departments, some feedback I've had from people is that it can be quite useful to speak to some of the charge nurses because they probably do more risk assessments than most medical supervisors do, and they often have good awareness of what adjustments need to be taken. So for example, Rollie G recently told me that she finds it quite useful getting advice from the charge nurse about chemotherapy or in psychiatry about stopping loanworking or working with patients with particular risk of violence and aggression. And also that the risk assessment is meant to be a bit dynamic. So what's relevant in the first trimester won't necessarily be relevant in the third trimester, and that if anything changes at any point, so whether that's your rotating to a new department or your own health changes during pregnancy, that it should be reassessed.

SPEAKER_00 5:07

Yeah, absolutely. That's what I was going to say was it's not a tick-box done, it's a dynamic thing, and you should have it really reviewed every trimester, but more frequently if needed, and you can initiate a further conversation. I had some complications during my pregnancy, so I did have to reassess and I found the risk assessment framework quite helpful because it does provoke conversation in different areas and it allows you to think about areas of work that you maybe hadn't thought of at the top of your head, like things like loan working and things that are maybe not quite so obvious. I think one of the hardest things about this assessment is what reasonable adjustments are reasonable and what feels like a reasonable thing to ask for. And BMA have actually released some very recent guidance on this. It's only just been released in the last month, which kind of outlines what is reasonable to ask for in terms of out-of-hour shifts, night shifts, long days, and so it's worth reading that information, seeing if it applies to you. That can be difficult. Yeah.

SPEAKER_01 6:04

The NHS Scotland maternity policy also gives, I suppose, some specific examples about things like fatigue that might not be immediately obvious to someone who hasn't been involved in carrying out risk assessments before, but kind of the impact that fatigue might have on you at various stages throughout your pregnancy and your ability to undertake particular types of work. But also that the NHS Scotland policy is a kind of a once-through policy that covers all the health boards in Scotland now. And one of the things that I also make very clear is that if you're not able to undertake a task that you know the work that you normally do, that you should be offered an alternative work if that's possible. So, for example, if you're not working night shifts, like you could work day shifts instead. And it's quite unlikely for most junior doctors that it wouldn't be possible to find some alternative work that you could do during the day. I think during the pandemic, we already saw evidence of that where people were moving in various roles as they as they were shielding, and it became quite clear that there are lots of other activities within departments that you might be able to get involved with, even if you can't necessarily complete your normal role.

SPEAKER_00 7:07

Yeah, absolutely. Another group of people that can be helpful because sometimes a supervisor might not know how a reasonable adjustment can be made or what your special equipment is there, perhaps for kind of musculoskeletal issues, which are really common in pregnancy. The occupational health department of your board or trust is very helpful to link in with as well. The policy in the one that I was part of was that you didn't necessarily need an occupational health review unless there was something that came up in the risk assessment. That might not be the case in all boards and trusts, so it's worth checking that out locally. But I ended up having an assessment with them because of the issues I had in pregnancy, and it was helpful for them to you know give their expert obviously opinion in occupational medicine in terms of adjustments that myself and my supervisor maybe hadn't thought about. That is also a useful group of people to link in with early to get that extra support as well. Another source of support could be that the obstetric team themselves. So you know, my team provided written and guidance on what their suggestions were for my hour of hours working, and which was helpful to have. And your GP as well is also a very good source of support and help for an objective assessment if needed. I've heard of trainees being told that they have to get a GP note to have reasonable adjustments made. Now I'm I'm not certain that that necessarily is the case, but I know that some employers have asked for it, and I think that's where the BMA new guidance is now much clearer and hopefully will prevent that from being necessary. But nonetheless, um the GP is definitely a good source of support for any issues that come up.

SPEAKER_01 8:40

If you do have any reasonable adjustments during your pregnancy, that shouldn't affect your pay during your pregnancy, that you should be pay protective. In terms of other people, you might be informing about your pregnancy as well as your department. You might also want to inform your training program director, especially if you want to kind of think about the impact it might have on your future rotations and also ultimately on your CCT date. You'll obviously also need to formally notify your employer, and that involves giving um paperwork called a Mat1B for you usually guess around your 20-week appointment from your midwife. Um obviously, we focused in this section more on people planning to take maternity leave from people who are pregnant, but if you're planning an adoption, there'll also be a process of notifying your employer so that you can get those dates in as well. Or if you're becoming a father, you'll also need to notify your employer of your intention to take maternity leave as well.

SPEAKER_00 9:37

There's a like a deadline of informing your employer. It's written down as the 15th week before confinement, which is a term that I think sounds really old-fashioned, but essentially it means that the Sunday of the 15th week before your due date. There's no need to inform your employer before then, but ultimately practically it is useful to inform to get those reasonable adjustments if needed.

SPEAKER_01 10:00

And also when you do inform your employer of pregnancy, if you do end up taking time off where sickness absences related to your pregnancy, those are treated separately to other absences you might have in terms of the sick leave policy. So it can be helpful for your department to be aware of that when they're managing sickness absences.

SPEAKER_00 10:22

There's quite um a lot of kind of different rules about sickness absences as well, that if they come at a certain time of your pregnancy, so if they come within I think it's four weeks of the due date, that actually can count as the start of your maternity leave, whereas if it's before that, then it doesn't necessarily mean that the maternity leave starts. There's lots of other complicated rules about if the baby comes early or anything like that. Um and that's all very clear on the BMA website about when maternity leave actually officially starts. That kind of brings us nicely on to organising the maternity leave and planning, you know, dates when to go and it's similar to adoption leave as well. Titlement is up to 12 months, that doesn't have to be taken in its entirety and it can be shared as well. And intention of whether or not it was going to be shared leave or how long is something that has to be communicated with with your employer and in advance. And when to start is very individual for people. I personally started my maternity leave at week 37 of my pregnancy, but I had annual leave to use before that, so that gave me a two-week cushion before, and that's because term is from 37 weeks, so you know I didn't really want to end up going into labor at work, but that's what suited me. I know others that have worked till later and others that have taken return to leave earlier. You can start your return to leave, I think, from the 11th week before your due date.

SPEAKER_01 11:50

I was working from home because of the pandemic, I wasn't able to work for home and I wasn't able to kind of be in the building physically in the third trimester. So I was doing telephone clinic, and so I suppose physically it was slightly less onerous role than, for example, if you are the med on tape. And so I worked up until 39 weeks, and at that point I think I was probably getting a bit tired, but I think I'd been in the building, I would have been struggling a bit because just rolling over in bed at night was getting a bit challenging. And then I had a week of annual leave at 39 weeks. The evening, my maternity leave officially, I suppose, starting. I was on on the Friday Saturday evening. My watch was broken and my son was born over the weekend. So it all kind of worked out quite well in timing for me. But I think for me, uh, it was helpful to work up until a bit later because it kept my mind busy. I suppose it was locked down, so it's slightly different in that there weren't really very many opportunities to do other things to keep yourself busy. I was fully expecting to be overdue and sitting around the house for a bit longer. Equally, I know other friends who've had more complex pregnancies who've wanted to have more time off at the end and wouldn't have felt able to work from an earlier point in their pregnancy. And it's worth bearing in mind what you're going to do with your annual leave. So usually you're expected to use most of the annual leave that you accrue from the block up until the point that you go on maternity leave prior to your maternity leave, but you can agree to carry some of that forward with your line manager to with your clinical director. You can usually carry, certainly in our health boards, it's usually five days that you can mutually agree that you would carry forward through to the end of your maternity leave, in addition to the leave you'd accrue on maternity leave. But if you were to unexpectedly start maternity leave at an earlier point and had planned annual leave in our department, you'd usually be allowed to carry whatever you had not been able to take because you'd unexpectedly start maternity leave early through to the end of your pregnancy. But it's just worth clarifying with your department exactly how that will work. And that might involve consulting HR though, particularly if your department hasn't really had much experience of it, because it would be a great pity to lose your annual leave that you've worked hard to accrue.

SPEAKER_00 14:14

Yes, and I know that some people have been able to use their annual leave when they come back and almost use it spread out so that they come back for four days a week rather than five. Other border trusts don't allow that, and you have to take all that accrued leave essentially at the end of your maternity leave before you come back back. Although you are actually back, you've finished your maternity leave, but you have to take the leave before you start your clinical work again in that block. And that, you know, is variable from employer to employer and is one of the many regional differences that you'll experience.

SPEAKER_01 14:47

Maternity leave or adoption leave is 12 months. And if you're a mother who's had a baby, you'll have to take at least the first two weeks of that. That's mandatory. But then after that, you can choose to share it as you want with another parent on shared parental leave. And you can share it either kind of in my case, I took 11 months of parental, I took 11 months of maternity leaving. My husband took a month of my maternity leave as shared parental leave. So he had two weeks' paternity leave, and then later on in the year took a month of shared parental leave. Uh but you can also choose to take that in kind of blocks. So some people might choose that you'll take four or five months of maternity leave, then you could return to work if you wanted for a while and then take another block of maternity leave or shared parental leave, depending on what works for you and your family. If you're taking shared parental leave, you can either take it simultaneously, so you're both off at the same time, or you can take it sequentially so that one of you is on leave when the other is not. With shared parental leave, depends a bit on your employer's terms and conditions. So if you're an NHS employee, if you and your partner are both NHS employees, you will only get the same amount of pay between you in total as one of you would have had. So if your partner were to take any shared parental leave and you've already had the period that would have been paid during your maternity leave, then they wouldn't get any pay for that time off. Whereas if you have a partner who has a non-AHS employer, their employer might give them some occupational pay during the time that they're on shared parental leave. And so it's really worth reading through the fine print of your employment and maternity policies, which you might not have spent so much time looking at in the past, because there's potentially some really valuable information in there in terms and often kind of graphical examples of how this might all work, because I think it's something that's probably difficult to describe in an abstract way.

SPEAKER_00 16:56

I actually found the whole maternity pay thing full stop really complicated to navigate because it's just like a different language, isn't it? It's like you're paid in weeks, which we're not used to. We're used to being paid monthly, and there's all sorts of acronyms like OMPA, you know, M A S M P and then if you have 12 months of continuous service in the NHS, you're entitled to occupational maternity pay. That doesn't necessarily have to be with the same health board, which is obviously very common for rotating trainees, although the lead employer model in some parts of the country has helped that, so you don't have to kind of go between different boards and trusts and try and navigate your way around the rotations. But some of us do still rotate between boards, and that would potentially break your continued service with a board or a trust itself. In that case, you might not be able to get in your statutory part of your pay with the board, in which case you have to get the statutory part of it from the government, and which is what I had to do. It works out as the same amount of money, it's just knowing the process of applying for that, and you have to get a special form from your employer to say why they won't pay the statutory amount, and then you have to send that application form off to the Department of Work and Pensions to get that part of it. So the structure of maternity pay is you get your occupational maternity pay if you qualify for it, and I think that's for eight weeks, not mistaken. Then that's followed by 13 weeks of half pay.

SPEAKER_01 18:26

Then of half paid plus statutory, so that you get kind of six months in total, and then after that, I think you get 13 weeks of statutory pay by itself, which brings you to about like nine months in total. Because then the remainder is unpaid. Unpaid, yeah. Some employers will allow you to spread the occupational pay throughout your maternity leave. My employer doesn't because they find that there was too many mistakes being made. I was just saying. And so it can be a bit unpredictable how much you're going to get paid in any given month. There are times when you will not be expecting to be paid, but you might receive some pay because of the amount of tax you've paid in the year. Kind of HMRC will start to calculate that actually you've paid a bit too much tax and higher band, so they might pay you some tax back. If, say, there is a pay increment applied during the year, a pay rise applied during the year, you should receive the back pay that you would have been owed already, as any other trainee or junior doctor would. The other thing to be aware of is that if you have two separate employers, so say you have a split job between the NHS and the university and have two separate contracts, or have two separate NHS contracts, you may be entitled to two sets of statutory maternity pay. You can't be entitled to statutory maturity pay amateurity lines, but you can be entitled to two sets of statutory maternity pay. And there's good information about that, which we can include in some links at the end as well.

SPEAKER_00 20:01

The navigating the continuous service and pay and what you're entitled to can be quite tricky. And I've had some friends that have been really caught out by that. For example, um one friend who actually took a year out, not a formal year of training, but in between kind of training programmes to do some teaching with a university, and because there was a full break in NHS service, and they were not entitled to any occupational maternity pay for their maternity leave, so ended up only receiving statutory, and that was not from the NHS, that was from the Department of Work and Pensions, and that works at about £170 a week for the time that you're entitled to it, with obviously if you were to try and take 12 months, it would be three months without it. So that's something to really consider in terms of the financial implications. My particular situation was related to changing health boards from being out of programme, which is why I had the disruption to the continuous service in my board, although it didn't affect me financially because the pay works out the same, but it's just to consider that actually these things can really affect what you're entitled to.

SPEAKER_01 21:06

The other time that can be quite tricky is returning to work. If you were employed on a fixed room contract, so say you're employed as a clinical fellow and you go on maternity at the 11th month of your 12-month contract, your contract will be extended up until the end of your maternity leave. At the end of your maternity leave, you would also be paid for any accrued amulet leave that you would be owed during that period that you've been on maternity and you're not expected to return to work, although obviously you might be able to apply to return to that post if it still exists, and that if you're still recruiting someone. If it was a fixed term post, you're you're not necessarily entitled to return to that post if your contract had been dead. However, for most people, especially if you're saying a trainee in a rotational training program, you're going to still be employed at the end of your maternity leave. And in that situation, you are expected to return to the NHS for a minimum of three. months paid employment to avoid a requirement to repay your occupational maternity leave and your your occupational maternity pay is is it can be quite substantial it could be in the region of tens of thousands of pounds and so what your health board might suggest is that if you're not sure whether you're planning to return or not that they not pay you the maternity pay up front and then that you could choose at the end of your maternity leave to be paid at or not. The other option is that you could you know plus a site to to to pay back if you needed to. But three months paid employment sort of that's the the way it's phrase on the NHS Scotland policy what that can include in the in the NHS Scotland policy is is any approved leave. So that includes annual leave and if you were to take a full year off and you kind of had five years NHS service you'd have accrued about eight weeks of annual leave and public holidays during that time. And during that eight weeks of annual leave you'll accrue another week or so's leave as well. So then you probably have another three to four weeks left. So you might obviously have to return to work for that time or there is the option of parental leave which you could take in that time as well if your employer agreed that could be used if you for some reason weren't in a position to be returning to work or weren't planning to return to work. And that might supply if you were planning to take a period out of program following your return to work. So for example if you're planning to take time on an OP, this situation is recently arisen for a colleague I know or perhaps more commonly is when people are planning to go out of program because you'll tend to be employed by the university rather than the NHS if you're going out of program on research to do a PhD or something like that. And so it's important to just plan that in advance before your maternity or kind of early in your maternity so that you don't face an unexpected request to return your occupational maternity page that'd be quite a painful process to go through. But if you do feel you're in that situation, I would suggest speaking to HR at a very early point so that you can work it out together. In terms of the annual leave while you're on maternity leave, as we're saying you do accrue your full annual leave and it's work just kind of at some point before you return, sending an email to your department to try to just agree in writing what the date at which you'll technically return to work, which is the date your maturity leave ends, but then the date at which you'll actually physically return to work, which would be after your accrued leave, assuming you're taking it in a blog usually if you're planning to return less than full time and you hadn't been less than full time, the convention is usually that you will take the annual leave at the same percentage you were employed at before your pregnancy. So if you were full time before your maturity leave, when you first return to work from your maturity leave, if you're returning on accrued annual leave, you will then return as a hundred percent full-time person to be paid for that period of accrued annual leave. So then if you're becoming a less than full-time trainee, the point at which you've become less than full-time will be at the point you finish your accrued annual leave. And so it's another one of those times where it might take a couple of hours of head scratching to figure out exactly when those days fall. Bearing in mind that there are to take a week of annual leave you take five days of annual leave not seven because that was a a math mistake that I made the first time I was trying to work out when I was returning to work. It just didn't look quite right.

SPEAKER_00 25:31

No idea so it's good to just be able to double check these things and make sure that yeah having a friend to sense check it I think is a really useful thing to yeah particularly someone that's been through it maybe a few times can be like oh no because sometimes it's difficult to interpret these things and you interpret it wrong and the language is quite formal you're not hundred percent sure how it applies in your situation.

SPEAKER_01 25:58

And there's certain parts of our contracts that are slightly different to the agenda for change contracts which is what a lot of the people who are working within admin or nursing teams will be working on and so they might be slightly less familiar with the logistics of your return to work and your annual leave and how it accrues as opposed to how for example a nursing colleague's annual leave might accrue and how that's worked out that return to work. So it's just worth bearing in mind just making sure that you're getting advice from people who are familiar with your contract and that's where a union might be helpful at times as well in working it through.

SPEAKER_00 26:37

Thinking about the kind of returning to work as well there's other elements to it in terms of how you're supported back into the clinical environment some areas of the UK have formal return to work programs.

SPEAKER_01 26:54

There's simulation and other workshop events you can attend other places and specialties don't necessarily have that but there are kit days keeping in touch days which you can organise with your employer which are days that you are paid for I think you can kind of have up to 10 I think 10 kit days although if you're taking shared parental leave you can take up to 20 split days with agreement of your employer.

SPEAKER_00 27:19

And that's 20 per parent I don't know anyone who's taken that many but and again like a kit day and what it comprises of and what it looks like is variable depending obviously what your spirit is but also we'll need probably a bit of discussion depending on your department's experience of having people come and undertake those days. I I know people that their employer about kit days and their employer had no idea what a kit day was and you know tried to basically say that they could provide it which is obviously not the case. So it can sometimes be useful to speak to other people about what they've done and provide concrete examples of what that can look like just so that you're going into the discussion with an idea of what a kit day could be made of and help employers not experienced.

SPEAKER_01 28:07

What's really important about formal kit days is that they have to be taken while you're actually on maternity leave or shared parental leave or adoption leave. They can't be taken when you're in that accrued annual leave portion although you and your employer might agree that you might come in to do certain activities on those annual leave days but then you'd have to be given an annual leave day and low somewhere else because effectively you'd be working not on annual leave. I think you and your your supervisor, your employer you should agree on what you're going to do with your kit days and you're not obliged to do kit days if you don't want to and technically your employer isn't obliged to offer them if there wasn't something to be done. However it kind of recognises good practice that you should be facilitated if you wanted to and I think when you're returning to a clinical role both for your own confidence it's it can be useful and and also just to start to feel like you're getting your head back around things. And it can also be quite useful for just solving some practical and logistical things. So one of my kit days I spent half the day sorting out my logins and going through you know some of the kinds of mandatory trainings and things like for me mine look like one day spent doing that and going on a wardround where I was really impressed by how supportive a consultant was in terms of say this is your day do whatever you want get whatever you want out of it. And he was someone who had never been on parental leave before never had a prolonged absence from work before and took just real kind of ownership of the situation. I think what was really striking about that was that the people who kind of facilitate your return to work and your your maturity leave don't have to be people who've been in that situation before that anyone can be an advocate for this situation because it hit the exact same principles could apply to someone who's been on sick leave or any other kind of leave. And so it might be worth thinking about that yourself when you're supporting people returning to work in the future. Other things that people find helpful might be to use it to attend some training days. So especially if there's face-to-face training days back again now it can be a good way to kind of keep up with colleagues and kind of keep up with some of those conversations around what's happening in different hospitals and kind of those conversations where people kind of say oh gosh we really changed how we're doing Han at the moment and some point you're just picking up on some of that those kind of conversations you might have been anxious to leave of for a little while you might have been involved in say an audit or a QI project before you went to Matur and you might be applying to go to a conference to present it that might be a useful thing to do but you're on maturity leave already some conferences have facilities to support children and childcare available or they might have kind of a room that you can sit in at the conference on kind of video with some space and some toys and that can work really well for some people. Some specialties have kind of targeted return to work courses and they're really great if they're available in your area. If you're due to renew your ALS or APLS or something like that being on maternity leave it it's quite a good time to do it because it can also help just make you feel more confident returning and dealing with those emergency scenarios. I think there's a bit of variability in terms of access to study budget when you're on maternity leave. My TPD was very supportive of people using study budget while they were on maternity leave but worth checking with your employer and your supervisor before you go off about what might be available because you know courses and conferences are expensive as well.

SPEAKER_00 31:44

Those are really nice examples and kind of kind of visualize kind of what a keeping in touch day can be used for especially if an employer isn't used to them and doesn't really know what they are. And also you can do things at Aish of hours as well.

SPEAKER_01 31:55

So I did I joined in at Aish of hours led some of the elderly weekends where they were happy to have me as a bit of an extra body in a super newer way but it was easier for me to arrange childcare at the weekend. I'd also planned to go in and shadow part of a handshift but my son became sick and so we agree it wasn't going to work out after all but those kinds of things can be just sometimes just logistically easier than trying to do things during the week he don't have childcare available.

SPEAKER_00 32:22

Another element of returning to work to consider it is support with breastfeeding if that is something that you have chosen to do and wishing to continue because there's certain provisions that have to be made for those that are breastfeeding their children in terms of having adequate rest on their shift to express and to store milk and having a clean place to do so and somewhere that you can store the milk as well. And that's something worth finding out about in advance obviously about what facilities are already provided for and if the facilities are not there, which they should be by law they really should be there but worth finding out what they comprise of and if there needs to be an adjustment to them. And a breastfeeding risk assessment is something that should be done on your return to work similar to the maternity risk assessment. It's uh not a nice to have it's a requirement but again it's something that might be unfamiliar territory to the person that is responsible for carrying it out with you. So again the a guidance signpost as well from the BMA has just been updated with regards to what kind of reasonable adjustments might be appropriate for those that are breastfeeding and we'll make sure that a link to that is included with this podcast release.

SPEAKER_01 33:39

I think breastfeeding as well is one of those things where people have had very individual journeys. Some people may have chosen never to breastfeed some people may have wanted to and it not worked in the way that they would have hoped during their maturity need and some people might still be breastfeeding frequently at the point at which they return to work or some people might be not feeding at all and some people might might really need those adjustments and and other people might not or you might find that things are changing quite quickly as you and your child adapt to spending more time apart. And um it's also you know people often comment on how amazing it is how children adjust to feeding when you're there and adapting to other things when you're not as well and so it can be something that causes people a lot of anxiety and so it's definitely worth trying to get what you need in place but then if that's not working for you flagging mass now you're going to see you can make more changes or what time things might change in terms of needing mass adjustments as well and so just expecting it to be a bit dynamic in the kind of first few months as you return to work or longer some people's breastfeeding journeys are several years long and that will flex over time what impact we what adjustments you might need to make in your day. I suppose one of the other practical things to think about in returning to work is childcare. Everyone will have different plans for their childcare and what's going to work for them. For me nursery is more part of childcare and in Edinburgh at the moment it's kind of guarantee a nursery place a lot of people are having to put in you know their child's name or not even name because they might not have a name yet out quite early in pregnancy which you know is stressful and you might not be sure you're going to be living in the exact same place. In my situation I initially applied for five days of nursery because I didn't know what days I would be working when I returned to work and then I was able to let them know a bit closer to the time what days I was going to need and my nursery were very supportive of doing that because there was always someone else who was going to be filling up the next day but just check in with your nursery and what the options are. Childcare is expensive and there are some supports available for it. So there is the tax-free childcare scheme which is available to parents who are working in the UK there is a a ceiling on how much you can earn to be eligible to you know participate in that which may not affect a lot of junior doctors but might unexpectedly hit some people if you say had a banding change if you're quite full-time on a senior rotation. So it's just worth bearing that in mind. And then it will also vary around the country but at age three in Scotland every child is eligible for thirty hours term time free childcare in England I think it's slightly more complexity to that in terms of how many hours you get and some income limits. And obviously some families also be eligible for child benefits as well and there's been some changes in the kind of income thresholds at which you can apply for child benefit. So it's worth just exploring which of those might apply to you and your family because planning childcare for your return to work is probably one of the things that is stressful. And when you do make that return to work, bearing in mind that there will be days when your child is not able to go to their childcare setting because they are succumbed to one of the many childhood illnesses. I think I read that in the first few years at childcare children have between kind of 15 and 18 illnesses a year and they affect you as well. Especially I I was working in acute and general medicine in winter so I was in flu and COVID supernamy and then coming home to a very snugly child and it felt like neither of us were well for weeks on end. And actually your child will be off sick as frequently than it feels like and working if you have a partner working with them in advance to plan who might be the one who comes home if your child isn't well can help take some of the stress out of us in the moment. So my partner is a doctor as well my husband and so we kind of have a bit of a hierarchy of you know if someone's on nights they're kind of they're going to go to work regardless. If someone's on coal or has clinics that's probably pretty important too but there are probably some days when you're slightly more dispensable and so there's even been days where I've gone in for the morning and come home for the afternoon so that then he could sleep before going on a night shift but I've gone in to do my clinic in the morning and you just have to roll with the flow a little bit there is an entitlement as well to carers leave it's called various different things but special leave where you do have to care for a dependent who's unwell so in this case a child in Scotland there's some flexibility about how long that can last for a bit in different health boards and trusts that will vary but so in some places it might be that you have a certain number of days paid leave per year after which you might be expected to take some annual leave or on paid leave. And so just worth bearing in mind what local leave applies to you in that case you're being kind to yourself when you succumb to the illnesses and ailments that arise as well because it's really tiring at times but you will get through if it does end.

SPEAKER_00 39:19

That's nice words because yes you forget about all the kind of bugs and things that are not just in the hospital and nurseries very much the talk about leave as well reminded me that we didn't touch upon the antenatal leave that you're entitled to well that you're entitled to leave for your antenatal appointments and that you don't have to worry about that but you obviously do need to give notice of what those are.

SPEAKER_01 39:43

But that time would be quite short notice as well because you obviously have your kind of standard appointment you know others may crop up along the way or you might need more frequent monitoring for adoption leave as well your partners are in time offer two anti-agle appointments I think this was you know particularly if there's complexities to the pregnancy I think if you have if just open and transparent conversations with your department there can be sensible pragmatic compassionate decisions as well if you are experiencing any complexities or challenges and maternity leave as well starts usually on the day that the child is born.

SPEAKER_00 40:21

Yeah. Certainly my experience with the antenatal appointments mine were made each time I went like I was never told or able to know what they would be in advance even the routine ones and then on top of that you might suddenly be like oh you need to go for a scan or whatever with not very much warning. So just being as you say very open and quick with communication with your colleagues. I found mine were extremely supportive and there was no issues at all but do know some people that really got quite anxious about asking for their antenatal appointments which they're obviously entitled to.

SPEAKER_01 40:53

Psychologically as well a lot of us are people who are used to saying yes to every opportunity and trying never to let people down and sometimes you feel some guilt about not being there or not being able to take things on but I think this all goes in cycles and there'll be times when you can be the person who fills every gap or says yes to every project and there's times when you have to say not for me right now then it just kind of comes and goes in cycles.

SPEAKER_00 41:27

I think you're right that guilt is real and I think what you said earlier about being kind to yourself also applies here as well that you would never think badly or criticise your colleague if they were in the position you are in terms of firing adjustments or requiring appointments off or whatever. So it's knowing that becoming a parent and being a parent is transformative and is awesome but it's also can come with challenges as well. So you know be kind to yourself and realise that that there's flexibility to be had around your training and your job and it's just knowing you know how to apply the policies and they're there to protect you work in your favour as well. So hopefully some of the things we've talked about today have been helpful.

SPEAKER_01 42:07

Eva was there anything else that you thought would be useful that's a kind of final words I think one of the main things I take away from talking people is that obviously everyone's maternity or your journey to becoming a parent will be very different and meek and some of it might happen very quickly and unexpectedly or or other times it might be a long road to get there and everyone's maternity will also equally be different and in its own way and even after that returning to work and I think it's important to figure out what's comfortable for you and right for you at the time and that will keep changing. And I think if you need time off or you need to take on less commitments that particular time that's fine. That's right for you but equally when you're a parent that doesn't have to be a reason you can't do anything you want to do or get involved with that work. You can work whatever less than full-time percentage that your department can facilitate in your DNA can allow and that can change from time to time. I changed less than full-time percentage kind of every six to twelve months since I've gone back to work and everyone's coped quite happily with that. And I know some people have said that they felt that they find it hard to say those things and other people have felt that sometimes people might not want to offer them things because they're worried that they're too busy because they've got children at home and that at work to a large extent you can still be a person that you always were if you want to and that's okay. But if you need to take time to do other things for a while too or if you need to take time off some days as well that has to be okay because that's how we facilitate kind of a dynamic workplace where we have lots of people with lots of different experiences and that once you have navigated your experience through the challenges of calculating a crude annually if your maternity pay and your returns work that I think it's actually something that gives you a lot of empathy for the experiences that other people in your workplace are going through as well. I think probably can help you support colleagues better in the future too.

SPEAKER_00 44:08

Yeah I think that's absolutely the case you realize especially if it's your first time navigating this what kind of HR things or training kind of differences that other people might come across for other reasons other than you know maternity or adoption and understand that these things can be quite complicated and quite difficult to navigate and you really do depend on the goodwill of your colleagues sometimes kind of help make those transitions easier as well. Great well that has been hopefully a helpful discussion for those listening some practical tips of what to think about when planning to become a parent and we will signpost some of the things that we find really useful ourselves, the useful information. This is going to be one of our career conversations podcasts we've got loads more uploaded on the education portal to listen to they're designed to have conversations that are not necessarily about clinical guidelines or anything like that but things that are useful as part of your career in terms of quality improvement or leadership in this case navigating a really important part of your life whilst also balancing work at the same time so hopefully you found that useful thank you very much for listening everybody thank you