Pandemic Pregnancy

When I became pregnant, COVID-19 wasn’t even a thing. It was mid-December and I don’t recall hearing anything about what was happening in Wuhan until January at the earliest. So it was probably a thing, and there were cases, but the thought of closed schools, clinical work on hold and shelter-in-place were not on my radar. I was honestly mostly focused on the application process for private school for my two oldest kids. They were (and I recognize how ridiculous this sounds) applying for entry to pre-K and K, and my biggest worry was where they would be going to school the following year. Now I’m doubtful that they will even get to attend said school in person, but that’s a topic for another day.

On February 25th I screened positive for Trisomy 21 and perseverated over that for a week until my normal cell-free DNA results.

We slowly began to take precautions at work to screen for COVID-19. It began with questioning patients prior to their visit to see whether they had recently traveled from Wuhan (this eventually expanded to all of China, and as everyone knows that question soon became obsolete). We also asked about cough and fever. Carts with PPE were positioned outside of these patient rooms.

I developed a cough on March 6th, which was terribly awkward to have while everyone was on high alert regarding COVID (for the records, I have had a negative COVID-19 PCR and also negative IgG and IgM antibodies). One of my patients even sent me a personal note saying that he was worried about me because I had been coughing (I wore a mask in every patient room during this time) and seemed short of breath. I had to, with some embarrassment, tell him that I was short of breath due to climbing 3 sets of stairs while pregnant. Fortunately he was a patient I knew quite well.

I had an ob appointment March 10th and my ob was pretty close to 0% concerned about COVID. She told me the reports out of China were reassuring. Pregnant women seemed to fare well and there were no cases of vertical transmission. She also told me to drink a glass of wine, which was interesting because she usually errs on the conservative side (also for the record, I did not drink a glass of wine).

My close colleagues, however, were more concerned and ended up encouraging me to drop one of my higher-risk duties – seeing patients in the hospital. I stopped doing that the week of March 2nd. The week of March 9th I made a huge pivot in my career and left one of the clinics I had worked at for 6 years. Too many things weren’t working out. I was losing staff, knew I wouldn’t have any when I returned from maternity leave again (it was a drawn-out nightmare the last time) and was so exhausted from pregnancy and turning 37 that I knew it was finally time to call it quits.

March was a month of major upheaval. Our world paused in March – with school canceled starting March 12th (initially only for two weeks but that eventually progressed to no school for the rest of the school year) and shelter-in-place coming 5 days later. Everything was being canceled. It was such a crazy time.

We largely stopped seeing patients in person, with my last real clinic held on March 16th. Everything has been virtual since. To be honest, it’s been challenging. Some conditions in dermatology are easy to treat virtually (acne, for example). Other things, like checking over someone’s skin to look for skin cancer, are impossible. I have been seeing 1-2 patients a week for skin biopsy and evaluation of more serious rashes, but always wearing ample PPE (I have my own that I cycle through). We have just started talking about opening up clinic more robustly, and I am concerned about the plan (or lack thereof). It doesn’t sound like anything is changing, other than spacing out clinics and appointments to encourage social distancing. Of course, we are asked to wear PPE, although it is unclear whether this is readily available.

Normally, I wouldn’t be too concerned. But last week, at my follow-up ob visit, my doctor was suddenly very concerned. She told me there had been new reports of COVID-19 found in placentas, IgM antibodies in newborns, vertical transmission (from mom to body), second trimester miscarriages, stillbirths and premature births. The numbers of reports were small, but there was definitely more alarm. Moms are tested at the time of delivery at our hospital and COVID-19+ moms are recommended to separate from their newborns. Having had three kids, I can’t imagine how heartbreaking that would be.

In sum, I’m starting to worry about ramping up capacity to see more patients. I’m not reassured by the plan currently in place and now I’m much more anxious about doctoring while pregnant. At the same time, I feel a bit silly, because I don’t work in an emergency room or ICU, and certainly don’t do any high-risk procedures (any biopsies I do near the face are usually relatively quick and nothing compared to an intubation). I also feel a strong obligation to my patients. I know how scary it can be to have a spot that you are worried could be a skin cancer, or a rash that keeps spreading. Our patients have been so wonderful these past few weeks, understanding that we are taking every precaution to keep them safe, but I certainly don’t want anyone waiting months to be seen. Since I am taking maternity leave, I would be gone until early 2021. Finally, I care deeply about my colleagues. Although they might not be pregnant, they could have co-morbidities or take medications that make them immunosuppressed, live with elderly parents or in-laws or immunosuppressed children and spouses. I don’t want to burden anyone else with having to see my patients because it seems to imply that my pregnancy is more important than their personal circumstances.

It’s an uncertain time for all and I don’t envy our management who has to make some tough decisions moving forward. For now, I’ve reached out to my ob to see if she can give me some clarity on making a decision. If need be, I’ll reach out to my colleagues to see how to best mitigate risk. I’m taking leave at 35 weeks so essentially only 13 more weeks to go. Hoping those 13 weeks are as smooth and uneventful as possible!

Maternity leave in review

In two days I’ll return to work after my third maternity leave. That’s one job, three pregnancies, three maternity leaves and three “first days back at work”. My first post on this blog was about returning to work after my second was born (see October 2016 archives) and now here we are again! In honor of this occasion, I wanted to spend some time (kid naps allowing) to reflect on the past few weeks.

This maternity leave started earlier than planned when my contractions started the morning after my last day of work. I had been expecting at least a few days (if not weeks!) of extra time to wrap things up, but baby had other plans. I subsequently spent the first 3-4 weeks wrapping up work. I know that sounds really terrible, but it was actually okay. Everyone knows that newborns don’t sleep, so it gave me something to do in the wee hours of the night, and it was something that would definitely prevent me from dozing off with the baby. I am also fortunate to have a lot of support staff and they helped me make phone calls to patients (since that’s not something that can be done in the middle of the night!).

My husband didn’t take his paternity leave right away, so it was a bit of a whirlwind. Even though we had family helping out, if I had to do it again I would ask him to take a few weeks off in the very beginning. It would have been immensely helpful to have a bit more overnight help those first few weeks and I would have probably been able to take some daytime naps without the baby! It seemed pretty stressful for him to work while so sleep-deprived and this definitely led to more bickering than usual. Fortunately, things improved with time (and sleep!).

We briefly had a night nurse helping us out…untilĀ she fell asleep holding the baby. I couldn’t believe it. As my husband always says “why are people so bad at their jobs? You have one job – learn how to do it right!” So I guess another thing I would do differently is not hire a night nanny. Yes, it was helpful to have someone hold the baby for a few hours overnight, but I did enjoy doing the bulk of evenings since so much baby bonding happens during that time. I also found that I didn’t rest easy when she was over, perhaps because I was worried about the above. Fortunately, our little guy persevered and now his sleep isn’t as atrocious (although it is definitely nowhere near ideal for having to go back to work!).

My older kiddos have done really well with their new little brother. Toddler Y (our middle child) had a tough time those first few days, but now he is sweet as pie. One of our major challenges when I return to work will be carving out individual time for all three kids. Right now, the older kiddos have independent activities on Saturday mornings, and I plan to build onto that time.

One of the highlights of maternity leave was seeing a lot of family. My mom spent a few weeks with us right before and after Baby Z was born – not quite as long as the last time, but just the right amount of time during the hardest days. We also had both of our families visit on separate occasions and I was able to visit home twice (the last time for 3 weeks!) during maternity leave. The kids have a blast around family, so it was so nice to see everyone on multiple occasions.

Another highlight was meeting an awesome group of moms with kiddos around Baby Z’s age. I have excellent mom friends whom I met shortly after my first was born. Some had second babies so I didn’t feel the need to branch out much with Toddler Y. But this time around I knew that Baby Z would need some baby buddies and went out of my way to meet people. Well, this group of moms is just awesome, and it’s been great getting to know them.

On an organizational front, I did a TON around the house. I cleaned out the whole attic, donated and threw out a bunch of items from all throughout our home (trying to get a head start on minimalism for 2019!), made headway on two home improvement projects we have been working on, had the guest room painted, reorganized the guest room/soon-to-be Baby Z nursery, cleaned out the entire shed and organized all of the kitchen drawers. I gave away a ton of baby things we no longer needed, worked on Baby Z’s scrapbook and first-year album and also researched and toured a slew of private schools in the area. I did much of this with the baby strapped to my chest, but needed a bit of assistance for the manual labor.

Of course, the highlight of maternity leave was the hours upon hours I got to spend with Baby Z. I wore him almost constantly in a sling (now carrier) during the daytime hours. He often slept in bed with me overnight (not necessarily by choice, but we made sure the bed was as safe as possible for infant sleep) and he accompanied me to appointments, a handful of work meetings and a slew of errands. He’s an excellent eater, and I will forever be grateful to my employer for allowing me to have all of this time with him.

When I return to work, he will be about 4.5 months old. I know international readers will balk at how little that is. However, having had all of my children in the US, I feel so incredibly fortunately to have had 4.5 months of paid maternity leave, as well as the assurance that my position is stable. When I return, I’ll be able to set time aside as I wish to pump and to adjust my schedule as needed to make this year as manageable as can be. In fact, I’m returning part-time this month, and I am so very grateful to be able to rev up gradually.

I will always be sad about leaving my baby. What will it be like for him to not be strapped to my chest all day? (Honestly, probably not as bad as it will be for me!) I will worry incessantly about something going wrong while he is out of my care and I will miss his little noises and tiny fingers and sweet smile. I will stress out trying to give everyone attention in the few hours we have before work and after work/before bed. But I have faith that it will all be okay. Not easy, but okay.

Many moons ago, when I was obsessing about going back to work vs not going back to work (not really an option for me at the time but an interesting hypothetical argument) and then obsessing about daycare vs nanny, the one thing that stuck with me was reading that kids will thrive with a decision as long as the parents are happy with that decision. So I always focus on the positive aspects of my job and the positive aspects of their relationships with other caregivers.

I also have this to get me through: my older kids are alright. They’re happy little clams, in preschool now. My oldest is four. If we repeat his life cycle 4 more times, he’ll be twenty – an adult! In other words: time flies. As my children have grown, I’ve had (some) opportunity to think about who I am independent on them, how my husband and I interact independent of them, what I will do once they leave. Yes, I am not very far in and they are still very, very small and very, very dependent, but there are snippets of time when these opportunities for thought arise. When they have arisen, I have always been very happy to be working. This is what has worked and been okay for me, but it may not be the best case scenario for anyone else, and that’s okay too.

So in less than 48 hours, I’ll be waking up and changing out of my pajamas first thing. I’ll put on make-up, grown-up clothes, triple check my bags to make sure I have my work things plus my pump things, and then I’ll leave my sweet little baby behind. First I’ll have to convince my older kids (who have been out of school for three weeks!) that getting dressed and leaving the house early is also a good idea. I am not sure which of those feats will be harder! And in a few weeks time, doing this will be the new normal, and these lovely (and hard) maternity leave days will be a distant memory!