motherhood and apple pie?

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If you have lived in the US for more than an hour, you have undoubtedly heard the expression: "That's as American as motherhood and apple pie." I have no issues with the apple pie component of this statement, my last post on obesity notwithstanding. I have no knowledge of how well or poorly America treats its apples.

However, I wonder how our fair country has the ability to claim it stands for "motherhood" when we are laggards compared to our world-wide peers in requiring paid maternity leave for working mothers.

A recent report from Bloomberg.com indicates that of 181 industrialized countries studied by researchers from Harvard and McGill, only THREE--Papua New Guinea, Swaziland, and the USA do not guarantee that women who take leave due to childbirth can be compensated during their maternity leave. The FMLA of 1993 guarantees that workers in covered businesses can take up to 12 weeks of leave and not lose their jobs. However, they may have to take these weeks UNPAID, unless the business or organization has a specific policy that provides paid leave.

The US military provides active duty service members with six weeks of paid leave for mothers and ten days for fathers.

Nearly half (46%) of the overall US workforce is comprised of women. So the immediate cost of providing paid maternity leave for all wroking women would be fairly hefty--estimates are around 938 million dollars in the first five years. But this just reflects the direct costs to the business, and does not consider the indirect benefits that can be accrued when children have their mothers at home with them for as long as possible. It has been shown that children of mothers who return to work within the first 12 weeks following delivery are less likely to receive standard immunizations and regular well child care.

In the EU, the minimum number of paid weeks of maternity leave is 14, with an average of 18 weeks.

So, why am I writing about this? We are unlikely to be able to change this situation immediately, if ever. I guess I am eager to hear your thoughts. Maybe hear how you managed, if you are or were a working parent when your children were born, to eke out as many weeks as possible. Did you have to use up all your vacation time? Sick leave? Did you end up quitting your job because it just wasn't worth it? How did you manage to navigate the intricacies of working as a parent?

As for me, I have three children. The first was born (26 years ago) while I was working for a small start-up biotech company, that developed the original vaccine for a bacteria known as haemophilus influenzae type b--we just call it HIB for short. At the time it was the most common cause of bacterial meningitis (infection in the spinal fluid) in children less than 2 years of age. I was very lucky, and my boss, who was the owner of the company, and a pediatrician, told me to take off as much time as I needed. There were no HR policies, as there were only 8 employees. So I was able to stay home with my newborn, to provide whatever she needed. I went "back to work" after about 6-8 weeks, but had complete freedom to take off to go to doctors' visits, I could pump in peace, or run to the babysitter's any time I wanted. I didn't  lose a thing.

My second and third children were born after I started working at the University of Maryland School of Medicine. I was a state employee and we had no maternity leave policy. We did have a generous sick leave policy, and sick leave accrued over time. Whatever was not used by the time you left or retired, was paid out in a check. To take maternity leave I first had to use up ALL of my vacation time, and anything over that was counted as sick leave. So the number of weeks I took off were pretty much up to me (except that I couldn't stay home longer than six weeks based on how many physicians were available to cover call), but were deducted from the accumulated sick leave for which I was paid when I left. Therefore, if you compare the total compensation I received over the course of my 21 years there, I ended up generating a smaller total than a comparable male or a woman without children.

Nonetheless, I have to admit I was pretty lucky compared with many other women, who either had no options for paid maternity leave, or couldn't afford to stay home with their children. In addition, I know many women who ended up using ALL of their allowed leave (paid or unpaid) and then had no time left to take off if they or their child became ill later in the year.

As a pediatrician, and a child advocate, I feel strongly that our country needs to work toward facilitating the health and well-being of our children. Therefore I would LOVE to see us mandate paid leave for parents. As an administrator, I of course worry about the acute, direct costs of providing such a benefit. However, I see the potential rewards for having a happier, healthier workforce, and for investing more in our children.

After all, it's as American as motherhood and apple pie.

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About Dr. Ackerman

Alice Ackerman, MD, MBA, FAAP, FCCM is the Chair of the Department of Pediatrics at Carilion Clinic and Professor and Founding Chair of Pediatrics at the Virginia Tech Carilion School of Medicine. Dr. Ackerman is recognized nationally as an expert in pediatric critical care.

She has been at Carilion Clinic since June of 2007. Her primary goals are to enhance the health care of children in the Roanoke Valley and Southwest Virginia, and is actively working to do this both as physician in chief of the children's hospital, as well as through involvement with many state-wide initiatives.

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The AAP website for parents
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