Are work being unreasonable?? And when to start mat leave - working as a doctor

[jellyspoons]

Hi,
This is my first post so hope it goes OK!

I work as a hospital doctor and am pregnant with my first baby, due in September. I work shifts, and so far work have said they have no obligation to reduce my hours at any stage in the pregnancy whatsoever (including nights/13 hour day shifts/carrying the crash bleep), though if I get to the stage where I really can't cope then they would have a rethink and sort something at that time. We're short staffed as it is so I can see why the consultants are reluctant to take me off the oncall rota.

My current job finishes on Sept 3rd (I'd be 37+6), and my last two shifts are night shifts. The week before I have very tiring oncall shifts Mon-Thurs. If I finished the preceding Friday to that, I'd be 36+2.

Work have asked me to swap my night shifts and oncalls from later in the pregnancy to earlier in my pregnancy as a "goodwill gesture", especially the night shifts in early September at 37+ weeks as these will be difficult for them to cover as they encompass the change of job period. There are other night shifts at 33 weeks and 28 weeks I'm also due to do.

Currently I've been remarkably well during my pregnancy (hope it continues!). I wonder if I'll get bored if I go off work too soon, but, I also don't want to push myself more than I can manage. Work implied that if I swap the night shifts in early September at 37+ weeks then they might be more amenable to sorting out cover for other shifts earlier in the pregnancy - though I'm not sure whether to believe them! I'm planning on taking 9 months mat leave but may want to extend it to a year, I'm not sure yet. So I don't want to go off too early and sit around bored pre baby, then be forced to go back before I'm ready to at the end of mat leave. I also reckon I'll be over my due date as my mum was late with all 3 of us by 2 weeks!

So! I think I should probably go on mat leave at 36+2 and leave them the issue of sorting cover for the subsequent shifts, but I also am unsure as how much I should pander to the consultants putting pressure on me to swap shifts, in order to get goodwill from them. I also don't know whether if I just carried on, then saw my GP and got certified as "too tired to do oncalls" then they'd be forced into being reasonable and I could work 9 - 5 or equivalent for the last few weeks before going off at 37+2 - this would be my preferred option if possible, I think, but it seems a bit risky rely on (especially as the oncall shifts, whilst knackering, are 9 hours and so they could probably make me do them I guess).

Thoughts??? Anyone else been in a similar situation?
Thank you!!

[Lonecatwithkitten]

Jelly I am a vet a worked till 36 weeks. My bump was always small and my midwife like yours said your fine, baby is growing no need to worry. Her point was because I had kept fairly fit and standing a lot had maintained strength in my abdominal muscles that everything was always going to be tight and neat. She was very right neat 7lb 10oz baby was what I got.

[jellyspoons]

Hey everyone and thanks for the responses! Xenia I think I'm in a bit of a different situation from what you're describing. In my case my husband is a Dr too (GP registrar) and he's actually desperate to do the main childcare when I go back to work at 9 months - he's planning to do this for 3 months whilst I go back full time until I can get a part time position. He's very into kids, I think eventually we'd both love to be part time.


Anyway! I'm now 38 weeks and have been off on mat leave since 36+2. It's generally worked out OK, I was very grateful not to have to do the nights at 34 weeks - at that stage I was starting not to sleep well and feeling pretty tired being on my feet for long periods. Instead of the nights I did 10 hour A+E day shifts, which were pretty hard work but not as bad as nights.


Annoyingly, the consultant / registrar in charge of the rota did try and make me do EXTRA hours to make up for not doing those nights (i.e. they put me down for 43 hours of day shifts, instead of 36 hours of night shifts...). I managed to persuade the reg in charge of the rota that this was unreasonable though, so got out of the extra shift!

I also rang up HR and discovered I was owed 33 days annual leave this year (I had previously been told it was 30) so with that extra leave I managed to get out of working nearly all my day shifts in August, so I just had to do the on calls. Carrying the crash bleep was a bit ridiculous at 36 weeks, I did a fast walk rather than a run!

Am now enjoying maternity leave, going out for coffee with NCT people and nesting! Bump is on the small size still but growing and my midwife isn't worried - says it's in proportion to me and not to worry. So I'm not!

Thanks for all the support out there,
Jelly

[mamadoc]

Glad to hear that you are getting some concessions.
I am sure that 'it won't count for training' stuff is blackmailing bollocks too and anyway you just passed your ARCP for this post so presumably all signed off anyway.

Small bump could be something or nothing.
DC1 bump was small, baby was small IUGR
DC2 bump small again, baby twice the size of his sister!
I had growth scans for both but apparently the 1st one was done too early and was falsely reassuring/ should have been followed up.
So do get a growth scan but get a consultant opinion on it don't just sidle up to someone in a corridor (tempting when you know people and can bypass systems)

[Xenia]

I agree and it also depends on how you feel and the nature of your work. I was certainly lucky not to be ill. However I do think women need to know that plenty of us take very short leaves and that that can be the best solution including longer term so you do not because the main child carer at home and the balance of equality and power in a relationship with a man are changed forever to the disadvantage of a woman who leans out, not leans in. It is at the time of first babies that most of the damage is done to women in career terms because many "choose" (or their social conditioning makes them think they choose) to put their career second to their husband's.

[MildredH]

Great news Jelly.. Glad you've had some kind of resolution although it sounds as though you've had to do a fair bit of compromising!

I'm 20 weeks, working as a med SHO in a frantic DGH. Struggled with last set of nights and got more in 2 weeks. Seeing occ health in the morning to discuss whether they could be shortened. An A&E SHO friend just got signed off nights entirely at 22 weeks by the same dept so I'm hoping for a favourable response!

Half of the problem is that no shift in the last 3 months has been fully staffed meaning loads of pressure to keep clerking new patients without breaks or even time to pee often!

[Daughteroughter]

Jelly spoons have you discussed with your clinical tutor I am a senior manager in an nhs trust and have had a discussion with ours last week about a number of fy1 and fy2 who are pregnant to sort maternity leave, not least because I found one sitting in a corner crying with exhaustion and she was only 30 weeks

[breatheslowly]

No one has suggested that the OP throws in the towel on her career and becomes a SAHM. All that is being suggested is that she looks after herself and her baby and takes the support that is available to her. My GP said "you're only going to have this baby once, so you might as well look after it and yourself as well as you can" and in many ways having someone 'external' saying that made it easier to make the decision to do so.

Your personal experiences Xenia are fairly unusual and whilst they clearly were what you wanted to do or felt you needed to do, it is perfectly possible to achieve a middle ground of taking care of yourself while pregnant, taking the whole of your maternity leave entitlement and having a fulfilling and rewarding career.

Take care of yourself and your baby Jelly.

[Xenia]

As I say it depends on the person but I do not agree that doing less work is always putting yourself first. What is so often morphs into is career destruction, putting yourself last, becoming an unpaid servant at home whilst a higher paid man who has not made the same choices swans in thinking he is a God as he now earns more and his career has become the important one. Avoid that as much as you possibly can.

[breatheslowly]

My GP signed me off at 29 weeks (from a professional job, quite stressful but not shift based or as physical as medicine). My GP said that women in stressful professional jobs have smaller babies. I googled it and couldn't find any evidence to support this. I think she had probably suffered during her pregnancies and was sympathetic as a result. GPs can be fantastically supportive and it is well worth discussing your work with your GP if you haven't done so.

[chickieno1]

Good luck with rest of your pregnancy jelly.

I'm a doc but luckily was doing research and no on calls when pregnant with ds. I was working v long hrs though and on my feet and also scanning pts lots which didn't help my back and pelvis. Worked until end of 37th week and then moved countries which was stressful. Ds was 2 weeks late and I was exhausted. He was good size emcs and healthy thank God. Looking back I would say try and get as much rest as possible and try and finish work as early as you possibly can.
If you're worried about size of bump I would try to get a growth scan. Surely they would see a colleague at your hospital if she was worried?
Congrats on passing the year!

[DerbyNottsLeicsNightNanny]

Haven't read the whole thread so apologies if I repeat anything. I'm 29wks pg and am a teacher, usually work 3 days pw. From very early on in my pg I got a reduced hours GP note saying I should work 3 mornings pw only - its been a godsend! I do think some people at work are a bit p*ssed off about it & I do feel a bit guilty but have decided to put myself 1st.

First pg I worked full time until 40wks with no probs. 2nd time around has been a different story with more 'issues' and generally feeling not as well.

My advice would be work as long as YOU want to & to get a docs note if needed to help you work the hours that suit you best

[Xenia]

I don't think working will have made the baby small, don't worry about that. Babies are very robust even if mothers are working in the fields all day. Also most of mine looked fairly small (except twins born at 40 weeks!) but they were fine.

I worked until I went into labour in a similar professional job and that worked out fine, back full time after 2 weeks. I think it just depends on the person as to what works best for them.

[Abra1d]

I would have been appalled if a doctor treating me in hospital when I was pregnant or otherwise in need of care was compromising her health or her baby's because of some macho requirement by her superiors. I mean, what is the actual point?

I looked very small right up to birth but my son was nearly 7lb 5ozjust very curled up and breech. The midwives kept asking me if i was a fitness instructor (snortonly time in my life that's ever happened but I did have very strong abdominal muscles back then). I kept being measured and told to keep movement charts. I got so stressed by the concern I developed blood pressure problems, then picked up a UTI and then they decided I might have pre-eclampsia.

[Twirlbitesruinedmylife]

Glad things are looking generally up

Take care of yourself and bump

I'm short and have a small body even in proportion to my height so even though my bump measured right for dates people at work kept asking if I was having twins. Don't worry about what peole say you look like but do get yourself measured.

Best wishes

[jellyspoons]

Hey all,

Well, hanging in there and executing plan A of smiling and nodding when asked to do unreasonable things, but actually not organising any shift swaps etc seems to have worked.

I did my 4 nights at 28 weeks and 3 long days last weekend, which were exhausting (I stupidly did a swap to get a friend's wedding off - I organised this when I was about 6 week's pregnant and didn't really think about it! - so ended up working crazy numbers of hours within 8 days). BUT, one of the consultants in charge of the registrar rota came in on one of my night shifts for a sick patient and ended up asking me what was happening with my nights, how much longer was I going to do them for.

I said the truth which was that I'd be asked to continue as long as possible and not to organise anything in advance to get out of nights, and that I had one more set of nights to go at 34 weeks. And that I wasn't looking forward to them and thought they'd probably be really hard. And the consultant (who has previously been really militant over email etc) then asked why I hadn't swapped them with someone. I kept my ground and said I didn't want to tire myself and swap nights to earlier in the pregnancy, plus it's pretty tricky to do swaps on our rota anyhow. She then started saying about how maybe I needed to swap into doing long days or shorter A+E shifts instead of nights, and I had to remember that if I did any less hours than I was rota'ed to do then it wouldn't count as training. I said that wasn't really bothered about 6 weeks of this job not counting as training, I'm going to be a trainee forever anyhow. Therefore if I did reduced hours and it didn't count as training I was happy with that. Then the consultant said that was what Registrar A said last year, and she totally screwed over her colleagues and the department and it wasn't fair on anybody, and "everyone" thought she was really unreasonable. I managed to bite my tongue and not stick up for my friend (Registrar A) who I know worked bloody hard despite SPD etc etc trying to cover an understaffed rota. Hmmm... didn't feel too good about things after that coversation!

BUT! Amazingly enough 2 days later this same consultant emails all the registrars to say - Registrar X has agreed to do jellyspoon's nights (at 34weeks) at locum pay rates, Registrar Y has agreed to do the long days that registrar X should have done, and jellyspoons are you happy to do the 9 hour A+E shifts that Registrar X should have done? Of course I said yes so no more nights for me, yay!!!!!

There's been no mention of me making up the hours due to going from nights to 9 hour day (A+E) shifts for those 3 days, so I'm hoping that if I keep a low profile it won't get mentioned again. Anyhow, I've been doing lots of unpaid overtime recently (had to write a report for a case going to court, and I went on a compulsory course on my day off...).

So yes, feel a bit better about it now, it seems by holding firm the consultants got cold feet about making me do nights at 34 weeks and have caved, yay!

The crash bleep is a battle I'm not even going to try and win, I'll just resolve to not run down the stairs - it doesn't actually make you much faster running I reckon so not worth it over a quick walk. Long days I'll see what happens, if I need to start doing reduced hours and coming in at lunchtime I'm sure the other registrars will be supportive (even if not consultants). And actually I only have a total of 3 long days and 6 evening A+E shifts left before mat leave starts (including the ones to make up for nights)... so I reckon I can manage those!

Main worry at the minute is my bump's been measuring small (as done by my hubby after people at work made me paranoid telling me I look tiny for 29 weeks) so I'm going to see the midwife on Tuesday and see what she thinks, if I need a growth scan etc. Feeling pretty guilty about working too hard and not letting Blob grow enough... oh well not much I can do about it now. Also felt AWFUL last week when I missed my midwife appointment as I failed to get away from work in time.... idiot. Oh well.

Next 3 weeks I don't have any on calls, which is going to be amazing, then have a lot of annual leave in August interspersed with some on calls. Fingers crossed will be OK.

Thanks for all your support, sorry for the mammoth posting. On the plus side I passed the year (ARCP) whoo! Even despite not being allowed proper amounts of caffeine for eportfolio purposes!!

Would love to hear how other people have got on, hope everyone out there is doing ok.
Jelly

[Itaintmebabeitaintmeyourlookin]

Any problems go on sick leave without any worry. They will not be there in the middle of the night if you feel exhausted and unwell.

[Zoomania]

Of my hospital medic friends most stopped nights at 28w I think. Med reg friend stopped work at 31 w with three weeks a/l then maternity leave starting 34w. She already had SPD starting which has resolved now she has stopped running around doing 12 h days. I know plenty of medics who worked til late only t have baby early and wished they had had a longer break first. I know a med SHO who worked late but 9-5.

You have given them enough notice..there should be no need to say they will suddenly have to get your colleagues to cover.

[Itaintmebabeitaintmeyourlookin]

Medical staffing don't care, they really don't. We are simply a commodity they need ... The number of times I have heard Oh we bleeped you for urgent on call cover for tonight! Can you do it? No? Are you sure, can you think about it... And many variations thereof usually finishing off with, Can you ring us back before 4 , I go home then....GGRR

[Twirlbitesruinedmylife]

Just wondering if you have considered talking to your HR department. It may be your department is not following your hospital's policy.
I'm concerned that you may be under so much strain there is a risk to patient safety and if you agree then you really need to look at your trust's whistle-blowing policy.
In addition, if your trust is an FT (and possibly even if it isn't) you should have a non-executive director on the board who has a special responsibility for staff safety.
I have only dealt with unions for non-medical staff but maybe the BMA can help you.

[Itaintmebabeitaintmeyourlookin]

First reaction..... Bastards .. Lol

More measured reaction.... I bloody hate HR


Sensible comment..... Do they want all shifts covered so you don't have to repeat part of your training? If you are employed via the Deanery can you ask fr LTFT training? If you are Trust Dr just be a LOT more firm.

Simply say you can't do it and exhaustion/ nausea etc are impacting on your stamina to do the full time hours.

Under no circs do your nights early, that s outrageous

[MildredH]

I agree with the earlier poster. There is no way that they can ask you to work extra hours to compensate for not doing long days. It sounds as though they are chancing their luck- hoping to pressure you into agreeing. Earlier advice entirely correct- be polite but firm. (I realise this is much, much easier said than done with the situation you describe). Is it possible to liaise more with medical staffing rather than with your seniors?

This thread makes me slightly nervous. I'm 17/40, working as an SHO in gen med at a hectic DGH. I struggled through trimester one only having two sick days for vomiting. Feeling lovely now in second trimester but apprehensive about later on. Our rota is 50% medical take, always 12 hour day or night shifts and our medical staffing dept are not known for being reasonable!

I wish you well. Really hope you get it sorted.

[stickortwist]

I tried to name change but failed.... I just wanted to let you know that im not in the slightest bit suprised that asked you to to extra nights now. Whilst pregnant with ds2 i worked a v busy gen med sho rota in a dgh. At 32 weeks ish i walked into hr halfway through a 13 hour day and sat and cried that i couldnt carry on. I sent myself crazy trying to plug gaps in the rota as they couldnt get locums and working extra long days and nights it was hellish. it took a long time to get over.
However with ds3 i managed to work till 36w as i had more supportive colleagues and a fluke of the rota meaning no nights after 28 w.

Ive always been able to find someone who would hold the crash bleep for me. If you want tl do it officially i would see oh at about 20-30 w when ypu start to show more and say you dont think you can safely perform bls ( or use defib although showing my age they are probably hands free now)
Sorry for spelling . On my phone!

Good luck and dont let them make you the scapegoat gor any rota gaps

[MorganLeFey]

There is a handy NHS/RCP/OccHealth document giving general advice to employers & employees in pregnancy - like reducing 'long hours' (definition was >40 p/w I think)... although amusingly my NHS OccHealth didn't seem to be aware of it! The MWF have a campaign that nights in general should be stoppable in the third trimester.

I stopped nights at 28 weeks (specific risk assessments things were also lone working & violence in my post) & consecutive long days. So obviously did my normal days in place of zeros for out of hours that I had not done.

Thankfully my Supervisor (recently returned from Maternity Leave) was really helpful with my risk assessment/her recommendations - although the clinical director had suggested in our intro rota meeting with all the doctors on it that I swap the on-calls I was due to do in the early part of my mat leave - effectively doing more on calls in the same period & partially covering my own leave - I was too stunned to respond eloquently at the time (!)

Anyhow - jumped through the OccHealth hoops, though they were really vague about the strength of their 'recommendations' to my line managers. My plan B was seeing my GP & presented specific concerns/risk assessment & the NHS guidance (!) so got a handy fit note with the 'fit to work' and adaptations of no nights, shorter hours etc. Then had enough confidence to present to the rota side of things that options were I did my job with adaptations - so kept doing the day part, or I would be signed off not fit to work until Mat Leave could be forcibly started at 36/40. They opted for former & didn't need to whip out the note.

I momentarily felt selfish & demanding but then thought it wasn't really just about me but the bump too & latter stages of pregnancy start being higher risk again & I would blame myself/work if anything went wrong.
Although perhaps easier for me to do this as my report-writing supervisor was on board & it was a short post with this specific trust & not in my overall specialty - so less concerned about grudges!

I started at 37/40 & finished at 35/40 using some annual leave. I did not want to be stressed out in latter stages & wanted to properly - practically/physically/emotionally etc. prepare. As it happened she came at 37+4 (Caucasian primip - I was expecting to go beyond EDD) - so pleased I did! Unforunately, I planned to get portfolio perfect in 38-40/40, whoops... Also would have had plenty of other sedentary things to do if overdue - like revision etc.

Good luck.

[Isatdownandwept]

The conversation goes "I am really sorry, but whilst I am happy to continue my normal shifts and normal scheduled rota for as long as I am able, I really cannot take on extra at any point in my pregnancy, which is what you would be asking me to do if you want me to bank up extra nights and on calls now. But I am of course happy to do my fair bit until my GP tells me to cut back. Am sure you don't have an issue with that?"

Really. It's that easy. If they come back and say its unfair on them to have them cover for you later in your pg you need to say that you are very sorry but the job is demanding enough as it is and you are really quite shocked that they seem to expect you to even think of doing extra at any stage in the pregnancy, and surely they don't think it right to deliberately plan to overload you at any stage? And so on. Just be very polite, but keep repeating. If they keep pushing then I would simply say that the level of stress that they are putting you under with all of this is making you feel very upset and that if they want to pursue this then it would have to be with the involvement of HR, given that you have already pointed out again and again that you are perfectly willing to continue your shifts and rotas as contracted for as long as you are able.

Your bosses are being primal. You have all the legal rights in your hands but I appreciate it is easier said than done to use them. Better to just keep politely telling them they are arses until they get the message. If they don't then if it were me I'd get signed fit and if they blow up at that I'd go to BMA.

[mamadoc]

Glad to hear you plan to finish at 36 weeks.
You are under no obligation at all to swop those nights so DO NOT be pressured into doing it. They can sort out their own problems.
Long shifts and crash bleep seems less clear but I am sure if you had a fit note saying no nights and no shifts longer than x hours they would have to honour it. Not at all sure they can force you to make up the hours that sounds crazy and just like blackmail.
Remember your baby needs you much more than your job. No-one is indispensable. If you did run around swopping it all and martyred yourself to the bitter end I guarantee no-one is going to appreciate it anywhere near enough for it to be worth it.
And, as you say, this is just good practice for re-orienting your priorities when your baby is here. I still work bloody hard but I leave on time as pick up is not negotiable (unless genuine life/death situation). I take whatever paperwork stuff I can home for after bedtime eg dictating letters, CPD and somehow it gets done.
Good luck