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She graduated medicine from King's College with a BS C in surgery and anesthesia from Imperial. Her elective placement in Malawi internship at the World Health Organization and Fellowship at the Guys. And ST Thomas's Simulation Center led to her interest in global surgery and clinical education. She took maternity leave while an SD four trainee and returned to work a year later as less than full time, Zarah is also currently the women in surgery representative, as well as a regional representative within the British orthopedic trainee Association, MS Jeffrey. Ok. So I thought I'd just be creative with the title, but I think I should clarify that back again. Doesn't mean that I am pregnant again, but I'm back at work again. Um And I don't have any conflicts of interest to declare. So I actually um found out that I was pregnant while finishing a stretch of nights, um that we had talked about having a baby beforehand. I felt like I was in the right head space for I had a training number. Um But we had a lot of friends who were sort of going through um some fertility issues and were in their thirties And so I don't think my husband was as mentally prepared as I was. He thought we would have to wait longer before hearing news that I was pregnant. And so when I did tell him, um, he was very shocked and, um, immediately said we are not ready, we are not ready and went and opened his Excel sheet and tried to work out whether we could actually still afford to have a baby or not. Um, the context being that he had just decided to do a career change and, um, was going from investment banking to real estate investment, which I don't really understand, but at the time, he was doing a master's while transitioning between the two careers. And so, um, he was very nervous that we wouldn't be able to afford a baby. But we do have a saying in our culture that babies bring their own prosperity. And so actually, it was only a day later when he found out that he had got a job. And so that had worked out quite well. Um Anyway, so I was finishing my stretch of nights and, um realized that I could possibly be pregnant. It was mid 2021. Um, we were still around the time of COVID peaks and um I thought actually maybe I'd have COVID because I just felt really tired, not very well. Um It could have also just been because of night shifts, but, um, went home, did a pregnancy test. Anyway. Um, and after telling Heather and my husband, the second person I told was my writer coordinator. So, um, it was, it was really because, um, he had gone to his Excel sheet and my equivalent was always to do a, have a, to do list. And, um, as part of that list, I kind of wanted to go through all the, all of the risks and think about what I need to tell roto coordinators and my manager and what I did still want to be doing while pregnant and operating and what I didn't. And so I looked into what those risks and hazards were. And so, um I did a lot of reading long work hours was one of them. I know that working less than 40 hours a week meant that you had um a reduced risk compared to working higher numbers of hours greater than 40 per week. Um meant that you were at a higher risk of having miscarriages, um preterm labor and low birth weight babies. Um Similar kind of risks for night shifts. We were in the peak of the COVID, the COVID pandemic. And so patient facing tasks were, was another thing I had to think about. And then all of the risks that come with operating. So infectious diseases, the aerosol generating procedures that we were a part of in theater iodine scrub would affect um my own thyroid, my baby's thyroid, um then of course, radiation And so I put up this slide for anyone who, who's not entirely clear on how much radiation goes to a baby, um or a fetus in uter. But the amount of radiation you get after wearing um a 0.25 millimeter single lead apron um during lumbar spinal surgery, for example. Um so 40% of that radiation um that go that reaches the abdomen of the mother goes on to the fetus. And so the number of procedures you can do um for lumbar spinal surgery is 23 before you reach the fetal exposure limit of one gray. Um And so it's a similar number for femoral nailing with distal locking. And then actually, you can do quite a lot of dynamic hip screws. So that's fine. That's 800. Yeah. Um but coming back again, cement, I'd read up actually, there aren't that many studies done on cement. Um But none of it was conclusive enough for me to feel safe cementing. Um So I would always try and tell people I wanted to step out while cement was happening just to reduce any risk of harm to the fetus. And then standing and heavy lifting again, had similar kind of risks associated it with um with long working hours and night shifts in that you had high risk of miscarriages and um preterm labor. So I think along the way, I discovered that I would have a lot of different symptoms. Um in my first trimester. I was sick a lot of the time. I was vomiting a lot of the time. And so, actually I found it really helpful to tell a lot of my seniors that I was pregnant. And, um, they were quite surprised that I was telling them very early. I think it was only six weeks in. And most people wait until they have had the first trimester. But I think just having the support and having people know that I was pregnant and why I was off sick so much was, was reassuring. And um actually, it was surprising um how many people would offer, whether I wanted to step out or whether there was any, any special precaution that I wanted to take and they were supportive of it. And so actually, that gave me a lot of peace of mind while I was around. Um just other things that I think were helpful was just trying to speak out when I wasn't feeling well. I think I would have been more, more worried to do that if people didn't know I was pregnant. So I had a lot of nose bleeds halfway through the procedures. And so there was a point where I was almost swallowing my own blood to like carry on doing something. But actually, I just thought this is not worth it and just tell someone and then just leave and come back when I sorted myself out. Um And one thing that I, uh, one piece of advice that was passed down to me from other people was, uh, wear Ted stockings in theater. And that really helped me because I never fainted thankfully. And that is just my, um, one piece of advice that I would always pass on to other people that need it. Um, but, uh, actually it was only, um, it's by speaking to other people that also gave me a lot more confidence and that's something else that I would advocate for. It was really surprising that before, um, CT two, I'd never met a mother in orthopedics before. And so I'd never really thought about how or when to have Children properly um via discussion with other people. It's only once I got a training number, I got into SC three and I went to a big training hospital where there were lots of other um mus in training and as uh orthopedic consultants that I could then feel comfortable having that kind of conversation with senior colleagues. Um, and trying to figure out what was best for me. And that's kind of what led to this part of my journey. Um So another piece of advice I would say is just keep having more than one risk assessment meeting because all of your symptoms are likely to change. Um And so the symptoms I was having before the tiredness, the vomiting, the nose bleeds, they sort of disappeared by the second trimester. And um that's when it sort of got a little bit more fun. I was still operating and having a good time. Um, got to see my baby kicking around a little bit on the ultrasound scan. Um, had a lovely baby shower organized for me as well. Um, and that, that was probably the peak of it all. Um, just something that I found useful was again, I go back to my to do list but having a pre maternity leave checklist. So I would tell my employer that um I would be going on maternity leave. You need to give them 15 weeks notice, um and give them a ma B one form and then arrange keeping in touch days, work out your eligibility for map pay and then uh one tip I give here is to or you may not, you may decide not to do this, but I actually just ended up spreading that map pay across 12 months. Um If I briefly just go through what map uh pay looks like. So it's all dependent on how much um work you've done for the trust as well as continuous service within the NHS. So you'd be eligible for statutory maternity or adoption pay and occupational maternity and adoption pay based on those two things. Um So if you've had in my trust, if you'd had 26 or more weeks, continue service within the trust um by uh 15 weeks before your due date or um and one year or more continuous service in the NHS. And then you were entitled to both types of maternity leave pay. And so you'd get, um, full pay for the first two months and then that went down to half pay for, um, the next, uh, 9 to 26 weeks. And so I decided if I just split all of that across the 12 months, it just meant it was more of a steady income. And so that's definitely something that helped me at the time. Um And so I do just briefly want to touch on the fact that that was probably the highlight, the second trimester, the third trimester, we entered the peak of COVID. And so I got a call from occupational health saying that you shouldn't be patient facing anymore. And so I decided, ok, that's fine. I'm just going to work from home as a surgeon, which basically means nothing. You just sit around and um well, I used it to, you know, finish up on any projects I had audits and things that I wanted to. Um I finished writing up and so I used it productively for myself, but it just meant that um I did sort of lose out on training. Then I was reaching a point where the lead gowns didn't fit me anymore. And so that was another reason why I would sometimes opt out of surgery. I didn't feel like I was safe enough to go in. Um feeling like I myself and the fetus weren't properly covered. Um, even though we had ordered those, um, way back in advance myself and another trainee were pregnant at the same time, but we just didn't get them until we'd had our babies. I never got mine. She got hers afterwards. Um, so there are a few disadvantages there and I think some forward planning, but also perhaps if I had pushed departments a little bit more for um protection, perhaps it would have turned out differently. Um So once I'd gone home, I started finishing up some of the um research and audit work I was doing, I didn't really want it to carry on over to after me having a baby. I had kind of gone from um almost school to where I was now constantly working and constantly trying to build my portfolio and working towards the next stage of my career. And I just really wanted the time to focus on something different and focus on family and maybe go to all of the things that I hadn't always committed to before like birthday parties, spending more time with my parents, my siblings. And so that was a really exciting time to be in for me. And that's why I didn't arrange any of the keeping in touch days either. Um I thought if when I come back to um work, I just try and catch up at that point. Um But towards the end of the last trimester I did develop gestational hypertension. I had the last trimester scan which showed that possibly the baby's heart had some defects. And so that was a very anxious time. And so I was going to have a plan C section anyway. Um but they had brought, decided they wanted to bring the date forward. And so they said we can give you the first of February 2022 or the third of February 2022. I was like, I can't miss this golden opportunity for my baby to be born on 2222. So I just, I did just tell them, oh, my husband might be a little bit busy on either side of the date. Could I just get that one? And they actually did fit me in? So that is his birthday now. Um So it was, I mean, the whole experience itself after that was, was great. Um It was a Cesarean section and I had um a ring light over my head where the outside of it was actually a mirror. So I had this surreal moment where I could see everything that was happening to me, which was great. And um also my husband almost fainted, which is always fun. So everyone was sort of a little bit more concerned about him than me. But it was, it was amazing seeing him come out from behind the blue curtain and that was just an amazing moment for both of us and, um, so we got to take him home and because it was a planned C section, people are always surprised that I managed to try and look this way, but I did get a blow dry and everything done the day before. So it's not like this wasn't completely your plan. Um, so that's my son, that's Rosa, that's my husband heather. Um, so some of the maternity benefits I want to go through, uh um that people don't often know about free prescriptions and dental care during pregnancy and a year after birth. And all of your annual leave and pension contributions are accrued. So you can just carry on um your maternity leave afterwards if you need it, using the annual leave that you have got saved and then you get lots of membership discounts because you are not making as much money anyway. But a lot of people choose to keep their GMC license while they are not in um practice. Uh especially if you are going to do keeping in touch days. So the GMC have said that if your income is um less than 34,000, then you can get a 50% discount. B ma also give you a discount and then Mr CS Bo A and Bota are free during that time, asset suspend your membership fees, um but still give you all of the benefits and then MP S also defer your membership. And so maternity leave, we got to do lots of traveling. I put in two little, um, pictures to show a huge change in the type of equipment I was using from surgical instruments to nappies. And, um, you know, there were lots of highs and lows. I think there was a point where, um, the first three months I think were always really difficult because you just don't sleep. Your baby is constantly crying and just needs you all the time. Um, and then it sort of felt like it was getting easier, but I think it's the tiredness. Um, and there was a point where I had only slept 10 hours in a week and, um, your eyes do need to close for a certain amount of time. And I learnt that because I'd had styes on both my eyes at the same time. So I could barely see for a few days, um, while I was looking after a small baby and that was a fun experience. Um, but also, you know, it has a, it has an impact on your relationships with, um, people in your family. Um, you realize how much you rely on your mom at this point and, um, how useless, um, your husband might be able to be. No, I am joking. He was absolutely amazing. But, um, there is a point because you are both so tired. I did have to read a book called, um How Not To hate your husband after having kids. So, um it was, I mean, he has been amazing throughout. He has been able to um really, um I've been able to see him in a completely new light. Looking after this precious bundle of joy who you can see is almost drowning in that picture because um I decided I wanted to try and um get him into swimming from very early on. So I took him from three months old and we did this underwater photoshoot when he was around six months and um I paid 200 lbs for it. And so the company called me and we were like, we are so sorry, your pictures turn out so bad. We will give you a full refund. And I was like, I actually thought they were cute, but that's fine. I will take the refund. That's ok. I don't mind. Um but got to do lots of traveling and, and I have never had a chance to be able to do so much traveling in such a short amount of time. Um And so really there was, there were so many different experiences as part of maternity leave that I wouldn't have been able to have otherwise. And so I am really grateful for that. Um So coming back to work again, lots of things to think about just as um just as was the case when looking into being pregnant and going on maternity leave. Um you'd need to give 28 days notice to return to work. Um, you need at least 16 weeks notice to health education England. If you are returning lesson full time, then you'd want to talk about whether or not you need any um, support for coming back. And that would include more supervision, less on calls. Um, and then you can also check your eligibility for childcare um because there are lots of different childcare options. Um, nursery, childminder family. Um, we, we ended up choosing a nursery because we didn't feel like we, well, we have seen a lot of nanny cam type programs and didn't really feel comfortable about it. And we thought if there was a nursery and that, um, you know, there were lots of other people there, then there would be some kind of accountability. Um, and then we have family but they, they are quite far away. So my mom is able to help when she can but not all the time. Um And so, you know, finding a nursery is very difficult, trying to fund a nursery is very difficult as well. Those are all some of the barriers we face. We put ST rather to nursery a month before I was due to go back to work, but he ended up taking three months to settle in. So I'd be at work. I was quite lucky that I went back to work at a tertiary place where we didn't have an A&E and I was very well supported. Um I would sometimes get calls, um, during an on call. But luckily it wasn't very busy and I could just tend to go and pick him up early from nurse room when they did call me because he was being very unsettled or not happy there. But luckily he was able to, um, settle in soon after that and it's been ok since then. Um, the other thing that's helped is being able to go less than full time. So I'm currently working 60% and that means, um, that I get lots of time with him still. Um, but also get a little bit of time to try and read around orthopedics because I hadn't done that during maternity leave, even though I kept thinking I would. Um, and actually going less than full time is probably easier than ever now because you can just, um, put down any well founded reason including wellbeing or personal choice on the application form. Now, it doesn't have to be for um caring responsibilities or anything else like that. One thing I would say is just check you're being paid correctly on the B MA website. Uh And it's under the title of less than full time pay explained and you still do get discounts if you're earning um below a certain amount and then you do get discounts anyway with Mr CS Bo A and Voter and I am going to leave you with this picture of him. Now, uh from the little bean you saw earlier to this little toddler now. Um, of course, he is in a Liverpool outfit because um that is the team that my husband supports and I don't support one. So it's the default, isn't it? Thank you so much. Thank you. Um Can you just explain how the maternity pay works if you have taken six month standalone jobs? So you worked February to August somewhere as, uh, you know, S ac grade and you applied for the next job, you're pregnant in this job, six months and then you move into another and you're taking and you're going to deliver in that next job. How does that work? So the way it would work is, um, you, you need to have had uh, one year's full service within the NHS anyway, for um, statutory maternity pay. So you're covered for that in that situation. It's just a question of who would be paying your, um, your occupational maternity pay. So, it depends on where you are at the point of 15 weeks before your due date. So that would determine which trust is paying on maternity leave, but either way you would get one. Um So you mentioned that you've gone less than full time, 60%. What is your experience of training at less than full time? Um Overall, it's been very positive um in that I get to do um, the same, probably the same or similar number of theater sessions as my full time colleagues, but maybe less clinics. And so a lot of my colleagues have also said, well, maybe I should go less than full time. And so I said, you're more than welcome. And I think it's very easy to now. The only problem with that is that, of course, it extends your training and then of course, you're not getting paid as much. And so it does have its own financial implications. Have you found things that I've had some other lesson, full time trainees talk about is maybe that the attitude of some of the other consultants might be that they're not around or they're not pulling their weight or they're asked to do more and have you found that you've been able to, some people say they're being paid at 60% but maybe working at 80. So have you encountered any of those things and any thoughts as to how other people can help counter that? Um So something I didn't mention, which I meant to was that when I first started, actually the first hospital I went to, I was very well supported. The second one I went to had never had a lesson full time trainee before. And so they held a meeting with me to try and figure out how things would work before I started there. And um they told me that I would have to sort to work around what their ro was rather than the other way round. I sort of left the meeting feeling a little bit pressured to change the way I organize my childcare. I spoke to a lot of my other less than full time colleagues. And then I happened to be at an R CS England event where I managed to speak to a few other um women in surgery forum members who then explained that actually you should just speak to your lesson, full time champion at work. And so I managed to cc them into the emails that I had with some of the clinical directors and the other consultants that I was in conversation with at this hospital. Um it seemed that as soon as IC C them in, suddenly the rota had magically appeared and was exactly 60% compliant. And um since then, it's been ok, I, I felt well supported and well accepted, but again, I don't really know what's being said about me behind closed doors. I'm, I'm sure that it, I'm sure that there are, um there are still consultants who don't agree with the framework or what's in place at the moment. But um I'm just going to say it is a big problem and the T pds and the support people need to get their heads around this because the department is left short staffed and you can't use the 40% salary to employ a locum of any quality. So until we sort of get that elephant out of the room, it's going to be very difficult because any department is effectively 40% of a person down when you are supposed to be training the others and providing a service commitment. And it seems to me it should be very easy really to get around it. If you just put your mind to it and sort stuff out, it's not beyond the wit of man, I think the wit woman. Right. So.