Lizzie Wortley, Paediatric registrar

For Part One of this series, click here

I have learned a lot in my return to work recently, and I’m sure there’s still more to come. In the mean-time, here are some processes I learned through trial and error, and from following the advice of my predecessors – thank you!

There are lots of things to consider when going back to work, from logistics of childcare to what hours you want to work. Whatever stage you are at, have you thought about what you want your life to look like when you return to work? The answers to the following questions might change as time goes on.

Do you want to train at LTFT and have fewer on-calls and more days at home? Or do you want to be full time and complete your training more quickly? What child care can you have for long days, nights and weekends? Does your partner or potential child care regularly do the bedtime routine?

What appeals most; child care in your own home, or child care out of the home? Do you want your little one with lots of other children, or in a more one-to-one environment? What do other family members want?

Whilst the answers to these questions will affect what decisions you make about going back to work and how you do it, remember that you can always change your mind and adjust your training time and childcare arrangements as required.

PROFESSIONAL

Admin at home – get in touch with people and your paperwork updated

6-8 months before returning to work, confirm what job you are going back into with your local deanery.

2-6 months before returning: contact deanery to find out name and details of job share (if LTFT)

• Contact them
• Get to know them – could you both meet? Or call? Get a feel for each other and who has what commitments/when. Some commitments are NOT moveable for people.

3 months before returning, make sure your relevant paperwork is complete (LTFT application, DBS)

1-3 months before returning; contact the department and let them know you are returning from mat leave.

• Can you meet someone beforehand and get lay of the land?
• If you know department, can you have a catch up coffee?
• Can anyone mentor you through your first few weeks/months?
• Is there space to double-up a few shifts; would your job share (if lucky enough to have one) double up with you so you can work it out together?

Get out and about, back into work

Keep an eye out for your local PRACP course (paediatric return to acute clinic practice- called different things in different regions) and sign up. The London one involved simulations, discussions about worries, LTFT, balancing life and new guidance/keeping up to date. It was really useful to see you do know it, you just need practice and to meet other people in same situation. The pumping in a random room at lunchtime was also a new kind of bonding experience.

This also allows you to try out your emergency child care plans (partner, family, neighbours, etc – if you haven’t tried it before, here’s a full working day to do so!)

Try and meet your job share and/or supervisor before the job starts. If they know your face, they will be more invested in you before you are one of many in the mix

If you are going back to the same trust, can you do some KIT (keeping in touch days)? These are paid at full rate and you can have up to 10 of them.

At home reading and mental prep:

RCPCH has guidance on returning to work

These videos from BMA show interviews from parents about the realities of working and children

This includes the guidance from Academy of Medical Royal Colleges

And note their page on wellbeing – you are going to need a deflate valve at some point. These are now printed out in my office since reading up for this piece.

Ever been into mindfulness? Maybe now is the time to try. I try to do this every morning before work (try being the important word here), and definitely before a night shift to lower the adrenaline levels before arriving at handover. There are many great apps around – I use “headspace”

How do you currently feel about your career? Your local deanery may well provide free careers counselling for you. London provides 6 free sessions within a year of formal, professional careers coaching. Personally, I did this on maternity leave, and it was the best thing I could have done. All my questions about returning to work and anxieties were addressed, managed by myself and the coach and I returned to work full of enthusiasm for my career.

This is a great blog from Lucy-Jane Davis about being kind to yourself and accepting life is just different.

FAMILY

Childcare

As soon as dust has settled after the baby is born, look into your childcare arrangements. This blog on the BMA website gives good pros and cons of different forms of childcare.

If you are choosing a nursery:

• Ask to visit a few
• Do you like the ethos?
• Do you like how it feels?
• Is it practical? Timings of day? On your commute? Easy to get to pre/post nights? Can you see yourself bothering to trek there on days off post nights etc?
• Do friends recommend it? Flexibility is probably a major consideration for you.

Work out your ‘sick baby‘ contingency plan (often in a clinical job it can be hard to miss a day for child care) – what is your back-up? What is your back-ups back-up?

Put down deposit for nursery/ies you like. Let them know you’re a health professional and due to rotas etc, may not yet know days of week you need. (Fingers crossed they are sympathetic). Let them know as soon as you do!

As soon as you know days of week you will be doing – let them know. Advance planning really helps them.

If you go for a nanny – do you know about paying their national insurance etc?

• Nannytax is a website that takes you through employing a nanny and is a good place to start
• There are different tax arrangements if your nanny is Ofsted registered – but this costs them money.
• Put everything in writing – what happens if emergency and you run late? Will they cover nights for you? Will they do weekends? How much will you pay per hour for extra babysitting etc and weekends? If sleeping at your house when your away are they paid in hours or a set rate?
• Are they expected to do housework? Extra tasks to help with household management?

If family are helping out, do they feel they can say no? What will the arrangements be when they want to go on holiday, or just have a few days off? Do you feel comfortable having frank conversations and asking for things? Do they feel comfortable being frank with you?

What are your pre and post night arrangements? What are you going to do for zero days? As much as you want to see you darling child, there will be times when both mentally and physically you need down time. Please don’t feel guilty about using your child care arrangements even if you are home! Most places you will be paying for anyway, so make it work for you all. There is a lot to be said for consistency for your child – so if it’s a usual day to be at childcare, it is easier for them to settle if they go, rather than chopping and changing your on-call rota. However, this is a personal decision, and a little trial and error will help you work out what is best for your family.

For your relationship:

• Book in some babysitters in advance both before and once returned to work. You will need these evenings just to draw breath, let alone enjoy your time together.
• Is there something you are both interested in besides eating and TV/box sets? Could you investigate board games, puzzles, quizzes, arts and crafts, or even just an evening reading either together or separately-together. These activities can break the monotony of feeling you’re always stuck at home and give you both another outlet.
• It’s a good time to discuss your social lives, and what you both need. Partners can differ a lot in their social requirements. Introvert vs extrovert anyone?
• Often if still breastfeeding, a mother can feel resentful of doing all the bedtimes. How can you minimise this? How many nights out do you get a week? And do on-calls count if it limits your partners freedom?

This is a huge list of considerations and questions, as well as a massive to-do list for anyone going back to work. It can be overwhelming to approach. Printing it out, grabbing a pen, and writing stuff down can all help your formulate your plan of action.

Breast feeding:

This can continue whilst working. Legally all employers should provide you with an area to comfortable and privately pump breast milk. Your HR department should be able to help you with this. Practically, if you are lucky, you will be down to morning and evening feeds, which are usually manageable and may require the odd occasion of pumping. If your baby is still on regular feeds, then you can still continue to breast feed with planning and pumping & collecting milk.  This is a commitment that the RCPCH is dedicated to and is advocating parliament to ensure legislation supports working mothers to breast feed. Of course, you need to make the decisions that work best for your family, but technically it doesn’t have to be an either/or situation.

 If things don’t seem to be working out:

It can’t be ignored that this is a huge point of transition in your life, whether things appear to go smoothly or not. It’s an emotional, practical and logistical change (and challenge) that is most likely more than you have had to manage before.  Sometimes, unfortunately, it doesn’t go well.  Here’s some ideas if that’s the case. Please don’t go through this on your own.  It’s such a common life transition, and yet we don’t acknowledge or talk about it enough – lets change that now.  It’s often only by opening-up that we find out our colleagues and supervisors had similar problems and we’re all having days where we’re muddling through one way or the other.

There are times though, when it goes beyond a chat with friends. A good peer support network is great, but they can’t help you if you need more structured adjustments.   Reaching out is hard to do, but it usually gets a better response than you may anticipate.

At work

Who do you feel able to approach at work? Your supervisor, the college tutor or another friendly consultant who looks like they’d understand are all good starting points.

Your local school of paediatrics usually has information on finding help and support when needed.

The BMA has support for members, but also pages open to non-members struggling at work.

Your local careers service may be able to help you manage your new situation – see above.

The Practitioner Health Programme is an award winning NHS service for doctors to support them in stress and mental health conditions particularly, but not exclusively, impacting on their work.

At home

Reflecting on what it is about work or the situation that is difficult may help you differentiate between healthy stress returning to a new situation, and areas that need to change. Can your hours change? Does the childcare situation need to change? Do you need to have a frank discussion with your partner about work loads – it’s a change for everyone and the domestic status quo of maternity leave is unlikely to be able to continue.

Facebook has a number of groups that provide different levels of support, from the chatty peer networks (physician mums group UK; to more formally endorsed, but equally friendly LTFT trainees groups)

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Whilst I know this is not a panacea of all that should be considered or may occur during your time transitioning back to work, I hope it has provided you with some thinking points and works as a reference point to get your head in gear and provide you with some materials to help you during this time.

Good luck, I hope it works out, and I’ll see you on the shop-floor.

Thanks to everyone who gave me so much helpful advice and tips on returning to work. Some of this I have worked out for myself, found on digging around or been kindly pointed towards by friends, family and colleagues. None of this could I have done alone.

Dr Lizzie Wortley