Having children is the craziest, best and most stressful time of your life. Time warps once you have kids — one minute you are bringing them home and then seemingly seconds later they are off to kindergarten. Life becomes blurred as a series of moments strung together in your memory. This column addresses some of the struggles we face when adding work as an emergency physician into the delicate balance that is emerging motherhood.

Returning from maternity leave is often very bittersweet and is not without challenges. There are a million questions floating in your head; “Will I get paid during my time off?” “When should I return to work?” These questions pose logistical and emotional dilemmas that you are often trying to solve just days after you have had your baby. All of these questions lead to very personal decisions with no wrong answers.

Chances are your job has a parental leave policy of some sort. Depending on your institution and level of training, the specifics of this policy will vary greatly. The US lags behind ALL other developed countries in terms of length and support of maternity leave, in fact it is one of only 7 nations that requires ZERO paid days of maternity leave for new parents. If you have a minute watch this (http://www.aol.com/article/2014/10/29/maternity-leave-in-the-united-states-vs-the-rest-of-the-world/20985926/) it will really open your eyes.

Medical students, residents and attendings will all have different options for maternity leave. Academic institutions offer between 0 and 12 weeks of PAID maternity leave, although based on FMLA policies, you must be allowed to take up to 12 weeks UNPAID without penalty. Institutions often allow physicians to use vacation, sick time or accrued “banked” shifts in order to supplement paid leave. You can also use short term disability if you would like during this time. Speak to your boss early about maternity leave policies at your institution- an educated consumer is the best customer!

Deciding how long to take off after giving birth or adopting a child will depend on a variety of factors and no one prescription is going to be right for all mothers. Take some time to become familiar with your options to make the best decision for your personal situation. The right choice might even be different with each child. What might surprise you is a desire to stay home more once the baby is a reality which leads us to our next question…

Many institutions will have part-time options available to you if you ask. Most often, these options impact your clinical responsibilities as a reduction in required hours by a certain percentage. This will also have a direct effect on your finances since your salary will likely be reduced by roughly the same percentage. There will be a threshold percentage below which your benefits will be impacted that varies by institution. It is important to consider that there is not usually a reduction in non-clinical responsibilities or expectations. If you have good time management skills and can financially handle it, part time is a very good option to have more time at home.

If you choose to remain full time, you can try to negotiate your clinical schedule to maximize quality of time at home – switching to less desirable shifts (nights/weekends) may allow you some preference for a templated schedule. This allows an opportunity to develop a routine and might benefit your family lifestyle. If your institution pays a differential for those less desirable shifts, it might also be a way to reduce your clinical commitment by number of shifts without affecting your financial status.

Whether you decide to breast feed, use formula, or some combination of the two your child will need to eat while you are working. If you are using formula, you need to make sure to have enough bottles on hand and that your childcare provider understands your little one’s feeding schedule. Using a chart to track this for a bit before your return is a good way to establish the information that you’ll need to give to the babysitter and it is also a way that they can communicate back with you for how baby did while you were gone. If you are exclusively breastfeeding, it is a good idea to let someone give them a bottle occasionally before the first day back. Not only does this help them with the adjustment but it is a chance to give you a break to get a haircut or a manicure to make yourself feel better!

You will also need to become familiar with your pump if you plan to continue breastfeeding after your return. Most women have a love/hate relationship with their pump so ask around and do your research to pick the one that best suits your lifestyle and budget. Thanks to the Affordable Care Act, many insurance companies are now providing breast pumps free of charge but they may not cover all brands or models. A hands-free method of pumping is essential! There are many options including bras, DIY contraptions, or a relatively newer type of collection cup called Freemie that can be worn under your clothes.

The where and how you will pump during an ED shift is often solved on an institutional basis. The law requires workplace accommodations for breastfeeding and pumping, but these may not always be ideal during an ED shift. Talk to other women in your shop who have gone before you in this arena and they will share their secrets. Pumping in the car on the way to and from a shift may help to minimize the breaks needed during a shift. No matter how you get it done, remember that taking time to pump in a clean, personal environment is your right and you will be more relaxed for the rest of your shift if you know you have taken care of yourself and your baby.

Whatever you decide to do and whenever you return, you will likely face a flurry of different emotions on your first shift back. You are doing a great job! Remember to take care of yourself and enjoy this time – it truly goes too fast.

Remembering that maternity leave is transitional experience and the best way to feel good about your choices is to know your options. Be the educated consumer!

A version of this article was originally published in the AWAEM awareness newsletter January- February 2015