S5E18: Mothers in Medicine

Margaux: Who knows what day it actually is? Day in the life of a mom on maternity leave.

So, hey, everyone. Welcome to "Bundle of Hers." This is Margaux, and you probably haven't heard my voice in a while because if you follow our Instagram, you know that I had a baby back in January. I've been on parental leave since then and had to take a little break from "Bundle of Hers." Our other ladies have taken it to a whole new level and have been so amazing, so I hope you've been following.

But on today's episode, I wanted to bring in a special guest, Manpreet Kaur, who is Harjit's sister and also a doctor and had a baby as well. And we're going to talk about motherhood in medicine today.

Manpreet, welcome, and if you just want to introduce yourself.

Manpreet: Thank you, Margaux. I'm really excited to have this conversation with you today. So my name is Manpreet Kaur. I'm an internal medicine physician. I worked as a hospitalist. Currently working in outpatient medicine.

I had a baby. He's a year and a half now. So I'm really excited to talk about this topic. And I think it's very important, especially with women in medicine. It's an important conversation that is very applicable to a lot of women in medicine.

Margaux: It's so true. And in sort of navigating, becoming a mom and a parent, I came across this term called matrescence, which was coined by an anthropologist in the '70s named Dana Raphael. Basically, it's the idea that, like adolescence, matrescence is the changing and transformation into new identities of motherhood, and that includes the mental, emotional, and physical changes that are possibly just as awkward as puberty and when we were going through adolescence. But now we're doing it with a child and extra responsibilities. And having had these established identities, we're coming into a whole new identity.

And so that transformation, I feel like, definitely is still an ongoing process. And it was nice to have a term to describe all the chaos and the hectic feelings that I felt. But I wonder, does that term "matrescence" resonate for you at all? Or what do you think about it?

Manpreet: It absolutely does. I think that our bodies do go through a lot of changes and I think some of it, especially being in medicine, we think we would be prepared for. What I realized is my body went through so many changes in this whole process, not just after having a baby, but just even before having a baby and kind of the entire process.

There's a part of us that wants to be in full control of ourselves and our surroundings, and when that's not happening, it makes things that much harder. Not only our body but even our mind. It becomes the challenge in the process, right? Apart from learning to be a mom, apart from taking care of the kid and making sure that they're doing okay, is that part of it that you're constantly fighting, that "Why is my body doing this? Why is my mind doing this? Why am I responding this way?"

I mean, the other part of it was the community part of it. I think community, and especially in the world we live in today, has a different meaning. And Margaux and I both probably realize that our community or what community means when you're a mother is completely different.

Margaux: It's so different. I think, too, I realized after maybe the second week, or maybe right away when we brought Jordy home, is that taking care of a newborn and raising a baby really is not an individual thing, and you need people to help you. You need a community to help you. But like you were saying, the way our society is structured here and now is not set up to help where you can lean on those people.

And we were talking about this earlier where it's like you want people to help you, but I didn't always know what I needed help with or how to ask for that help, and people weren't always giving what I needed. And so sometimes it felt an extra burden to try to figure out what I needed and how I needed help or even getting the unsolicited advice.

Manpreet: Yeah. And I think part of that is a lot of us are really bad in asking for help and accepting help as well. Margaux and I have slightly different situations. At the time that I was pregnant and even when I had my baby [Dilsher 00:04:27], I was moving from Boston to Utah and was going to take up my job. My house was being built. So I decided it would be a good time to live with my parents just so I can get some extra help.

And I think that in my mind, I thought I had all the community I needed in place for me. And what I realized for myself is that I didn't know all the things I need to put into place for that community to work for me and to help me.

My mother didn't have . . . She had the 3 of us, but it had been over 30 years since she's been around children. And so I felt like, especially in the first week, which I think was probably the hardest week out of all of them, I had a lot of expectations of what I was going to be as a mother and all the things I need to do. My baby had his needs, and feeling for the first time in my life that I'm completely responsible for not even what they need or don't need. It's really just kind of survival, which is feeding, and sleeping, and changing their diaper, and all of that.

In the first week, I felt like I got a lot of advice and I just didn't feel like I got that much help. Part of it is it's new, everything is different, and so you don't know what to expect. You don't really know what you need.

And part of it is this also a judgment piece. Is everyone thinking I'm failing as a mother? It's Week 1. You worry about failure. And that's kind of the heaviest part of that first week, is just everything feels like, "I'm putting everything I've got and I'm still failing at it."

Margaux: I feel like I would have a victory on one day and feel like I finally was figuring it out, and then the next day it would be completely different and I'd have to figure out a whole new strategy for helping him go to sleep or feeding him or whatever it was.

And I think it comes back to what you were saying in how we're trained as physicians and in medicine to really look for answers and want to fix things and, for me, want a protocol to follow. That just doesn't exist, because there is no consistency when it comes to babies. So that really threw me for a loop.

Manpreet: I talked to my mother of how they were having children, and this goes back into communities. And so my mother had us all in India in a small village and they had kind of a doula situation. The woman that delivered the baby would stay with the mother and the child for an entire month and would help with bathing and feeding. They were the lactation consultant. They were the one that helped the mom and allow her time to sleep.

I just remember, especially in the first month, it comes back to this. I didn't need advice. I just needed help. I didn't know what I needed beforehand to get all the things done I needed to do.

The sense of community I think is important, and I think we live in a very independent society. It's not really one person. It's just our communities are not designed, I feel anyway, to raise a child as a community, and it right now is an individual responsibility.

Margaux: And I like what you're saying about the doula, the people in India, where it's just the expectation and that is how it is for everyone. There are these people who have this knowledge base and are there to be there for the new moms. Whereas here, like you were saying, our society isn't set up for that, or you have to have a certain amount of privilege or financial ability to have someone like that to help you.

I would say the knowledge base of helping women in the direct postpartum and then even in the couple of years after raising children is just not there. And it's like we're all having to learn or reinvent the wheel each time when we have a baby rather than having a collective of women who have the knowledge to help and it's just the expectation that they will be there for you.

Like you were saying, your mom hadn't been around babies for over 30 years, and that was the case with my mom too. And so it was kind of almost like relearning for her.

I think I had this expectation that she would just know and she would be there to help and do everything, and that wasn't the case, and that really surprised me. But I think it's because we don't, as society here, value the collection or the keeping of that knowledge. It's a hurdle that you jump through, you learn, and then you move on with your life is sort of the way that I feel like I should be doing it. But I think it's so powerful to hold on to this knowledge and this transformation.

I have some other friends that are having babies right now or in the next couple of months, and part of me just wants to be there for them, but I know that right now I don't have the capacity to do that. I want so much for them to have the support that I didn't have, and I don't know how to make that for them.

Manpreet: I think that kind of comes down to the whole community piece of it. We individually feel responsible. As an example, my older sister had her first child six months after I had mine. I tried to get her prepared for it. But I think sometimes, and this kind of goes into the whole advice piece, you think you can try to prepare someone for it and you just can't. I could give my sister all advice I want. It doesn't change the fact that she'll have to figure it out on her own.

And this kind of goes into even just the childcare and the help and the expense of all of it. It's not that you can't get help, but help is just expensive.

Margaux: Expensive.

Manpreet: And with family, it's just harder because they have their own lives and they have their own responsibilities and their own jobs.

Margaux: Right. And it's not set up for them to help us in the way that we need. One of the most valuable things for me in the first month was one of my best friends from college. She's had two babies, so they're toddlers now, so ahead of me. And she just booked a flight. She's like, "I'm coming. I know you're on leave. I know you're not doing anything and I'm going to help you."

She was the one that made me realize that I didn't know what I needed until she was there. Putting him to sleep and showing me how to get him on a nap schedule and take him for walks and feed him with a bottle. And she just was doing all these things sort of I guess in the way that I imagine these doulas in India may have been helping the mom. She was here for five days and that was probably the most relief I had felt since he was born.

And so I think that is what I would hope that other people can have, but like you were saying, it's not easy and we're not all trained or have the time or access to do it.

Manpreet: When we deliver a baby, it's not a half-hour deal.

Margaux: No.

Manpreet: You've gone through a week of significant transformations in your body, and then the baby comes and you don't get a break. Then that's when the real work begins, which kind of goes into the other part of motherhood, is the experience of breastfeeding, how our bodies change. And I think when we talk about what is natural, breastfeeding is a very natural process, but it doesn't feel very natural.

Margaux: And it doesn't always come natural.

Manpreet: It doesn't come naturally. It doesn't come instinctively. And especially now, breastfeeding is a big thing, even kind of something that in medicine we're really strongly trying to promote and encourage. We have lactation specialists, but even with that, it doesn't come easily, and the help and the teaching don't come easily and naturally.

Margaux: Like you mentioned earlier, you feel for the first time so responsible for this new, tiny human, and you are the one who's supposed to feed him with your body, but it's not coming naturally, and all the emotional feelings that come with that.

The feeling of failure for me, for sure, when at first he wasn't latching well and then my breasts were hurting, and you just worry that they're not getting enough food. It's like a whole new emotional realm of not feeling like your body can do what you need it to do.

Manpreet: I think it's this whole education piece of it as well, and that doesn't come easily. There are lactation specialists, but when you're not getting enough sleep, trying to figure this whole thing out, and then going to the lactation specialist, it becomes a hard piece.

A lot of mothers will say, "I can't do it," and they'll go to the formula. And I think there's a lot of shame around that as well for women that do choose that, and then people will say, "You just didn't try hard enough." And there's this whole kind of stigma around not breastfeeding now.

Margaux: Yeah. I think I understand so much more now why people choose to go to formula, because there were so many days when I was like, "I just want to give up and do formula. It would be so much easier and there's so much less stress."

And like you said, there's a lot of judgment and stigma because the American Academy of Pediatrics and the World Health Organization push that breast milk is best, and so that stigma prevails. But the reality is it should be whatever is least stressful for both you and baby. And as long as baby is fed, that's at the end of the day the best thing. They're eating and growing and both parties are happy.

That's just not the conversation that has happened. And unfortunately, so many moms, including myself, come home and cry and have that same experience that you were describing where you just feel like you should be able to do this thing and it's not working easily and it's not intuitive. It's so frustrating in addition to all the incredible changes that our bodies went through, and even continuing postpartum.

I know we talked a little bit earlier about how much swelling we both had and just all the edema and feeling heavy and sluggish directly postpartum, and how that also contributes to your mood, in addition to the sleep deprivation. It's just so many layers on top of each other that don't add up to set you up for success. And so we're just really fighting a huge wall, I felt like.

Manpreet: The part of it is the changes start right when you're pregnant, right? Your hormones are not doing what they used to do. Your body is not doing what it used to do. Your appetite is different. The food you like is different. Some of us get more sick than others.

Margaux: Yeah. And my body felt so foreign. I got a little bit used to it in pregnancy, but then right after, with all the swelling and the unpredictability of it, it just felt so foreign to me. I didn't feel like myself, but I was also sleep-deprived, and then my only focus was keeping this tiny human alive. And so I just became a shell, I think. That's how I describe it. I was just a shell of a human in that first month.

Manpreet: What do you think helped?

Margaux: Forcing myself to take time for a bath and knowing that the 10 minutes that I'm in the bath, he's going to be fine with my husband. He's not going to starve to death. And if he's crying, my husband can handle it. I just need this time for myself.

And that was one thing that my friend who came to visit forced me to do. She was like, "You need to go take a bath and close the door, put on your music, and don't even think about anything else but yourself."

And so getting into that cycle helped me reconnect to my body. And then going outside for walks, which I kind of avoided for a long time, that helped too.

Manpreet: It comes down to taking care of yourself, right? Whatever it may be. And so I think I'm doing a better job of it now than I did immediately after because I think initially I just felt like I had no time. I had no time to take care of anything for myself.

Just basic needs, right? Basic. Shower, eating food, and taking time to eat food. When you don't have kids, you take your meals for granted. But if you get 5 to 10 minutes of uninterrupted eating? I think there's a lot of guilt around self-care.

Margaux: The guilt is so real.

Manpreet: Especially as a full-time working physician, I feel . . . I'm away from him. Currently, it's about 40 hours a week, and I feel guilty for taking any more time away from him than that, but I'm learning that you do still need to take that time for yourself. So whether it's exercising, whether it's going for a massage, or getting your hair done, I think all of that, actually, helps you be a better parent. I think kids learn from what you do rather than what you say, so if you're taking care of yourself, they learn to take care of themselves as well.

Margaux: And something you said to me earlier that really resonated was when your kids see you happy, that helps their happiness. Like you were saying, taking the time to do the little things that make you happy then does transfer over to them, and it is in a way taking better care of them when you are taking time for yourself.

Even though the guilt will always, I feel like, be in the back of my head about leaving him or not doing enough or not hugging him long enough or snuggling or having to pump at work or whatever it is, as long as what we're doing he sees me as happy, I will try to keep that in my mind when I transition to going back to work.

I think now, almost three months postpartum, I'm able to absorb and let these concepts and thinking about how my actions and my happiness and wellness are affecting him. I can think about that now, but I would say in the first month, those baby blues were so real. And fortunately, I feel like I only had it for a month.

And even now, still, I will get periods where I feel pretty sad and tearful, but I think it's important that we just touch on postpartum blues and depression, because that's such a real thing for so many women.

Manpreet: I always think about that as well. I don't think I was full-on depressed at any point in time, but I felt things come in waves. There were days where I felt amazing and then there were days where I just don't feel good.

For me, I thought maybe a lot of that was probably hormonal and a lot of it is probably sleep as well. I think a lot of it was expectations, and not expectations others put, but rather just expectations I've had for myself of how I was going to be as a mother or all of those things. You know when you have an image of what you think it's going to be and it just shatters?

Margaux: Yeah.

Manpreet: And I feel like the first month, that's what it feels like. It feels like, "I'm going to do this, this, and this," and you're like, "No, you can't do any of that."

At some point, it becomes about survival. What can I do to just survive this? Do enough so that this kid . . . feed and all of that, and I can just function. There are nights where it's like 3:00 in the morning, the baby has been crying for two hours, and you're holding them and you're like, "What can I do to not lose it?" And there's a point where you're just like, "I can't do it."

Margaux: The thoughts.

Manpreet: There's that thought like, "What if I just can't do it?"

Margaux: Can I just leave? What if I just . . .

Manpreet: Can I just walk away?

Margaux: Yeah.

Manpreet: That's the scariest part.

Margaux: You're pushed to the brink.

Manpreet: You're just like at the last of it. You don't have any energy left. You don't have any mental energy left. You don't have any physical energy left. You don't have any emotional energy left, and the baby is still crying. If and when we do have another child, I wonder if I'd be going through that same thing. I don't know.

Margaux: Now when I think about having another kid, I'm like, "I just will not set expectations," and that will be my expectation. We're just going to go on this wild ride again and see what happens.

Manpreet: You think you have it under the belt and you think you've got a system down and the baby is like, "Nope."

Margaux: Yeah. And that's so hard being in medicine where we have a certain expectation of predictability and knowing if this, then that, or you prescribe this for that and it gets better. There's nothing, there's no prescription, there's no protocol, there's nothing for motherhood.

Manpreet: How do you feel being a resident or a doctor has helped or hurt you?

Margaux: Subconsciously, I thought as a pediatrician I would be prepared to take care of a newborn, and that was so wrong. There is nothing in our training that really helps you other than knowing when it is an emergency and to go to the hospital. And so that kind of really took me aback when Jordy was born and we got home and I really didn't have the tools that I thought I had had from my training in pediatrics.

And then the other thing is I feel like I know too much and I overanalyze everything. If he has a little cough, I'm like, "Oh, no. Is he getting RSV? Do I need to do this? Do I need to do that?" When really, he just coughed once. And so having that perspective of seeing really sick kids in the hospital makes me, I think, so much more anxious and over-worried, which is not always a good thing.

What about you?

Manpreet: I'm adult medicine, so I don't have that whole pediatric experience as you do, but I do think that I feel like a lot of my anxiety arises from his health. He's healthy. He's normal. He's growing well. But I find something and I tend to get really, really anxious about it because I'm thinking, "What's going on?"

I think there are some parts of it that are good and some part of it that's not from that medicine perspective. But I think that part of it is this whole wanting everything to go perfect and predictably. And I think nothing about babies is predictable.

We talked about milestones and our kids meeting the milestones and what we can do to contribute to that, right? And you were talking about tummy time and I was talking about how many words he knows. The reality is that with or without us, they're going to learn and they're going to grow, and most likely, they're going to be just fine.

I think there's so much pressure sometimes we put on ourselves as mothers that are physicians and we think our kids should be doing this and we should be doing this so that they can do this, when the reality is they're going to grow and they're going to turn out fine and they're going to learn what they're going to learn. And a lot of the things they learn, we don't actually actively teach them.

Margaux: Right. It's just their natural progression that we feel like we can intervene on, but it's not true.

Manpreet: Yeah. So now that you're coming towards the end of your maternity leave, what are your feelings about going back to work, and how's that transition?

Margaux: It's going to be so hard because I'm going from breastfeeding him pretty much every 2 hours during the day to going to work for 8 to 13 hours and having to pump and then coming home. I think about how little time I'll have, and that's going to be so hard I think. And the mom guilt just will be there for not . . . I'm not going to be there for him and I'm leaving him. I think that's going to be hard. And then trying to find the time to advocate to pump. I just have to set my foot down and do it as a resident when you have so many expectations.

One thing you were telling me earlier was that you do kind of get that time back for yourself.

Manpreet: Yeah.

Margaux: That was really helpful to hear.

Manpreet: I think, for me, even when I went back to work, I was really nervous about it. I was really, really worried and kind of missing Dilsher and all of that. But I think there's a part of it that I was almost relieved to go back to work because there's a part of your identity that you lose. You become a mother and you're just home taking care of a kid and you just don't feel like yourself.

For me, actually going to work was kind of getting some of my identity back that I felt I lost, right? It's just that concept of losing and having kind of that intellectual stimulation where you're talking to people, you're having conversations, you're doing what you have trained all this time to do. I was really happy to go back to work for that.

I feel like I'm a better mom because I do go to work. I feel like my kid sees a happier person because I do have that outlet.

I definitely still have the guilt when I leave him and he's like, "Mama," and he doesn't want me to go or he's hugging me. It makes it so hard to leave in the morning, but when I get back home and he's really excited to see me, it just makes up for that.

Margaux: That's really encouraging to hear, to have that perspective from the other side. So I really appreciate it.

I think we're getting towards the end of our episode, but this was such a wonderful conversation. I loved sort of reliving . . . I don't think I had taken too much time to reflect on these past three months, and so it was nice to reflect on this with you, Manpreet. Thank you.

Yeah, having this time to reflect I think was super helpful for me, and I really appreciate you coming on the episode. Is there anything else you want to say before we wrap up or any concluding thoughts?

Manpreet: Thank you for having me have this conversation. I think it's an important conversation for all of women in medicine to have because a lot of us, like I said, prepare for medical school and to be physicians. We think it's just going to come naturally. So I think it's great to have this conversation.

I think there are a lot of parts of having a baby I just felt like I had no idea. It's good to hear stories of other people kind of going through the same thing because sometimes it can feel like, "Oh, I had no clue what was going on."

Margaux: Yeah. And so isolating.

Manpreet: Isolating. Yeah.

Margaux: Thank you for joining. Thank you for tuning in to "Bundle of Hers." You can continue the conversation on Instagram @bundleofhers. And until next time, bye-bye.

It's been too long. How was that, Chloe? Do we need anything else at the end? I totally forgot what we do.