By Matthew Loftus
I became a family doctor because I love taking care of families. I did my residency just outside of Baltimore, where I saw a diverse group of patients: African-American families from East Baltimore, Southeastern Baltimore County residents whose grandparents had emigrated from Appalachia to work at the steel mills near the port before they shut down in the 1990’s, and folks from the surrounding suburbs of Baltimore of all ages and classes. Whether they had Medicaid or private insurance, most were working at least part-time and all were having so many babies our clinic had a hard time booking appointments for all of the regular check-ups.
One of my favorite parts of being a family doctor is taking care of mothers throughout their pregnancy, delivering their babies, and then getting to take care of their babies as my patients. The 6-week checkup was often a fun one -- at this point, my newest patient has started to smile and coo. But, it is also usually the time for another, less encouraging conversation about breastfeeding.
The American Academy of Pediatrics recommends exclusively breastfeeding babies for the first six months of life and then continuing to breastfeed until at least one year after solid foods are added. The direct health benefits of exclusive breastfeeding are minimal at best, but the experience fosters closeness and connection. When counseling new mothers about breastfeeding, many of the moms I saw were motivated by its convenience, cost savings on baby formula, as well as the intense intimacy and ability to comfort an upset baby. For many mothers, breastfeeding is one important way they bond with their baby. However, at the 6-week checkup many mothers - who previously wanted to breastfeed - share how hard it is to do so after returning to work.
What has continued to bother me since my residency about these conversations is not so much the breastfeeding, per se. What is more troubling is the fact that these mothers want that unique connection with their child - a good, natural desire - but their work comes between them and their infant after just a few weeks. The decisive factor for these moms was not their own comfort or what they think is best for their child; it was the demands of their workplace that dictated their decisions.
Because I cared for many of these mothers throughout their pregnancy, I knew most had pushed to keep working as long as their bodies could bear. Other things I saw were just as troubling: mothers going back to work when they were still sore from their cesarean or vaginal delivery, mothers who couldn’t get the time off to bring their children in for check-ups, and mothers who did come to appointments, but due to their nonstandard hours, had to check with the child’s child care provider to answer questions about their child’s growth and development. Among the low-income patients I took care of, I saw in all of them a sense of resignation to the inevitable frustration at having to spend more time at work and less time with their children than they wanted.
These unhealthy work-family dynamics impacted many of the patients I saw, not just new parents. I had patients who needed to take care of themselves and patients who were caregivers, but struggled to get the time off of work to attend appointments at our clinic. Even if they could take time off to care for a sick loved one or see me to follow up on their respiratory infection, oftentimes that time off would be unpaid. My patients were sacrificing income in order to get or stay healthy.
From my time as a family doctor in Baltimore I saw first hand that it takes time to be a mother or father -- or any faithful family member. There are seasons of life and unexpected moments when our obligations to kin require more of our time than others, such as when there is a new child in the family. Paid family leave is one provision that would allow more families to honor their God-given role in caring for members and - especially in the case of childbirth and bonding with a new child - forge familial bonds that will continue after retirement. We can hope that each individual business and employer will come to these important conclusions about honoring their workers on their own, but the bonds within families are too important to leave up to chance. Not only that, but workers with the least power and freedom to negotiate for the time they need - such as some of the patients I saw during my residency in Baltimore - are those whose families are most vulnerable and access to workplace benefits is most restricted.
The vicissitudes of human life are not always conducive to what our society has deemed as the ideal worker. Pregnancy, childbirth, raising children, and taking care of family members who fall ill and age will naturally require time to care; a worldview that perceives these interruptions as hostile intrusions into productivity considers human beings created in the image of God as nothing more than machines. Family care, albeit sometimes unpredictable, is integral to what it means to be created in the image of God. It does not matter if the worker is stationed at a cash register or in an operating room -- in either case, the worker in question is still a human being with a frail, created body and a family. When we treat workers like machines rather than persons embedded in relationships, we demean their created personhood and dishonor their Creator.
Matthew Loftus is a family doctor who teaches and practices in Baltimore and East Africa. You can learn more about his work and writing at www.MatthewAndMaggie.org
Do you have a story to tell?
Stories are important: they can direct research, inform policy, and create community. If something in Matthew’s story resonated with you, we want to know. Your story will not be shared, but a member of the Time to Care team will reach out to start a conversation.