5th Trimester dilemma: "What if I can't leave work to take my baby to the doctor?"

Chicest infant accessory: Vaccine bandages!

Chicest infant accessory: Vaccine bandages!

See this adorable baby boy? His name is Biden, and those bandages on his delicious thighs are from his four-month vaccines—which his mom Teri, an attorney, got for him with no problem at all because she's still on her maternity leave. 

Teri knows she's lucky to have a longer leave than most U.S. women, and studies show that Biden's health will benefit: Babies whose mothers return to work before 12 weeks are less likely to have gotten all of their immunizations by 18 months old. Another international study showed that every additional month of paid leave can reduce infant mortality by 13%. Infant mortality, as in death.

I know I struggled logistically whenever I had to leave my desk job for the two-plus hours required for a well-baby checkup. And when my little guy was sick or in pain? I struggled emotionally, too. Still, at least I had the flexibility (barely) to make up the hours at night or ask a colleague to pinch hit for me. But what if, like so many moms, you couldn't lose a shift without losing rent money or your health insurance? 

I interviewed pediatrician Emily Spengler, M.D., who practices at Saint Barnabas Hospital in the Bronx, a federally qualified health center in an underserved area. She estimates that 25% of her appointments are for patients under six months old, and many of those parents struggle to make it in. "Generally, you do see a fall off," she says. "I'll see them for a first visit, then one month, maybe the two-month appointment, and then there's a fall off." So, what helps? I think her thoughtful, hard-earned advice is beneficial for all of us:

Choose a convenient practice: Location is important but pay special attention to the hours, too. "Make sure your doctor is available on the days when you are, and find out what kind of coverage the practice has for weekends and nights," says Dr. Spengler. "A lot of my patients will know that they have a specific day off each week. Others may find that their hours are less predictable, and they can certainly see a colleague of mine. But those first few appointments are pretty bonding. And switching can feel frustrating if that's not something they've planned for."

Don't space out vaccines: "There's no evidence for spacing out vaccines, and dragging them out over more appointments just increases the risk that you might miss one," says Dr. Spengler. And in fact, she notes, the first set of shots can be given as early as six weeks if you're returning to work and it's more convenient for you to accelerate the vaccination schedule (but do check with your own doctor about his/her preferences). This is huge info for anyone going back between weeks six and eight!

Schedule (way) ahead: Many practices will let you book all of your well visits for six months at a time. Might as well get them on the calendar so you can plan your work schedule (or backup caregiver) around them. Speaking of which...

Send in backup: "There's nothing wrong with sending a family member or babysitter in your place. That's preferable to missing the appointment," says Dr. Spengler, who also suggests that you can then call into the appointment to speak to the doctor directly.

Ask your doc to give you written notes: "That's a big push in medicine, to be more sensitive to various levels of health literacy and to communicate more clearly," says Dr. S. "So written information can help parents better understand instructions." That's especially helpful if you have a non-primary parent or caregiver attending the appointment in your stead.

Giving vaccines is our superpower, and most pediatricians will bend over backwards to make sure you’re getting them.

Don't be embarrassed: If you need to cancel or miss an appointment, don't let that be the start of a slippery slope of awkwardness that makes it even harder to come in the next time. "The last thing we want as pediatricians is for our patients to feel judged by us," says Dr. Spengler. "Many pediatricians are parents themselves and are very intimately aware of the struggles of making it to multiple appointments during what may be both the happiest and most stressful time of life."

Most of all, be open with your doctor: "It's always, always better to share more information about your struggles than not," says Dr. Spengler. "It makes it easier for your doctor to help, particularly in those early months. Giving vaccines is our superpower, and most pediatricians will bend over backwards to make sure you're getting them."



This is your baby's brain on money. (A stealthy, scientific case for paid parental leave.)

Debate the politics of paid leave all you want (I'll happily join in, as long as it's not at my Thanksgiving table), but hard scientific data? You can't argue with that. Meet one brilliant mom who's uncovering facts that could move the needle on major public policies for American parents.

Kim Noble, MD, PhD, is one of my working mom heroes. She’s mom to two (completely adorable) girls, ages 2 and 4. She’s also a pediatrician and a neuroscientist (see: all of those hard-earned letters after her name). But more than that, the work she does, studying poverty and early childhood development, has the potential to make massive change for families on a federal policy level...and to impact your own next parental leave. 

I asked Kim to fill us all in on her latest research at her Neurocognition, Early Experience, and Development (N.E.E.D.) Lab at Columbia University’s Teachers College. After a successful preliminary pilot, she and her collaborators are about 75% funded for an unprecedented national study that could provide the first-ever causal evidence of the impact of poverty reduction on babies’ and toddlers’ cognitive, emotional, and brain development—all by doing something really simple: giving brand-new moms a little extra cash. If all goes as planned, it will launch next summer.

Can you give me the layman’s—or maybe I should say laymom’s, sorry—description of your research?

We are recruiting 1,000 low-income moms nationally, in the hospitals when they give birth. Half will receive a large monthly income supplement ($333 a month), and half will receive a nominal amount ($20 a month), for the first three years of their children’s lives. They leave the hospital with a debit card that’s already activated, and then it’ll automatically reload monthly, and they can spend the money however they wish. We’re not shoehorning families into a specific kind of intervention. We’re giving the parents the money and making it unconditional.

Where are you recruiting?

We will be in four sites around the country: New York, New Orleans, Omaha, and Minneapolis, places with different costs of living but also different levels of social services. New York, for example, has a high cost of living and but the social services that moms qualify for tends to be pretty generous.

Dr. Noble with her own two girls, Lucy and Sophie

Dr. Noble with her own two girls, Lucy and Sophie

Do you imagine that the impact on kids will be due simply to the moms’ having more resources? Or is it more subtle than that? Perhaps they’ll be freed up to work less, have more time to bond and play?

You hit the nail on the head. We think that there are two main, measurable pathways through which the extra income is going to work: One is what we are calling the “investment pathway,” the idea that with more material resources, moms are going to be able to buy more books and toys, take more trips to the museum, afford better childcare and better housing in better neighborhoods. The other pathway is what we are calling the “reduced family stress pathway,” the idea that if moms are less worried about keeping the lights on or paying the rent, less in need of taking on that third job, that they’re going to be able to spend more time with their kids and be less stressed out when they’re doing it.

What does it mean for a new mom to worry just a bit less about money?

Well, we know that whenever someone is strained or stressed, they have less of what we call cognitive bandwidth, fewer mental resources to devote to everyday decision making. And that kind or strain can take the form of economic strain, or time strain.

How does that alleviating that strain impact the baby?

Moms are better able to manage the day-to-day pull of family life. Making sure they get their child to their well-baby checks or make that dentist appointment, better able to make family routines, reduce family chaos, which we know are all important for anchoring children’s development.

I wonder if some of the women in the trial might experience career growth during these three years.

It’s possible that their income will grow. It’s possible that it will simply stay steady instead of fluctuating. It’s also possible that the supplemental income will allow them to secure more career-building prospects, as opposed to patching together odd jobs.

What kind of leap can we make from your research to the potential impact of paid parental leave, if any?

That’s absolutely one of the things that we think there might be implications for in changing public policies. It was important to pick a dollar amount that could be feasibly informative to policy makers. The difference between those two amounts [$333/month vs. the control group of $20/month] is about equal to the earned income tax credit and other policy relevant social services that low-income moms may receive. If we know that increasing a mom’s income allows her to take more time away from the labor force shortly after having a baby and she’s therefore able to spend more time with that child in a warm and nurturing manner, we think that’s going to have cascading positive impacts on the children’s cognitive brain development.

I love that word, “cascading.”

It’s a waterfall effect. Once it starts, you can’t stop it.

And it adds up, it pools, into something that only grows. Kind of like the potential impact of your research.

We hope so. We really want to make a difference.

Want to learn more, or donate to this research? Email Kim at kgn2106@tc.columbia.edu.