GPTQ Registrar Liaison Officer and mum Dr Lisa Fraser provides advice for registrars about pregnancy and breastfeeding. The change, responsibilities and the symptoms of pregnancy can make pregnancy a stressful time for women. GPTQ and its practices are committed to making registrars feel valued by enabling them to feel safe and supported in their pregnancies. More broadly, general practice is the specialty that embraces, celebrates and is committed to the highest level of workplace support as a reflection of the value it places on their doctors throughout all stages of life, celebrating diversity in the workplace, and also as it value-adds for our patients. GPTQ supports female GP registrars by providing written information, as in this resource and through its staff and policy documents, and advice and advocacy for all registrars. Immunisation Prior to pregnancy ensure your immunisation status is known and that your vaccinations are complete, including varicella, influenza, hepatitis A and B, and rubella. Baseline HIV and HCV serology should be done. Needle-stick injuries Take extra precautions to follow safe sharps disposal and correct surgical technique. Needle-stick injuries are a stressful event in pregnancy and are best avoided. If it occurs, follow your workplace instructions for immediate cleaning of the wound, and see your supervisor and your own GP immediately for initial management, counselling and serological testing, and consideration of HIV prophylaxis, as appropriate. Manual handling and physical tasks Towards the end of pregnancy tasks that require prolonged standing or surgical procedures (as for trigger vasovagal reactions) may become difficult to complete for some women due to presyncope, nausea or vasovagal episodes. Discuss this with your supervisor. There may be measures you can take to modify your environment (seating, room ventilation and temperature). Alternatively you may need to temporarily allocate certain procedures to other doctors. Exposure to diseases and chemicals Standard precautions should be used when carrying out procedures. This includes a mask for suspected cases of influenza, tuberculosis, measles and other droplet-spread diseases – firstly for the patient, and additionally for the doctor. If there are any other diseases you are potentially exposed to that may affect your pregnancy, please discuss with your supervisor. In a typical general practice chemical exposure is not a common risk. Mental health The changes in life and responsibilities, together with the natural physiology of pregnancy, increase the risk of anxiety and depression. If you feel overwhelmed or that you might be experiencing this, see your GP and see a psychologist; forget the stigma. This may be available through your RTO’s employee assistance program. Your treatment is confidential and breaking your confidentiality, for example to AHPRA, requires evidence of impairment and very rarely needs to occur. Getting help is the best way to be safe for you and your patients. If you are worried how it will affect your practice, health, financial situation or life insurance, research this in the first instance or discuss with your medical educator. Look for opportunities to talk to other medical women; consider joining the Queensland Society for Medial Women or local mothers’ groups to support you in your journey, which is unique for medical women, particularly those still in a training program. Not only do doctors experience more anxiety and depression than non-doctors, but female doctors experience higher rates of perinatal anxiety and depression than non-medical women, so make sure you know the signs in yourself and take some preventative action. There is stigma, even among the medical profession, which is inappropriate, historical, and trying to be made extinct at every opportunity. Prenatal leave Leave for medical appointments and investigations, and illness associated with pregnancy is category 1, provided a medical certificate is supplied. It is category 2 if there is no certificate. Sometimes specialists see patients later in the afternoon, evenings or on weekends but do not miss routine antenatal care due to concerns about work. Most people are able to negotiate this time away. Parental leave If you have completed 12 months of continuous service with an employer, the Fair Work Act entitles you to 12 months’ unpaid parental leave. In a hospital position, this may entitle you to return to your previous position. When the leave begins part-way through a contract, or extends beyond the limit of the contract, the position may not be assumed to continue beyond the contract end date. Requests for parental leave must be in writing and provided to your employer at least 10 weeks before the start date (unless that is not reasonably possible). It is helpful to notify your practice earlier to allow planning for managing the patient load including offering a position to another registrar, if the registrar feels safe doing this. Particularly in the first trimester it can be difficult to decide when to tell an employer as the risk of miscarriage is at its highest; however, nausea is often at its worst. Registrars are welcome to raise paid maternity leave when negotiating with an employer as part of their overall remuneration package; however, the employer is not obliged to agree to this. It is not commonly done. Centrelink have a paid parental leave scheme for up to 18 weeks to the primary carer; it is income-tested – see their website for details. Queensland Health will pay the full-time salary for three months of maternity leave or six months at half-time pay; discuss with line manager for details. Some corporate medical groups have paid leave arrangements. Training RACGP training policy Maternity (parental) leave is category 1 leave. You are entitled to take up to the normal duration of your fellowship in leave. Radiation May be an issue for rural or procedural GPs. Seek advice from your local GP, radiology specialist or public health unit. Returning to work Think about the childcare you will need. Consider all the options – family, nanny, long hours’ day care, family day care. Research them. Talk to your family and friends. If considering long hours’ day care, it is strongly recommended to book your child’s place as soon as they are born. You will need reliable care and a good supply of care for sick days as you will have significant numbers (up to 25 have been reported in studies) of these in the first 12 months if using a group-care environment. Consider whether you will breastfeed and how long you want to be at home with your baby. There is no right amount of time off, just the decision that is right for you. Balance the need for attachment, breastfeeding and learning the parenting role with your need to continue training, get out of the house and earn money. And remember, you can only start out with the best decision you can at the time. Experience and time often changes things, and that is the natural way in life, not a failure. You are entitled to change your mind and change your plans to suit you and your family. The minimum you can work is 10.5 hours over two days. Remember you can always increase your hours; consider starting with the minimum and increasing from there if you are doing okay. Breastfeeding There are policies in some health facilities around supporting women breastfeeding. Discuss with your manager how it will work. You will need time every three hours to express, a private place to do this, a clean sink (NOT in a toilet) to clean your equipment and a fridge for storing the milk. Interviews You are not obliged to tell an employer if you are planning a pregnancy in an interview, unless there are clearly specific health risks for the pregnancy. Other advice – thriving not just surviving The workload of a growing family is significant. Together with work and training it can feel like there is not much time to just ‘be’ with your baby, doing the slow, simple things. Work on the balance that is right for you and prioritise your time as a parent. Consider getting your groceries delivered, making purchases online, making double quantities of dinners, and paying for help managing the work of the house or minding children, particularly when the need for study in the three to six months prior to the exam presents itself.
