Most people expecting a baby look forward to painting the nursery, picking out a pram and beginning to wind down for a period of leave.
GP trainee Lynn Hryhorskyj and her husband, neurology registrar and BMA junior doctors committee co-chair Mike Kemp, had all of this to look forward to. But their journey turned out to be very different. Instead of sitting at home receiving guests and well wishes, Lynn and Mike found themselves separated from their daughter Edith, who was to spend the next three months on a neonatal unit 17 miles away.
Today, 17 November, marks World Prematurity Day.
While support is improving, their experience raises important questions about leave entitlements for parents of premature babies, and highlights the lack of provisions for senior doctors who don’t have access to enhanced shared parental leave.
Early arrival
‘I’d had a normal pregnancy and antenatal appointment the week before. I started feeling unwell that day, but I just thought I had bad indigestion,’ says Lynn. ‘But then, I felt jittery and flu-ish and the pain got worse.’
Mike, who had come home late while on call, says Lynn was being extremely stoic but by 1am they went to hospital.
‘My blood pressure was very high, and it soon became clear I was really unwell with severe pre-eclampsia complicated by HELLP syndrome,’ says Lynn. ‘The obstetric registrar was amazing, calm, upfront and caring at the same time. She explained that if my bloods came back abnormal, our baby would be born.’
On 16 August 2019, at just 28 weeks pregnant, Lynn gave birth to Edith by emergency C-section. She weighed 960 grams (2lb 1oz).
A nightmarish situation for many reasons, Mike and Lynn were faced with a number of difficult decisions. Lynn recalls: ‘As Mike’s two-week paternity leave was due to come to an end we were faced with some challenges. I couldn’t drive following my C-section, so how would I get to the neonatal unit each day? There was no roof on our house as we had major renovations underway – how was Mike going to coordinate that, visit and go to work?’
Mike says: ‘We needed each other a lot for support; the idea of going back to work and leaving Lynn to go to the unit each day was daunting. Thankfully my department leadership were very supportive, and they arranged additional leave so I could be there and support Lynn’s recovery.’
‘What people don’t realise is it’s not always the baby that’s sick – it’s the mum as well. It’s important for the partner to be there.’
Using enhanced shared parental leave
‘As junior doctors, we were really fortunate to have access to enhanced SPL [shared parental leave],’ explains Mike. ‘We knew more than most about it because of our involvement with the BMA.’ As fate would have it, Lynn had been heavily involved in the negotiations that secured enhanced SPL, and she became one of the first people to benefit from it.
Since 1 April 2019, junior doctors in England have been able to claim occupational pay when taking SPL at the same rate maternity and adoption leave is paid at. This enabled Mike and Lynn to both be off work – Lynn on maternity leave and Mike on SPL – after the birth and both receive occupational parental pay.
Enhanced SPL improves the statutory rates of shared parental pay and gives couples more choice on who takes leave and how it is taken after the birth or adoption of a child.
Support needed for parents of premature babies
Despite how lucky he feels to have been able to take enhanced SPL, Mike adds that in their particular situation, parents of premature babies shouldn’t have to use it, or maternity leave, for the period of neonatal hospital care.
It means they have significantly less leave and pay to take to care for their newborn at home than parents of full-term babies. The experience has led them to question why there isn’t an additional provision in place for parents of premature babies.
‘There’s an inequality if your child is premature as the mother goes on maternity leave straight away. You’re also going back to work when your child is younger. Most people plan for a pregnancy and think how they’re going to afford the costs of living. We had been expecting Lynn to still be at work but all of a sudden, her income dropped significantly to maternity pay.’
In the three months Edith was on the neonatal unit, they were only aware of two other dads who were there for the duration of their child’s stay on the unit. ‘It’s sad because not only does the mother need her partner’s support, but it’s important bonding time for the baby. There are studies showing that skin-to-skin contact with both parents is important for the baby’s cognitive development. If we know this, why aren’t we providing the right support?’
Improving access to enhanced SPL and closing the gender pay gap
Although enhanced SPL is a vital first step towards giving families more flexibility, enabling new fathers like Mike to take extended time off, Mike and Lynn are concerned that the benefit hasn’t been made available to senior doctors.
‘We’re not in a rush to have another child, so by the time we’re thinking about it, in theory we may have finished training – so I wouldn’t have access to enhanced SPL. It seems cruel to have this taken away,’ Mike says.
He is clear that without access to enhanced SPL he doesn’t know how they would have coped during their fraught and challenging experience. It has made him think about what would have happened had he been a consultant when Edith was born, as consultants do not currently have access to enhanced shared parental leave.
Until those provisions are in place, doctors are heavily reliant on the support and understanding of individual employers. ‘I was fortunate that my department was very supportive,’ says Mike. ‘I’ve now moved to LTFT [less than full-time] training, working 80% so we can have a day a week at home together.
‘Providing dads with flexibility to be at home with their children earlier helps break barriers; it gets us involved in childcare and stops it being a women-only issue. As a result, we may start to see the gender pay gap narrow as outdated attitudes shift.’
So, what now?
Mike has a draft motion to improve leave provisions for the parents of premature babies, which he hopes reaches the BMA annual representative meeting, the association’s policy-making body, in 2022.
‘We’re doctors and should be leading by example. Having these provisions not only sets the tone for the gender pay gap but it paves the way for the future.’
In its March 2020 budget, the Government promised to create an entitlement to neonatal leave and pay for employees whose babies spend an extended period of time in neonatal care, providing up to 12 weeks paid leave so parents do not have to choose between returning to work and taking care of their vulnerable newborn. However, due to the pandemic, these changes have yet to materialise.
The Government also plans to consult on the design of a new work entitlement for employees with unpaid caring responsibilities, such as for a family member of dependents.
Mike will be running the London Marathon in 2022 for Bliss, the charity for premature and sick babies. For more details you can follow him on Twitter: @mikejkemp
Lynn Hryhorskyj is a GP trainee and Mike Kemp is the BMA junior doctors committee co-chair. Edith is a healthy, mischievous two-year-old.