What is the Family and Medical Leave Act (FMLA) and How Can You Use It?

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As most of you already know,  the United States does not have a nationally mandated leave policy that covers time off.  Employers can have a wide variety of leave policies, some more generous than others.

Acknowledging this, in 1993 President Bill Clinton included the Family and Medical Leave Act (FMLA) in his agenda to support parents in the workforce.

FMLA covers pregnancy and birth, adoption, foster care placement, serious personal or family illness, and family military leave.

In order to be eligible for FMLA leave, an employee must have been at the business at least 12 months, and worked at least 1,250 hours over the past 12 months, and work at a location where the company employs 50 or more employees within 75 miles. FMLA covers both public- and private-sector employees,

FMLA-eligible employees can  take up  to 12 weeks of unpaid leave a year.

In general, your rights under FMLA are as follows:

  • the same group health insurance benefits, including employer contributions to premiums, that would exist if the employee were not on leave.
  • restoration to the same position upon return to work. If the same position is unavailable, the employer must provide the worker with a position that is substantially equal in pay, benefits, and responsibility.
  • protection of employee benefits while on leave. An employee is entitled to reinstatement of all benefits to which the employee was entitled before going on leave.
  • protection of the employee to not have their rights under the act interfered with or denied by an employer.
  • protection of the employee from retaliation by an employer for exercising rights under the act.
  • intermittent FMLA leave for his or her own serious health condition, or the serious health condition of a family member. This includes occasional leave for doctors’ appointments for a chronic condition, treatment (e.g., physical therapy, psychological counseling, chemotherapy), or temporary periods of incapacity (e.g., severe morning sickness, asthma attack).

However, if you are in the top 10% of earners at your place of employment, your employer may be able to claim that denying the employee their position is “necessary to prevent substantial and grievous economic injury to the operations of the employer.” 

Some states have expanded the FMLA coverage, extending the definition of a family member to include domestic partners, step-parents, grandparents, parents-in-law, among others. It’s worth it to check on your state to get specifics.

The Importance of Skin-to-Skin Contact

Commonly, after the birth of a newborn, the infant is put on her mother’s chest, called skin-to-skin, or kangaroo care. The baby is naked except for a  diaper, and put tummy down on the mother’s bare chest,  with the baby’s  head  turned to the side, neck straight and nose and mouth uncovered  A blanket covers the two of them.

This practice became very important in Brazil in the 1970s, when they had a very high rate of death of premature infants. However, the medical staff noticed infants who  were held by parents much of the day fared much better than their peers. It was the Brazilians who coined the phrase kangaroo care.

The practice has now become a common recommendation, for all babies, preterm or fullterm.

So how does it  benefit the babies?

Researchers have found that skin-to-skin contact:

  • normalizes the baby’s body temperature (in fact the mother’s temp rises to warm a cold baby and drops to cool an overwarm baby)
  • stabilizes the infant’s respiration and oxygenation
  • increases glucose levels, thus reducing the risk of hypoglycemia
  • regulates blood pressure
  • reduces stress hormones in mother and baby
  • decreases crying
  • encourages the baby into a quiet-alert state, which is optimal for successful feeding

And, for those of you who are breastfeeding, skin-to-skin contact has been shown to stimulate milk production in the  early days.  How?

Last post introduced the topic of the hormone oxytocin and the maternal

instinct (albeit the subject was worms but the same link between oxytocin and the maternal instinct exists in humans).

Oxytocin is also the hormone that stimulates milk let-down.  The baby sucking releases prolactin,  the hormone that regulates milk production. So skin-to-skin increases the release of oxytocin, the “love hormone”, both of which decrease stress, which encourages babies quiet-alert state,  which improves baby’s ability to breastfeed, which encourages the release of prolactin, which increases the mother’s milk supply.

Skin-to-skin contact with infants and fathers also produces many of the same benefits.

Just remember, whoever is holding the baby, skin-to-skin should be awake and make sure the baby’s head is turned to the side, with  the neck straight and nose and mouth uncovered.

In the middle of the night…

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My first child was born 22 years ago, when basic cable was really, really basic. It was January, and those were some long, cold nights nursing her in the middle of the night, while I struggled to stay awake.

TV was my friend. Specifically AMC (American Movie Classics). It was either that or half-hour long infomercials. It turns out that in January 1995 AMC was running a marathon of versions of Doc Holliday and the Shootout at the OK Corral.

The first one was entertaining, the second wasn’t bad (sort of a different take on the story) but by the third film it was all getting very old.

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New parents nowadays are in a much more enviable position. They have tons of options for middle-of-the-night binge watching while feeding or soothing baby. It’s an embarrassment of riches. How to choose?

I polled a handful of friends for suggestions. Only restriction — the shows should be soothing, or at least not disturbing. We want you to be able to get back to sleep ASAP. So Game of Thrones and Criminal Minds are not included in this list.

I’ve loosely categorized the shows to make this post easier to skim. As always with parenting, time is of the essence. This post would be way too long if I provided a summary for  each show so instead I’ve linked each one to Wikipedia.

Starting with my favorites: British shows.

British dramas are ideal for watching at any time, but especially appropriate for the wee hours of the morning. They are not action-packed, and have a slower pace than many American shows. Even the police procedurals are light on violence and noise.

The Crown

Doc Martin

The Bletchley Circle

Lark Rise to Candleford

The Night Manager

Foyle’s War

Agatha Raisin

Home Fires

Delicious

Pride and Prejudice (definitely make sure it’s the 6-part BBC version with Colin Firth. You won’t regret it)

The Great British Bake Off

Next, Australian shows:

Similar to British shows in that they tend to be less action-packed than American shows, but also delightfully likeable. Also, Australians seem like people you want  to be friends with.

Offspring

A Place to Call Home

Perennially fresh sit-coms:

There are some sit-coms that stand up to the test of time, are still funny and don’t even seem dated.

M*A*S*H*

Friends

Seinfeld

Gilmore Girls

The Office

30 Rock

Arrested Development

 

 

And more recent sit-coms:

 

 

 

 

Modern Family

Blackish

Parks and Recreation

Silicon Valley

Veep

Catastrophe

Odd Mom Out

Younger

Some really good dramas:

 

 

 

 

The NIght of

Friday Night Lights

Transparent

Mozart in the Jungle

The Americans

The Get Down

GLOW

Wolf Hall

And some difficult-to-categorize but really absorbing shows:

Shark Tank

The 1900 House

CNN Decades documentaries

My hope for all parents is undisturbed nights of rest. However, circumstances differ and many parents sometimes find themselves awake when it seems like no one else is. First of all, don’t despair — this too shall end. Second of all, you’re definitely not the only one awake — there are plenty of others in your temporary boat.

In the meantime, I hope some of  these shows will help the time go by.

 

Parenting as Grandparents

When I started this blog, I envisioned it as an informational, and sometimes entertaining, resource for young parents. What I didn’t think about was grandparents filling the job of parents.

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Grandparents serving as parents “is one of the fastest growing demographics in the world,” says Judy Kreag, a Licensed Parent Educator in Duluth, Minn. Kreag developed a course known as parenting again.

The current opioid crisis has sparked the rise in grandparents taking responsibility for grandchildren, though there are other situations, as well. In particula, Kreag has found that families touched by drug abuse have some special needs.

Often, the adult children have had their children taken away from them and the grandparents find themselves spending their money put aside for retirement on legal fees to get custody of their grandchildren.

“Courts are set up to try to get children back with their parents. They are not set up to give the children to the grandparents,” said Kreag. She knows of one couple who spend $30,000 to get legal custody of their grandchildren.

In addition, “the children are confused.” She spends a good part of the course

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discussing ways to talk to the grandchildren about why they’re not living with their parents.

Grandparents with adult children struggling with drug or alcohol abuse often feel guilt that their children have turned to drugs. “There’s a lot of shame involved and people don’t always want to air their problems,” says Kreag, who only has 3-5 couples sign up for the course each session, despite offering free dinner and childcare during the classtime.

Kreag says she recommends to her students they go to Nar Anon or Al Anon meetings where the literature discusses that you are not responsible for your adult children’s behavior.

Grandparents who are parenting also sometimes struggle to help with their grandchildren’s schoolwork, especially assignments that involve technology.

And, of course, an issue familiar to parents of every age, exhaustion. It can be very draining to parent at any age, but particularly at retirement age. Kreag says she stresses self-care.

To families who are looking for similar programs in their area, Kreag suggests checking with the public school district, county education programs, and religious organizations, such as churches and synagogues.

“Does everyone do this?”

Recently I read a very moving article in the New York Times  called “Maternal Instinct or OCD?”

Written by Kelly Kautz, it’s a piece that resonates in every  new parent’s mind — is my anxiety about parenthood “normal” or is this something more? Everyone checks to make sure their sleeping baby is still breathing, right? But do they check continuously throughout  the night, forgoing sleep themselves?

Eunice Pinney (American, 1770 – 1849 ), Mother and Child, c. 1815, pen and black ink and watercolor on wove paper, Gift of Edgar William and Bernice Chrysler Garbisch 1953.5.112

Everyone worries about the temperature of the bedroom, the level of air conditioning in the car, the sun glare on the baby, right? But how often? And does this anxiety make it impossible to enjoy being a parent?

Ms. Kautz vividly describes how becoming a new mother triggered a resurgence of the Obsessive Compulsive Disorder she had suffered as a teenager, which she thought she had firmly under control after working with a therapist on cognitive behavior therapy. She writes how she was operating in a fog of anxiety, checking on the baby obsessively, so concerned about her baby she wasn’t enjoying her baby.

But what resonated most with me was the comments section. Reader after reader described their struggles, wondering if others were similarly suffering. Then there were the readers who counseled the writer to relax, just stop worrying, enjoy your baby. (If only it were that easy!) Or those who asked what is wrong with erring on the side of safety when it comes to taking care of an infant.

What is clear throughout the comments is everybody is empathetic, but most are also unsure of when the line is crossed into the region of a mental disorder. Is it OCD, or maternal instincts? Post-partum depression or fleeting “baby blues”?

The truth is, advice from family, friends and neighbors, while always well-meaning, can sometimes send you astray. If your feelings or anxiety is troubling you, I urge you to seek professional advice.

If you  are already working with a mental  health professional, you should alert them to your pregnancy and continue to stay in touch throughout the pregnancy and post-birth. This is particularly important if you are taking medication. While pregnant or nursing,  every health professional you work with should be aware of every medication you are taking.  That includes vitamins, OTC medications, and herbal medications, as well as prescription meds.

(As I wrote in a previous post, many medications are deemed safe to  take while pregnant or breastfeeding, but it’s important to check them all with your obstetrician or midwife and pediatrician.)

If you are not yet working with someone, you can start with your obstetrician or midwife and ask for recommendations.  You can also work with your insurance company to find a mental health professional covered by your benefits.

In addition, national organizations usually have a resource list for you to find local  professionals.

For OCD, the International OCD Foundation has a very helpful resources page with tips for looking for therapists, programs, support groups and information.

Another useful resource is the Anxiety and Depression Association of America. 

It’s also relevant to note that anxiety on the part of new parents is by no means limited to mothers and partners should be alert to their own wellbeing, as well.

The most important thing to remember is there is no reason to be embarrassed or secretive about mental health issues. You wouldn’t want  to hide hypertension and just hope it  will get better, and neither should you try to ignore mental health concerns. Work as a team with your health providers and your partner to do the best for your family.

 

Sew This Easy Gift Bag for Toy Donations This Holiday Season

The winter holiday season is a difficult time for hospitalized children and their families. It can be a time fraught with stress and anxiety and disappointment in not having everyone healthy and  at home.

Knowing this, many organizations gather gifts for the hospitalized children, to help bring joy to  the season.

My friend, Laurie, and the others  who work at the same quilt shop designate a 2-hour period and sew as many of these simple gift bags as possible.  They give them to Children’s Hospital for the staff  to hand out gifts. I timed Laurie to make sure this was as simple as it seemed. Laurie is an expert sewer but the sewing requirements are very rudimentary. She finished from beginning to end in 35 minutes with plenty of time to chat while working.

I also took photos of  each step and  will lead you through step by  step. You will want to have access to a sewing machine for this project.

 

First off, choose colorful fabric. You need a yard for each bag. Do not remove the selvedge. I chose Christmasy fabric, but one thing is certain, you  will find fabric you love at any quilting or fabric store. Buy a wheel of grosgrain ribbon for the drawstring.

Turn under the top edge 1/2 inch and press. Also do the same down a few inches on each side.

Then turn the top under another 1-1.5 inches and press. This  will be the tunnel for the drawstring. Stitch across close to the folded edge to make the tunnel. Backstitch a little at the beginning and the end.

Fold the fabric in half, right sides together. Stitch the bottom together 1/2 inch from the bottom. Then sew up the side, encasing the selvedge if you have it.

Turn the bag right side out and cut 2 yards of the  ribbon.

Use a drawstring threader or large safety pin  to run the ribbon through the tunnel. Knot the ends  of the ribbon.

And, voilà, gift bag finished!

 

Returning to Work

For many new parents, the return to work after the birth of your baby can elicit anxiety and stress. There are so many decisions to make, childcare situations to consider, and schedules to keep, and through it all you  want to be able to enjoy both work and family life.

As a lactation consultant in a hospital setting, I usually dispensed a few pieces of advice to every family. The one I usually stressed was the introduction of the bottle. When breastfeeding is going well, often parents want to delay introduction of the bottle as long as possible. While I love that idea, the fact remains that babies who breastfeed well, love breastfeeding, sometimes to the exclusion of anything else. That makes the return to work even tougher than it has to be.

I remember, with my first baby, who only took enough from the bottle so as not to starve, I would have my mother bring my disconsolate baby to the train station, where I would nurse her in the car to finally calm her down. Needless to say, this was stressful for me, my baby AND my mother!

I usually advise, if you know your baby will need to  take a bottle,, don’t wait longer than 2-3 weeks to introduce a  bottle. (I used to say 4-6 weeks, but sometimes even that can be long enough for a baby to resist the bottle, so I’ve shortened the time frame.) Usually one bottle a day is enough to keep the baby in the habit of taking a bottle, while still mainly breastfeeding, until it’s time go back to work. This is also a nice opportunity for dads to help with feedings!

Which brings me to my second point… if you’re planning to pump while at work, a fast, quiet, efficient and effective double electric pump is crucial. In my earlier post on  the Affordable Care Act (ACA), I detailed the current benefits accorded to post-partum mothers, which include a pump.

Medela Symphony hospital-grade pump with attachments

Some mothers get advice from other mothers that they should rent a hospital-grade pump, either Medela or Ameda, because that is the strongest, best pump on the market. And they are the best! However, that does not mean you need the best. For many people, a Honda Accord is perfectly serviceable for their needs; they don’t need a BMW.

The downside is hospital-grade pumps are expensive, usually about $50-75 a month to rent and prohibitively expensive to own for a single user, and often not covered by insurance unless your insurance company deems it medically necessary. They are also very heavy, held in a hard plastic case, and not really designed for transporting back and forth every day.

I usually recommend, unless you have a low milk supply or a history of low milk supply, your baby is not gaining well or you are supplementing with formula, or your baby was premature or spent some time in the NICU, start with your ACA pump and see how that works for you. If not, you can always buy a better pump or rent a hospital grade pump here or here.

A side note, if you find the milk expressed by your pump is not as much as expected and/or it is painful to pump, you should check in with a lactation

An Ameda standard flange

consultant to see if the flanges fit correctly. You can find a nearby lactation consultant here.

In terms of retail pumps to purchase, generally speaking Medela, Ameda and Spectra are very well-received. These are also called single-user pumps because they are designed for one mother only. Read reviews before purchasing, but remember, for frequent pumping, you definitely want to have a double electric pump.

One thing to mention, hospital-grade, or rental, pumps have a barrier against cross-contamination and designed to be used by more than one person. It should be wiped down thoroughly after each use, and each user needs her own set of tubing, bottles, flanges and connecting parts. These cannot be shared.

Some breastfeeding-friendly businesses purchase one or two hospital grade pumps for a lactation room for all pumping mothers in the company to use. They just need to have their own pumping attachments to use with it. Maybe you can persuade your company to invest in a hospital-grade pump!

Here are a few other resources that you might find helpful:

  • Lawyer and mother Lori Mihalich-Levin has a website called Mindful Return, where you can find a blog and e-courses about returning to work after childbirth.
  • Idealistmom.com has a good checklist to follow, especially useful for mothers who are choosing to continue breastfeeding after returning to work.
  • Parents magazine
  • What to Expect