Pregnancy and Maternity Leave in Private Practice: EVERYTHING You Need to Know

Yesterday I had to cancel two clients because I couldn’t stop puking. How’s that for an intro?! And by yesterday, I mean the day I wrote this… I’m going to hold on to it until it’s time to tell you guys that I’m pregnant. I didn’t have this problem when I was pregnant with my daughter or with the pregnancies we lost. It didn’t occur to me that I’d have to cancel on anyone because I’m very rarely sick and I basically have to be told to take time off by my husband for it to even occur to me. I know, I know, there’s a self-care issue there. Workin’ on it. So as I was negotiating whether or not I could stash a bright blue emesis bag, unseen, beside me it landed that it’s not a great idea to throw up in front of any client, but especially not two women struggling with eating disorders. I thought, “Man, I didn’t see this coming” and this blog post was born (har har). So hi! Big announcement! I’m pregnant! I’m due a little after the next round of Practice-Building Groups end, lucky timing there. Because I’ll be on maternity leave, the next round of Groups won’t be for another year. While I know those of you reading this are glad for me, as a survivor of multiple miscarriages and having had many friends struggle with fertility, I want to acknowledge that for some it’s a kick in the gut. Another damn pregnant woman. For you guys, I get it and please feel free to stop reading after this paragraph. After this blog post I don’t plan to prattle on about pregnancy, partly because no one cares that I’m a huge ball of gas right now but also because some of you who have struggled want information from me and you don’t want to fight tears while you get it. I know this won’t apply to many of you, but I want to provide resources to those for whom it is or will be relevant. And this post is going to be loooooooong so that people aren’t inundated with Pregnancy Parts 2, 3, & 4. Just one monster post. Right now I have two women in practice-building groups who are pregnant and one who gave birth in between groups 1 and 2. I’ve had supervisees go through pregnancy and maternity leave while in private practice and I’ve done it as well. I’ve had friends in these situations, too. Many of us are starting practices and families at the same time and so many people feel like they have to choose. I want to offer a both/and perspective. I also want to give you a framework and the releases I used for each step (make sure to run it by your attorney before using these).

Case Studies

Me I’ll start with me. So Joel and I thought I would be a very long road to getting pregnant with our first because most of our friends were having fertility issues. Not that it’s contagious, but in our mid-30’s we were well acquainted with lots of 30-something acronyms like IUI, IVF, TTC, TWW. We got pregnant much faster than expected and after calculating the due date realized that Joel would still be in school when I delivered. As in, still not making a dime and still paying tuition and still needing time off after school to study for Boards and then taking said Boards and then getting a job. So yeah, no income on his end until the baby was 5 or 6 months old. And it’s not like I had paid maternity leave. Luckily I had an established practice and was making great money so I hoarded saved more than enough for us to live on for 3 months. I needed to have a lot of money saved to feel safe. Like a stupid amount. I want to blame the hormones, but it was more about my relationship with money at the time. So we lived super-simply and I socked it away. I would never have been able to save like that with an agency job. Not even close. I actually saved more than my highest agency job paid. I’d also never worked at an agency that offered paid maternity leave; you could just live off of whatever PTO you had left after your prenatal appointments ate a bunch up. (resisting soapbox resisting soapbox resisting soapbox resisting soapbox resisting soapbox resisting soapbox) So I saved like crazy and it totally worked out. We didn’t suffer while I saved thanks to private practice. I also increased my caseload, which sounds stupid to me now while I’m pukey, but it worked out for us. If you have the energy to see a few more clients a week, go for it. If you don’t have the energy, remember that stress isn’t worth more money. I had 3 months of maternity leave, which was the perfect amount of time for me, and was full again 2 weeks later. I worked 3 days a week, saw 8 clients a day with two 30 minute breaks to pump or nurse. It worked for me then. I’ll do it differently this time. I’ll go through the particulars in a few (consents, telling clients, timelines), but I want to give you some other case studies so you know “you can do eeet" (channeling a little Rob Schneider there, I apologize). Allison Let’s talk about my friend, Allison. No, this isn’t one of those times where I say “my friend wants to know…” and am talking about myself. My friend, Allison, she’s a real person. When I mention bullying someone into private practice, it’s Allison I’m talking about. She was at an agency job, working really hard with a tough population for little money over many hours. She was my best buddy in Seattle and I wanted her to have a better, less stressful life. Allison struggled with fertility. She and her husband had been trying for a while. She was putting off private practice until she could have a baby. You know, benefits, security, etc. After feeling like her career was on hold for so long and being bullied pretty consistently, she and her husband decided it was time. She finally quit her agency job, and on the last week of work, she found out she was pregnant. She didn’t have many clients yet. Then her husband got laid off. Guess who felt like a world class a-hole for bullying her into private practice? Well, that didn’t last long because Allison got to work. She made it happen. She networked her buns off. She is crazy good at what she does so her reputation helped her build as her private practice clients referred friends and loved ones. She really rocked it. And while she didn’t yet have a six figure salary to draw savings from like I did, she made enough in the 9ish months she was pregnant to take 5 weeks off comfortably. It wasn’t her ideal, but it definitely compared to the 6 week maternity leave norm I was used to in my old agency jobs. Then she built up and rocked it post-maternity leave. Allison Part 2 And now I get to use Allison as a case study again (the other one, not me). Allison and her awesome family recently moved to Asheville from Seattle when she was 20 weeks pregnant. She had been here less than a month and already has eight local clients and retained several clients in Seattle that she does online therapy with. Her husband is an awesome stay-at-home dad to their daughter and she is able to support all of them already. Now, Allison specializes in fertility counseling and grief and she isn't marketing her fertility niche right now because she’s pregnant and obviously that would make it harder for the client. So even without her primary niche, she’s kicking ass. Seriously, she built faster than me. The power of networking and niches, my friends. Neither of Allison’s pregnancies were “well timed” with private practice and yet everything worked out beautifully because she was willing to do what works. She hustled, don’t get me wrong, it was a LOT of doing what works. Kelly With her second child, my friend Kelly realized that as her maternity leave approached, her clients were making significant progress. I remember reading a study about the benefits of time-limited counseling, so this makes sense. I know I should look it up for you, but this post is long enough. As a result, some of her clients graduated from therapy around the time she took maternity leave. She transferred the clients that she knew needed more consistent care with the knowledge that some would return and some would not. Then she came up with a really unusual and pretty brilliant plan. She took her first month away from her practice. In her second month of maternity leave she worked one day every other week. Her third and final month of maternity leave she saw clients one day per week. Some of her clients didn’t see her until her maternity leave was over. For those she saw on her one day a week, this was a good way to keep the relationship and progress going with the clients for whom once a month-ish was appropriate. She says she could have taken all three months off without having to totally rebuild, but this worked for her and is a pretty cool way to stay in the therapy game. I’m also guessing it was nice to have adult conversations.

Nuts & bolts of how and when to tell clients, paperwork, procedures, etc.

I told my clients at about 12 weeks. I basically had to because my body was very clearly pregnant looking. I work with clients with eating disorders. They know how my body looks more than I know how my body looks; it’s often a part of the disorder. Waiting until you’re past the most high risk times for miscarriage is probably best. Around that 12 week mark is kind of the go-to for announcements in general. Making sure you give at least two month’s notice so your client can prepare for your departure is probably helpful as well. If you’re obviously crazy pregnant looking at that point, don’t just let that elephant hang out in the room, tell your clients. Another thing to consider is how long- or short-term your typical clients are. Mine are pretty long-term. I wanted to give them plenty of time to process what my absence would mean, get them comfortable with a transition plan, and if possible finish up any work before my leave. So, I told my clients early on. I had them sign a limited Releases of Information for my aforementioned friend, Allison, in case I went into a quick dramatic labor before my official maternity leave started. I wrote an email for Allison to send them, provided the contact info my clients preferred, and gave her access to my schedule (which wasn’t linked to my records) so she would know who to get in touch with first. Maternity ROI Short, Sweet Maternity Email from Other Clinician   I wrote an email as well because if I did go into labor before my official maternity leave, I knew it was likely that I could at least send an email. I had a separate document with everyone’s email addresses so I could BCC them. I considered putting it on the bottom of the document my email was on, but decided not to just in case I accidentally hit send, like a contraction made me or something. I'm in Labor Email   Returning from Maternity Leave Email I stopped taking new clients somewhere around the 6 month mark. I told every potential client who inquired that I was pregnant from 12 weeks on. Many people expect therapy to be a short process so if a slot opened up and a potential client was ok with me leaving for 3 months, I would take him/her on. I mentioned referrals in my paperwork, so let’s talk about that. I got my caseload and I got my handy dandy networking spreadsheet and I played polyamorous matchmaker. I found 3 clinicians for each client. I begged a couple clinicians to make room for specific clients because I knew that was who they needed to go to. Many of my clients were in a place that they weren’t going to need therapy while I was gone, but I gave them referrals anyway since a lot can happen in 3 months. I was very clear and consistent with the message to both my clients and these clinicians that if the fit was good between them and the client preferred to stay with them, I was totally fine with that. I told my clients that I wouldn’t take it personally and that I would actually be proud of them for not sacrificing their well-being by trying to save my feelings. I meant it, too. Two clients chose to stay with the clinicians I referred them to and I was grateful that they were doing great work with clinician I knew were awesome. Abundance, baby.

Clinical and Emotional Issues

As I stated with my colorful opening, I had to cancel clients because of nausea. It’s really important to me that I don’t lie to my clients. I didn’t say I had a stomach bug, I said I had been vomiting. Or maybe I said “pukey,” because I talk to my clients the way I talk as a person, not a clinician robot. Regardless, I made sure to be honest without revealing my pregnancy. After writing this and it sitting in my “to publish” folder I also had the unfortunate experience of having to run out of a session to throw up. I could tell it was coming and she was talking about some pretty important stuff. When she took a breath I said, “I’m so sorry to interrupt you, but I’m pregnant and I’m vomiting a lot and I can tell I’m going to have to run out of this session at some point. It’s not really time to tell anyone yet, but I don’t want to run out unexplained.” I was honestly in denial that this would happen to me, so I didn’t follow my own advice of having a plan for what to say. For better or worse, this is all I could muster while fighting waves of nausea. And then I ran out a few minutes later. I returned, assured her that I was okay, and got back to business. So, boom, my first client disclosure this pregnancy and I botched it. And it’s also fine. At least I made it to the bathroom. And if I’m being realistic, it’s probably going to happen again. Back in 2013, when I told my clients I got lots of “Congratulations!” but also, “Oh thank God, I thought you were getting fat!” (go easy on them, my clients have body issues) and “Oh, THAT explains your recent scarf obsession” and a big, emotional “What about me? What’s going to happen to me?” So be prepared with an answer to that. It’s a reasonable question. Some people just needed to talk about it once. The “What about me” client wanted to talk about it every session until I went into labor. She also wanted to process resenting my baby. I’ll be honest, that was hard and we did a lot of ongoing boundary work. And checking in about whether it’s an avoidance of what really needs to be discussed in session. Be ready for reactions like this, just in case. Have a plan for how you want to handle it. You may also need to tell a client who has struggled with fertility. If they stay with you, they will watch your belly grow and it will be something you will need to check in with and process over time. For someone struggling with fertility, even if their struggle was 20 years ago, your belly can become a barrier to the relationship, especially if it’s not addressed. I’m dreading a conversation with one of my clients. It’s okay to dread that. Clients who are parents may want to give you advice if you’re a first timer. I chose to respond to that graciously and it didn’t feel like a clinical issue with my specific clients. I didn’t let them take up their session time with it; it was more of a doorknob conversation. Consider your client population and how that will feel for you. Clients may ask you a lot of personal questions about your pregnancy, the baby, names, nursery decor, etc. This can be awkward and makes some of their session time about you. Your clients are interested in you and your exciting life transition, they’re probably not trying to be nosy, so find ways that are comfortable to you to address their questions and get the attention back on them. Some clients may leave before your maternity leave. They may see you as less invested in their process because you’re taking time off in the middle of their work. Be prepared for that emotionally and financially. Do what you need to so you don’t take it personally. If your practice is still relatively new you may be tempted to try to get some work done during your maternity leave. Unless you set it up like my friend Kelly, I strongly discourage that as a mother, as a business woman and as a clinician. As a new mom you have enough to do. Any work pressure when you’re supposed to be off is going to make you less present and even more spacey. Your little nugget needs you and you will enjoy him or her more if you aren’t trying to split time. As a business woman, I encourage you to not make any business decisions or actions on such little sleep. Not even returning emails or phone calls to clients. Now is also not the time for networking unless you really want to get out of the house and you already know and like who you are networking with. Don’t meet anyone new for a little while. I’m sure most colleagues would be understanding, but arriving without a shower and with spit up in your hair isn’t exactly the best first impression. As a clinician, hold your boundaries. If you told your clients you’re off, do not respond to them if they email or call. You already gave them 3 referrals. It’s confusing if you intermittently respond. Maintaining your boundary is great modeling and will keep you from getting sucked into a clinical issue when you aren’t in the best place to manage it. When I came back from maternity leave after my 3 months away from my practice I had a new perspective on my business. I had better boundaries with my time since it felt more precious. It’s a time a lot of clinicians raise their fees or get off insurance panels. I needed that time away from work to gain the clarity I now have. I keep writing “time off” and replacing the “off” with “away”. For any of you who are first time moms or dads, be very clear that this does not feel like time off. In fact, you are “on” more than ever and doing so on weird sleep and, for birth mothers, serious healing and recovery. It’s a bad set up to think of maternity or paternity leave as a break. When you return to work, you are likely still sleeping differently than before. You will not be as alert and refreshed and smart as you were pre-baby. That’s ok. I had to remind myself that even if I was at 80%, my office was still an intentional, clinically sound, warm, safe space for my clients to get help. You’re human and it’s ok for your clients to see that. You’re probably really excited about your baby and your clients may want to hear all about it. Check your boundaries. Disclose what feels right from a clinical perspective, not from a new parent perspective. They don’t need to see the 400 pictures you took yesterday.

A Note About Postpartum Mood Disorders

In normal life, I am pretty unsinkable. I’ve actually been called annoyingly optimistic. My postpartum life was different. Unfortunately for me, my hormones were a bitch, my daughter had feeding issues, and I got into a bad, dark place a few weeks after she was born. I recognized what was happening and got help as soon as possible. This time around, I already have a list of providers I plan to work with should I need to. I’m clear that I can’t be any good to anyone if I’m not good to myself. Here are two great resources should you need them Postpartum Support International and Postpartum Progress.

For Partners with Private Practices

I feel like this post has been pretty birth mom heavy. Sorry about that. Partners, I say take as much time off as you can afford. My honey was off from his rotation for 3 weeks and it was so helpful (it helped that his preceptor was a pregnant, European, OB who had a toddler. She was so supportive). We had the first week to our selves with our daughter and then were so grateful to have both sets of parents come, one after the other. You need more help than you think you’ll need. All of a sudden washing dishes is nearly impossible and sometimes I felt like I had to choose between eating and sleeping and peeing. Though he’s more laid back than I am, I know my husband had similar moments of overwhelm. Unless you take extended leave like your new baby’s mama, your practice will be less impacted. It’s highly unlikely that you’ll have to rebuild again if you take a few weeks off, but it may have a significant financial impact. Make sure you budget for that. You’re going to return to work dead tired. You’re going to miss your baby. You’re also going to forget that you have a baby sometimes— that’s ok. Moms do it too when they return to work. You will not be doing your best work while you’re still in a sleepless phase. I say to you what I say to the moms (like literally cutting and pasting): I had to remind myself that even if I was at 80%, my office was still an intentional, clinically sound, warm, safe space for my clients to get help. You’re human and it’s ok for your clients to see that. You’re probably really excited about your baby and your clients may want to hear all about it. Check your boundaries. Disclose what feels right from a clinical perspective, not from a new parent perspective. They don’t need to see the 400 pictures you took yesterday.

Wrap-Up

These are the things that worked for me, things I considered, lessons I learned. Take what works for you and ignore the rest. Like your birth plan or your parenting style, you know what will work for you much better than I ever could.

Ok, that’s as thorough as my pregnancy brain can get but if I missed something I really want to hear from you. I’ll keep adding to this post as folks make suggestions. I want it to be as thorough as possible. Comment below or email me. Have a great week, Allison