New mothers face a wide variety of stressors as they learn the ropes of balancing their work lives with the needs and wants of the new additions to their families.
But for at least one group of expecting moms, showing up at work every day posed a particularly difficult and stressful challenge at the height of the pandemic.
For Drs. Audrey Haywood, Radhika Shah and Anne Mainardi, pulmonology and critical care specialists in Erlanger Medical Center's intensive care unit, the daily risks associated with caring for the Chattanooga region's sickest COVID-19 patients applied to not only their own lives, but those of their unborn children.
Mainardi found out she was pregnant in June 2020, which was before COVID-19 vaccines were available, and little was known about how the coronavirus affected pregnant women.
She considered whether she should continue seeing COVID-19 patients, but said the hospital's personal protective equipment supply was steady and there was good evidence that wearing proper equipment provided strong protection against the coronavirus. She decided other clinicians were treating these patients, and she should, too.
But then toward the end of her second trimester, new data emerged showing that pregnant women are at an increased risk for severe COVID-19 infections.
"I only had a few - maybe two or three ICU weeks - before I was going to leave for maternity leave, and other people were willing to take those [shifts] for me, which I was extremely grateful for," she said.
Haywood and Shah both learned they were pregnant shortly after getting their first round of COVID-19 vaccines in spring 2021, which made them feel much better about treating infectious patients.
"That was sort of a ray of hope for us, and the cases were coming down, so it wasn't much of a concern at that time," Haywood said.
But local hospitals would soon face the worst surge of the pandemic to date when the delta variant drove a record-level surge in ICU patients.
"There were times that it really felt almost hopeless. You were just being bombarded. I would get page after page saying, 'This person needs to come to the ICU, and this person needs to come to the ICU,' and you're already at your max in terms of what you're used to taking care of," Haywood said. "It got really frustrating and difficult, and then there's the emotional side of it - when you're trying to do everything you can, and you still have bad outcomes with certain patients."
Shah said being vaccinated played heavily into her decision to stay on in the COVID-19 unit throughout her pregnancy.
"It just felt that the community needed our help, and also our colleagues, too, because we just had such a high volume of people that needed to be taken care of," Shah said. "You just kind of rally knowing that you and your colleagues and everybody at the hospital are in the trenches, and you can kind of get through together."
Mainardi said that on days when work was especially hard during her pregnancy, she would think about her unborn child.
"I didn't know it was going to be a girl, but I would think about my little baby and wanting to be someone that they would be proud of," she said.
When her son grows up, Shah said she will tell him that he was there with her working nights in the COVID-19 ICU.
"He was with me providing a service and taking care of people who really needed us," she said.
With only one COVID-19 patient in Hamilton County needing intensive care as of May 5, Shah said the team is "cautiously optimistic" that the worst of the pandemic is in the rearview mirror.
"We can't predict what variant will come through next, so we try to stay mentally prepared for the things that have happened before - in terms of surges and things like that - but it's certainly a little bit of a breath of fresh air right now," she said.
As many families across the Chattanooga region celebrate Mother's Day on Sunday, Mainardi, Shah and Haywood will all be working in the ICU.
Mainardi said being surrounded by a supportive team of physicians, nurses, respiratory therapists, nurse practitioners, physician assistants and other staff makes juggling motherhood and medicine easier.
"So many of them are mothers and leave their families every day to take care of others," she said, acknowledging that becoming a mom has given her a different outlook in terms of gender equality in her profession.
While there are many female doctors, few hold leadership positions in hospital administration.
"Now that I have a child, it's very obvious to me that there's only so many hours in the day, so you'd have to give up something ... and probably what you give up - what you can chip away at - is your time with your family," she said.
"It's not that men don't want to spend time with their families, and my husband is an amazing father, but it's just the way the system is set up. While women are having babies, men are passing them by," Mainardi said. "If men had to take off the way women had to take off when they have a baby, then maybe the playing field would be a little more equal."