Maternity leave after my second child was exciting. I fell in love with the son I brought into the world and got to know him really well. As my return to work approached, I was excited to reconnect with medicine but dreaded leaving my little boy at home.

The responsibility of motherhood is real and overwhelming.

At a particularly low, sleep-deprived point, I recall yelling at my husband after he fell asleep post-call without feeding our two-year-old daughter, which was his task while I nursed our then six week old baby. She was crying and hungry, and my husband was snoring one foot away from the three of us as I was nursing. When he regained consciousness hours later, I did not hold back. It sounded something like this, “How do you just not feed our child?! Do you know what would happen if I slept through feeding our baby? He would DIE!”

Drama mama much? We laugh now, but I believe a mom’s sense of responsibility is built from ten months of constant vigilance to create a safe and comfortable home for her growing fetus and then being that baby’s only sustenance for however long she chooses to breastfeed.

On maternity leave, I bore this responsibility with the luxury of complete control. Going back to work requires giving up control, which can be terrifying. To new mom’s out there: I suggest transitioning some of that control to your child’s caregiver prior to returning to work and practicing pumping and bottling while you still have the option of nursing if it is more difficult that you expect. This will also help identify and address other less obvious issues of being separated from baby.

Here’s a short list of important issues that require a thoughtful and gradual transition.

1. Bottling: Don’t assume your baby will take the bottle easily. Sri did very well whereas Ava varied between being fine, full-on refusal and chugging without ever being satiated by the bottle. I suggest having a caregiver give the bottle at least a few times before you return to work. Your baby won’t starve if they go on a food strike for a day or two after you return to work, but no mom wants to be on the receiving end of a “Baby won’t eat anything :(“ text in the middle of the first day back. Trust me, the mom guilt will already be thick enough.

2. Pumping: You’ll need to practice pumping to stock up on some milk if you’re planning on continuing breastfeeding after you return to work. Pumping requires perfection of technique to become efficient, and you may try a few different pumps and flange sizes to get it right. It’s better to learn this at home than in your office. You certainly don’t want pump issues to force early weaning. Fresh milk is best, but building a small freezer stash is very helpful.

3. Caregivers: Deep breath… No caregiver will do things exactly as you would. This is something you need to get comfortable with if you are going to have any sanity as a working mom. It is easier to get used to a caregiver by having them start prior to returning to work. I identified ways to help our caregivers be more effective and developed some amazing partnerships with them to raise my beautiful kiddos. Daycare is similar — if your kiddo can start before you go back, you can build a similar relationship with their daycare teacher. It is worth investing in your children’s caregivers more than just financially. When I’m at work, between morning rushes and frazzled evenings, my caregivers and I are like ships passing in the night — there’s little communication, and I’m grateful for the bonds we created before work started.

4. Getting used to being away: This may be the hardest part. I remember the first time I left Ava when she was almost three months old. I walked less than a block away and forced myself to get a pedicure while watching her obsessively on our Nest cam. Two and a half years later, I still get that pit in my stomach when I leave my kids. Even today, I had a work event, and Ava broke down as I left with that painful cry that pierces my heart. I walked out the door, got in the car and sat for a good minute thinking guilty mom thoughts, “This is ridiculous. Why am I leaving them today? She should be upset. I just shouldn’t go.” Separation anxiety goes both ways, but practice helps us learn to cope.

Preparedness, organization, time management, and dedication — these are skills we have perfected professionally. Luckily for us, they can also be applied for a harmonious working mommy-hood.

Arti Thangudu, MD is an endocrinologist and a 2018–2019 Doximity Author. She specializes in Endocrinology, Diabetes, and Metabolism and is a mom of two beautiful kiddos under three! She writes a blog for other working mamas, www.riverwalkdoc.com. She has also contributed to Medscape, Doximity and KevinMD. Outside of work, Dr. Thangudu enjoys traveling, cooking, and spending time with her husband and two children.