High Risk & Highly Capable

Around five weeks after birth, the meals and check-ins may fade, and the question “When are you going back to work?” can arrive before you’ve reviewed your options. Dr. Av explains the four systems that may shape maternity leave, how to prepare for financial and paperwork decisions, and why you should base your return date on your documents and needs, not pressure.

In this episode:

• Maternity leave can involve four separate systems: federal job protection, state paid leave, employer policy, and short-term disability. Each has its own administrator, eligibility rules, and pay provisions.
• Eligibility depends on work history, hours, and employer and workplace size. Pregnancy-related time off may count toward the same 12 weeks.
• Short-term disability may replace part of your income, but when you enroll matters. Check the replacement percentage, benefit duration after vaginal or cesarean birth, waiting period, and whether it offsets employer pay.
• Consider staggering your leave. If one parent has 12 weeks and the other has six, taking the six weeks consecutively after the first leave can extend family coverage to 18 weeks and give the partner time to care for the baby solo.
• States with Mandatory leave programs: California, Colorado, Connecticut, Delaware, Maine, Maryland*, Massachusetts, Minnesota, New Jersey, New York, Oregon, Rhode Island, Virginia, Washington, and D.C.
• States with Voluntary leave programs: Alabama, Arkansas, Florida, Kentucky, New Hampshire, South Carolina, Tennessee, Texas, and Vermont.

Timestamps:

00:00 - The week-five question: “When are you going back to work?” 06:18 - Your proposed return date is a decision, not a fact

09:42 - The four systems behind maternity leave

10:41 - FMLA: job protection, eligibility, and unpaid leave

13:39 - State paid leave and how location changes your options

16:05 - Employer policies and why leave often overlaps

17:32 - Short-term disability: coverage details and enrollment timing

20:26 - Partner leave and the case for staggering time off

25:32 - Tenure, career leverage, and planning a phased return

28:29 - Financial pressure, breadwinning, and asking for support

30:23 - Four questions to send HR or your benefits administrator

33:42 - Return-to-work planning, pumping time, and accommodations

35:24 - Get the answers in writing before giving a return date

Season Finale, Episode 9: You Were Never Meant to Do This Alone

In this season finale of High Risk and Highly Capable, I want to express my gratitude for your trust and engagement over the past few months. What we’ve built together is more than just a podcast; it’s a vital resource grounded in research about what women who become mothers later in life truly want from their care. Not what the system assumes we want, but what we say we want when researchers take the time to ask.

The Season 1 finale. Eight episodes, eight tools, and the one thing that holds them together: you were never meant to do this alone.

IN THIS EPISODE: the three questions that turn “high-risk” into a plan (Ep. 1) · name it, claim it, document it (Ep. 2) · the sixty-day cliff and the twelve-month fix (Ep. 3) · your care team and a birth plan built to bend (Ep. 4) · the Three Doors (Special Episode) · matrescence and the two-week line (Ep. 6) · the fourth trimester and the warning signs worth memorizing (Ep. 7) · building your village on purpose (Ep. 8).

LOOK UP YOUR HOSPITAL: the CMS Birthing-Friendly designation is public and free, with an interactive map of designated hospitals and health systems. Direct link: https://data.cms.gov/provider-data/birthing-friendly-hospitals-and-health-systems.

FOR EMPLOYERS, HEALTH PLANS, AND BENEFITS BROKERS: if your advanced-maternal-age members are navigating this alone, ASC Consulting Services builds and scopes maternal health programs for organizations, grounded in more than fifteen years of federal maternal health policy experience. Capabilities sheet and pilot conversations: [email protected].

Follow @HRHCpod and subscribe on YouTube: https://www.youtube.com/@avareenaschools-cropper3448.

This episode is educational and is not medical advice. Nothing here replaces care from your own provider. High-Risk & Highly Capable is a production of ASC Consulting Services, LLC.

JOIN HRHCpod EMAIL LIST. This is where the tools live between episodes: appointment-prep guides, question checklists, and the things that do not fit inside an episode. Subscribers hear first about everything that comes next. Share you comments or questions to [email protected].

Dr. Av argues that the strongest mothers are not the ones who carry everything alone, but the ones who intentionally build a village and let it carry them too. This episode is especially for mothers of advanced maternal age who may be juggling pregnancy, parenting, grief, and elder care at the same time. Dr. Av shares personal experience, current statistics, and a practical 4 step framework for building support on purpose.

Key Insights:

• In this episode, Dr. Av retires the “supermom” image and replaces it with a more sustainable model: shared care, not silent endurance.
• She explains why this matters especially in the sandwich generation, where many women are raising children while also supporting aging parents.
• The episode highlights how support often arrives after the baby comes, but pregnancy and the postpartum period are when many women need help most.
• She points out that the common practice of waiting until 12 weeks to announce pregnancy can leave women carrying fear and uncertainty alone during the most emotionally intense stretch.
• Dr. Av stresses that announcement timing should be a deliberate choice, not something inherited by default.
• She explains that a village should include more than family and friends - it can also include a partner, faith community, doula, therapist, maternal health coach, lactation consultant, or midwife.
• She notes that the most useful support often comes from people who have gone through a similar season recently, because guidance and hospital practices change.
• Dr. Av introduces fours moves to build support early and assign roles so help is specific, practical, and actually usable.
• She closes by reminding partners and loved ones that believing a mother when she says something feels wrong can be life saving.

Timestamps:

00:00 - Why the “supermom” image needs to be retired
01:12 - The sandwich generation and why this episode matters now
02:39 - Carrying caregiving, fertility, and grief at the same time
04:05 - Why support often centers the baby instead of the mother
05:35 - The postpartum danger window and why help fades too early
06:04 - Why waiting to announce can make the hardest stretch lonelier
08:07 - Why recent experience matters more than old assumptions
09:55 - Same hospital, different birth: how care can change fast
10:37 - Who can be part of your village
11:38 - Support can come from unexpected people
12:08 - Matrescence and why relationships change too
12:57 - Building support when your current village is limited
13:54 - Why an informed partner is not optional
14:24 - The 4 move village building framework
16:46 - Name needs clearly instead of saying “let me know”
17:17 - Assign roles so support becomes actionable
18:14 - Keep yourself in your own village
19:42 - Why loved ones must believe and act fast
20:39 - It takes a village to carry a mother too

The Fourth Trimester encompasses a season of care, not just one visit. Your body spent the better part of a year transforming, and it does not snap back in forty-two days.

In this episode, Dr. Av gives you the season, the standard of care that has already moved to meet it, and the short list of warning signs worth knowing by heart. You will learn what the current guidance recommends: contact with your provider within three weeks, a full visit by twelve, and an assessment that covers your physical, social, and psychological well-being rather than a quick look and a wave.

You will learn what changed underneath that guidance, and why asking for a visit at three weeks is not asking for a favor.

We named the season for the baby. We left the mother’s unnamed. Today it gets a name — and a plan.

In This Episode

•     Forty-two, eighty-four, three hundred sixty-five. Six weeks is the visit. Twelve weeks is the season. A full year is the window in which serious complications can still arise. Your care should be built around the largest number.

•     Where the name came from — and who it was about. The fourth trimester was popularized in 2002 to describe the newborn. It took until 2018 for the mother to be written into it. The name for your recovery is younger than most of the women listening.

•     What the guideline says. Postpartum care as a continuous process rather than one encounter: contact within three weeks, a comprehensive visit by twelve, timing individualized, and a full assessment of physical, social, and psychological well-being — plus coordinated follow-up when a chronic condition is present.

•     What changed underneath it. Postpartum Medicaid coverage moved from sixty days to twelve months, and the way maternity care is billed is beginning to change.

•     What is simply hard, named in the guidance itself. Sleep, fatigue, pain, feeding, stress, mental health arriving new or flaring back up — in a clinical document, in plain print. If you felt like you slipped through a crack, the crack is structural.

•     Why advanced maternal age sharpens all of it. At thirty-five and beyond, more of us walk into pregnancy already managing a condition and walk out still managing it. That is a reason this season deserves more of your attention, not less.

•     Your birth history is heart history. A hypertensive pregnancy or a serious hemorrhage is not a closed chapter. One sentence belongs in every appointment you have for the rest of your life.

•     The tool: the urgent maternal warning signs worth memorizing, the blood pressure number that is an emergency rather than a “mention it next visit,” and the four words to say when you seek care — I gave birth recently. Plus the hotline, saved in your phone before you need it.

Chapters

00:00 · Cold open — the email your body never got

00:48 · Welcome — from your mind to your body

01:25 · The name, and the arithmetic nobody does out loud

02:08 · Where “fourth trimester” came from — and who it was about

04:01 · What the guideline actually recommends

06:17 · What changed underneath it — coverage and payment

07:49 · Where the danger concentrates

09:58 · What it means at thirty-five and beyond

11:23 · The tool — the warning signs worth memorizing

14:49 · Recovery is not a race — rest, and what the world does

16:39 · The turn — toward your village

About This Episode

After I delivered my first child, I felt like I was having an out-of-body experience — detached from the room, hearing sounds I could not place, asking two questions on a loop. What just happened. And now what.

Nobody explained what was happening to me in that moment. There is a word for it: Matrescence. The process of becoming a mother — a full developmental passage, the way adolescence is.

In this episode, Dr. Av gives you the word, the science behind it, and the numbers we do not say out loud. You will learn why researchers describe matrescence as a lifetime adaptation rather than a nine-month event, why the fog you have been apologizing for may be a brain under load rather than a brain in decline, and where the line sits between the baby blues and something that deserves care.

We named the teenager’s transformation. We left the mother’s unnamed. Today it gets a name.

In This Episode

• What matrescence is — and why it does not require that you were pregnant. Surrogacy, adoption, or a road that took years: this passage belongs to you too.
• The lifespan science. Hormonal, neural, and cognitive change that begins before conception and continues into midlife and beyond — more than any six-week checkup was built to hold.
• “Mom brain,” reframed. What researchers mean by increased cognitive load, and the framework they propose linking sustained demand to cognitive reserve later in life.
• The receipts. Maternal mental health conditions are the most common complication of pregnancy and childbirth in the United States — and roughly three out of four women affected go untreated.
• Why advanced maternal age sharpens the disorientation — and what the sandwich generation carries on both ends at once.
• The tool: know the two-week line, name it out loud to one person, and save the hotline in your phone before you need it.

Chapters

00:00 · Cold open — “What just happened? And now what?”

01:30 · Welcome — turning inward

02:30 · The word: matrescence, defined in full

06:30 · The lifespan science and cognitive load

08:30 · The data we don’t say out loud

11:00 · Why us — advanced maternal age and the sandwich generation

12:30 · The tool — the two-week line, naming it, and the hotline

15:00 · The turn — she is not gone, she is becoming

Episode 5 (Extended Show): The Hands That Catch You: Midwives, Lactation Consultants, and Pelvic Floor Physical Therapists

In 1900, midwives delivered about half the babies born in America. By 1975, fewer than one in a hundred. That did not happen by accident — and you are still living with the consequences. In this special episode, Dr. Av introduces the three practitioners most mothers are never offered: the midwife, the lactation consultant, and the pelvic-floor physical therapist.

In this Episode We Explore:

•     How American birth moved — the where and the who — in barely forty years, and who ran the campaign.

•     Why the evidence at the time did not support the campaign, and why the midwife was not losing an argument about safety.

•     The part of this history that has not softened: the Black granny midwife, the written examination, and the licensing machinery that replaced skill with literacy.

•     The number that is climbing back — the share of certified nurse-midwives and certified midwives who identify as Black, rising every single year since 2019.

•     CNM vs. CM: the same graduate education, the same national certification exam, one different entry point — and why state licensure matters to you.

•     The misconception worth breaking: as of 2022, CNMs and CMs attended nearly eleven percent of U.S. births, and roughly ninety-five percent of those births happened in a hospital.

•     What the 2024 Cochrane review actually found about midwife continuity-of-care models — and why the finding is about continuity, not about who is safer.

•     The IBCLC credential, what it solves in the first month, and the lactation benefit most plans are already required to cover with no cost sharing.

•     Why where you live determines the lactation help you can reach — and why you build the team before the four-a.m. problem.

•     The pelvic-floor physical therapist: how common these conditions are, how rarely anyone asks, and the one sentence that gets you a referral without a negotiation.

•     The tool: the Three Doors.

Chapters

00:00  Cold open — “Fifty years later, that world went extinct.”

01:30  Welcome — the correction I owe you from Episode 4

03:35  Decode — how birth moved: the where and the who

07:10  The part that was not an accident — the granny midwife and the written exam

12:25  The braid — what a midwife is today, the Cochrane evidence, and the hands that caught my babies

17:45  The lactation consultant — the credential, the evidence, and the benefit you already have

20:35  The pelvic-floor physical therapist — the specialty nobody names

23:40  The tool — the Three Doors

25:40  The close — the room, the inheritance, and one sentence to say out loud

Episode 4: Building your Care Team & Your Birth Plan

Most women are never told they get a say in who delivers their baby. You do. In this episode, Dr. Av decodes the roles on your care team — OB, MFM, midwife, doula, lactation consultant, pelvic-floor Physical Therapist — shows you the evidence behind continuous labor support, and reframes the birth plan as a conversation tool, not a contract. Build your team on purpose.

In this episode:

• What "high-risk" means for who should be in the room with you
• OB vs. MFM — and how to ask for the specialist your risk factors warrant
• The doula evidence, and how to find out whether your plan pays for one
• The three-part birth plan: your non-negotiables, your preferences, your "if things change" wishes
• Four questions that reveal whether a care team is right for you

You are not a risk to be managed. You are a mother to be partnered with.

Mother by Design coaching complements, and does not replace, clinical care.

EP. 3 · Don’t Let the Care You’re Owed Get Lost in the Paperwork

Your insurance card is an administrative instrument, not paperwork. Dr. Av — who spent 15 years inside CMS — breaks down maternity coverage, the postpartum “cliff,” and the questions to answer before the baby comes.

In this episode:

•     How maternity coverage actually works (and why Medicaid covers about 4 in 10 U.S. births).

•     The 60-day postpartum cliff, the 12-month fix, and why the postpartum year matters most.

•     The tool: three coverage questions to answer before you deliver.

Mother by Design coaching complements, and does not replace, clinical care.

Ep 2 — Being Heard in the Exam Room: Fifteen minutes. That's all you get — and nearly half of us walk out having swallowed the one question that mattered. This episode is how you stop. Three moves — name it, claim it, document it — to turn your mother wit into words the room has to honor.

In this episode:

•  The data on mistreatment and being dismissed — and why it’s not just you.

•  Why your instinct is clinical data: you know your body.

• The tool: name it, claim it, document it — with the exact sentences to say in the room.

“Advanced maternal age” can land like a verdict. It isn’t one. In our premiere, former CMS maternal-health leader Dr. Av (Dr. Avareena Schools-Cropper) decodes what “high-risk” really means at 35+, why you’re part of a fast-growing wave of older mothers, and how to turn the label into a plan.

In this episode:

•     What “advanced maternal age” really means — and the demographic wave you’re part of.

•     The current data on maternal risk, said plainly — and why most of these outcomes are preventable.

•     The tool: three questions that turn “high-risk” into a care plan — what specifically, what changes, who’s watching.

Mother by Design coaching complements this and future episodes, and does not replace, clinical care.