We know that residency is difficult. You face long hours, high work expectations, and seemingly random demands on your attention. Your hourly wage is low compared to other members of staff who seem to work fewer hours than you do. And, especially when you start off, there’s a steep learning curve.
What if you got pregnant in the middle of all this?
For women, timing pregnancy isn’t easy. In fact, the most likely time to get pregnant seems to coincide with the most demanding parts of medical training. There are risks to waiting including infertility; there are certainly challenges to actually having kids during training.
What’s more, there’s no tried and true formula for family planning in medicine. Everyone’s story is a little different. I’ve written elsewhere about the best time to get pregnant as a doctor. The answer may surprise you.
In the rest of this article, I write in detail about the challenges faced by young women who do become pregnant during residency. Let’s open our eyes.
Challenge 1: Making it to doctor appointments (before you announce your pregnancy)
It’s common to wait until 12 weeks to announce pregnancy because at this point, the likelihood of miscarriage is quite low.
For some women, pregnancy is as easy as whoopsy daisy.
For others, become pregnant and staying pregnant is an endeavor requiring fertility tests, thoughtful timing, and anxious countdowns. Ever heard of the two week wait? Women who are trying to conceive know that they’ll be testing for pregnancy as soon as it’s possible to test positive.
And with a positive pregnancy test come appointments including for evaluation, bloodwork, and even ultrasound.
How do you explain this to your co-residents without telling them about your pregnancy journey? Obfuscation. Vagueness. “I’m going to the doctor,” or “I have to do some tests.”
Challenge #2: Miscarriage happens
Did you know that about one in four pregnancies end in miscarriage? Sometimes the pregnancies are so brief that the only reason we knew they existed at all is because of an early response pregnancy test. These so-called chemical pregnancies only last days are make no mark physically, but can be devastating to a couple trying to conceive.
Unfortunately, miscarriage can also happen many weeks into a pregnancy. These events of fetal loss are excruciating emotionally. What’s more, sometimes medical or procedural assistance is required for evacuation of tissues. This amounts to a small, painful, and very personal health crisis during residency.
Challenge #3: Planning maternity leave during pregnancy can be tricky
Planning maternity leave is confusing for medical residents. First, most new mothers are concerned about the well-being of their infant child. Newborns remain very small and very helpless even at six weeks of life. Many women believe this is too early to return to work.
For attending physicians, the mean paid maternity leave is 7.8 weeks.[2] On other hand, resident physicians at top tier institutions like Harvard, Stanford, and Johns Hopkins are offered on average 6.6 weeks of paid leave.[3]
Some might argue that attending physicians have more resources and can better withstand unpaid leave from work. Regardless, it’s tricky financially to take unpaid leave.
What’s more, taking more time off than allowed by GME can extend the length of training by unforeseen durations, which directly affects fellowship.
Challenge #4: Returning to work and breastfeeding
The American Academy of Pediatrics and just about every other medical institution endorses breastfeeding for the health of mothers and babies.
For physicians, breastfeeding can be challenging given the demanding nature of our work. Clinic schedules can be unceasing; hospital work scarcely less so. Although women are mandated to have safe and sanitary locations for pumping breastmilk at work, the logistics of leaving rounds or clinic to pump on schedule can be complicated.
What’s more, the sometimes unspoken frustration of colleagues at this change in work pattern can be challenging on its own to navigate.
Challenge #5: Sleep deprivation on sleep deprivation
Women who are breastfeeding inevitably wake up more often at night to care for their infants. It’s easier to sleep longer stretches if you are co-sleeping, but this practice isn’t endorsed by Academy of Pediatrics.
Sleep deprived weeks are a rite of passage for new parents. But if residents are returning to work at 7 weeks postpartum while trying to breastfeed, they are surely returning at a time of life where sleep is rare and precious.
To work and study without adequate sleep is challenging. Chronic partial sleep loss can be equivalent to skipping one or even two full nights of sleep. The effect of sleep deprivation on medical errors is controversial, but the effect on motor vehicle collisions is unequivocal. Residents with chronic sleep loss are more than twice as likely to suffer a motor vehicle collision.[4]
Challenge #6: Paying for childcare without breaking the bank
Childcare is expensive. Resident physicians earn on average $64,000 in 2021, which is close to the median salary in the United States.
This amounts to take home pay of about $4300.
That seems like plenty to care for one person, but quickly appears insufficient when you factor in the cost of childcare. In Florida in 2022, fulltime daycare (7am-6pm) costs $1400 monthly. If you consider that some medical residents may require two forms of childcare, for example, daycare + nanny, the costs escalate rapidly.
Challenge #7: When your child becomes ill
This is the dreadful phone call that no medical resident ever wants to get:
“Hi, Mrs. J. Your child is ill. Please pick them up. They can’t come back to daycare for another 48 hours until the illness has cleared.”
Do you know what I did in that situation? I took the sick days that were granted to me within my contract as a medical resident. Sometimes I pushed my husband to take his own sick days.
Medical culture doesn’t allow for weakness such as sick days. Maybe times have changed since I was a resident pre-pandemic, but there were some hard feelings when someone had to call out sick. Inevitably, coverage would be required for the missing resident’s clinical responsibilities.
This is a stressful situation for the resident already – a child is sick. It’s made worse because of an entrenched culture of stoicism in medicine.
Is It Worth It To Have Children During Residency?
Yes!
While it’s easier to have children in many ways as an attending physician – more money, more flexible schedule, no training considerations, it may be physically more challenging. Infertility is a real scourge.
Having had children during residency, I know it’s super challenging. We made it work.
When I was a resident, I remember wondering how on earth the neurosurgery residents worked twice as hard as I did. Having children in residency means you have to work harder sometimes compared to your peers. It’s not for everyone, but it’s very possible.
Thanks for reading.
References
[1] https://pubmed.ncbi.nlm.nih.gov/32134836/
[2] Lu DJ, King B, Sandler HM, Tarbell NJ, Kamrava M, Atkins KM. Paid Parental Leave Policies Among U.S. News & World Report 2020-2021 Best Hospitals and Best Hospitals for Cancer. JAMA Netw Open. 2021;4(5):e218518. doi:10.1001/jamanetworkopen.2021.8518
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2779764#:~:text=The%20American%20Academy%20of%20Pediatrics,benefits%20to%20parents%20and%20children.&text=Parental%20leave%20policies%20can%20impact,retention%20of%20women%20in%20medicine.
[3] Magudia K, Bick A, Cohen J, Ng TSC, Weinstein D, Mangurian C, Jagsi R. Childbearing and Family Leave Policies for Resident Physicians at Top Training Institutions. JAMA. 2018 Dec 11;320(22):2372-2374. doi: 10.1001/jama.2018.14414. PMID: 30535210; PMCID: PMC6583066.
[4] https://bcmj.org/articles/impact-sleep-deprivation-resident-physicians-physician-and-patient-safety-it-time-wake-call#4
