Wednesday, October 22, 2008

MiM Mailbag

Occasionally, we receive emails from readers looking for advice. With our readers' permission, we thought we'd share some of these here with the larger community for your collective wisdom and thoughts.

Hi ladies!

I'm a fourth year medical student and planning on going into Family Medicine. Thankfully, I think that this is a pretty family-friendly specialty, but right now I'm trying to figure out how children might be worked in for me over the next few years. This past June, I had a miscarriage at 9 wks (had that baby not miscarried, I would be around 6.5 months right now, and would have been due in Jan.) I thought that this would be the perfect set-up, go into residency with a 6 month old. Obviously, (wo)men make plans and the gods laugh. But now, I am having this feeling of being dead-set on getting pregnant, and not having anything man-made (ie residency) interfere with my husband and I being able to have a child (hopefully) within the next year. That means that I would possibly be having a baby during intern year. So mostly, I have a few questions:

Am I crazy in thinking that intern year and newborn are doable?

Should I just take a year off if I get pregnant within the next few months?

I'm getting ready to start interviews, like, soon....should I bring up these issues at the interviews?

Any advice is appreciated, honestly.

A medical student


  1. Obviously, no matter what advice is left here, you're going to do what is most comfortable for you. That said, looking back on medical school, internship and residency, I think internship year was by far the most difficult year of training. You're exposed to much more than you ever imagined during medical school and even in the most advanced programs interns are (typically) still treated like something just above the illnesses you're trying to eradicate from your patients. Combine that with the stress of starting a new position and often having moved - sometimes a great distance. It's my opinion that adding the stress of a baby to this mix is probably too much. On the other hand, I hesitate to advocate taking a year off, because starting again will likely be very difficult.

    I've experienced a miscarriage, so I recognize the desire to get over the feelings of hurt and loss - but don't set yourself up for something potentially worse in your desire to start a family now.

    I wish you only the best as you weigh all your options!


  2. Internship year has the fewest opportunities for sleep ...

  3. I am so sorry for your loss. I experienced a miscarriage last year as well, and had the same feeling of NEEDING to get pregnant right away. I did so, and the initial "perfect timing" of being due at the end of my 3rd year turned into having my daughter right in the middle of when I needed to be running around getting letters and doing sub-i's.

    In my case, I chose to take time off. I am really happy about my decision. I'm able to be here for all her first moments that I'll never get back... it's the only time in my career that I could really contemplate being a stay at home mom, and I chose not to pass up the opportunity.

    I can only speak for myself, but for me, becoming pregnant again allowed me to heal, and taking this time off to be with her is making me happier than I ever imagined that I could be. I wish you well in whatever you decide.

  4. Had a baby smack in the middle of intern year. (This was not a planned event.) At any rate, I was fine, pregnancy was fine, baby was fine and got twelve months of breastmilk, internship/residency was fine, child is fine (now three) and it is only now during my second pregnancy that I am thinking "How the living heck did I do this during intern year?!?" Honestly, you deal with what you have to deal with. If that is what ends up happening, you will get through it and your coworkers will get through it. There is never, ever, ever a perfect time to have a child and intern year sucks whether you are pregnant or not. That is my two cents.

  5. Also, do NOT bring any of this up at interviews. It is none of their beeswax, it is illegal for them to ask you, and they honestly probably don't want to hear about it anyway.

  6. As an interviewer for our residency (not FP) and a former chief resident, I would suggest that you ask oblique questions of the other residents about how "family friendly" the program is. If no woman resident has ever been pregnant, it will be much tougher for you than if there are always a couple of people having babies. (Of course, someone has to be the first... but it's easier to be the first pregnant resident in a year OTHER than internship.)

    You can of course feel free to ask questions of the Assistant Program Director/Program Director/interviewers, but be very tactful in doing so. IMHO you'll get a truer answer, and less risk of jeopardizing a position at a place you really want, by talking to the residents. (Note that interviewers are forbidden to bring up pregnancy, etc., unless you do so first. Also, although I can't imagine that a program would intentionally discriminate based on plans for pregnancy, when it comes down to making the difficult rank list decisions, little things *may* subconsciously make a difference in the program's collective opinion. If it were me, I'd say it's not worth risking it!)

    All of that being said... Internship is absolutely the toughest year of residency. But one of my residency classmates had her 2nd(!) kid during intern year and did just fine. It depends on how much sleep you need :) and how supportive your partner is. Taking time off may also be a valid option for you, but be aware that doing so AFTER graduating from med school will require explaining on your resume (and possibly on your medical license applications) from now on.

    Regardless, good luck, and know that - unluckily - there is no perfect choice. They all have consequences. So, make the choice that feels "most right" to you; you'll be much happier and much better able to deal with positive and negative ramifications if you feel confident that you listened to your heart.

  7. I will second the opinion that there is no perfect time to have a baby. It will always be difficult. But I also agree that with intern year, a lot of changes are happening at once: moving from student to physician, starting a new program, being in a new location. If you can limit the number of changes in a year, it would be best.

    I would also say, that as a fourth year medical student and a mom, and thinking about planning my next pregnancy, this conversation is very helpful. Thanks!

  8. I did not have children during residency and was not at the point of my relationship to do so...that being said, I would not have chosen to have a baby during internship year. Having gone through internship (brutal) and having a had newborn (and not a easily soothed, peaceful baby), the thought of those events occurring at the same time gives me chest pain.

    Can it be done? Of course it can. It will be much easier if you have family nearby and a husband who can be very flexible.

    Does it have to be done? Even waiting one year (which probably sounds like decades) would be a considerable difference in stress, I think.

  9. I did not have a baby until I was out in private practice. However, our residency director actually encouraged us to have kids during residency because the number of colleagues available to cover for you are much greater than when you get into private practice. I also think a lot of your decision depends on the flexibility of your spouse's job. If he doesn't have the ability to handle emergencies when you are unable to change your schedule on short notice, then I would delay pregnancy at least until second year.

  10. I am a fourth year as well, (going into military peds). I am currently 17 and a half weeks pregnant. My due date is March 30. I will be moving from Las Vegas NV, to Bethesda, MD (Due to the special situation I have, I do already know this) for residency and my husband is slated to deploy 4 weeks after my due date. Although I will still be interviewing in November at about 19 weeks.

    If I had all this to do over, I think that this MIGHT not be the best time to be pregnant. While my husband and I are so excited about this child I cannot help but be literally terrified at what my life is going to be like within the next year.

    I know this can be done, and I am hoping to do it as well as possible but I also fear for the time away from my new baby, the time away from my husband, the stress of being an intern and the stress of having an infant.

    All in all, while we are dealing with this as well as we can, and there really is NEVER a "good" time. If I were you, I would wait until at least you have a grasp of what it will be like for us as interns/residents before getting pregnant. Just for your own sanity, if nothing else!!


  11. Babies don't let you sleep very much for the first two to three months. And internship year doesn't let you sleep much for the whole year.

    My OB told me that the first three months of motherhood are more grueling than the whole year of internship. I wouldn't want to do them both at the same time.

  12. It's like breaking your leg. There's no good time to do it.

  13. Being that I am still in my last year of medical school, I don't have an opinion about whether or not a baby during internship is doable. But I wouldn't bring up your family planning during interviews, except maybe in very vague terms like "life-work balance".

    I just had my first baby and have learned that people in medicine have vastly different views about what YOU can handle. ("You would have to be a super woman to even attempt such a thing" to "its no big deal".)It is up to you if you want to take on a newborn and internship. It would be a shame if your residency choices were limited because an interviewer or program director thought your personal choices were not compatible with medical training.

  14. Is it too late to apply for one of those year out research things? That might be a decent alternative.

  15. I took a planned year off after med school -- caught the baby bug at the beginning of 4th yr, had chunky monkey #1 in August after graduation and then applied to residency programs. So I was interviewing with a 3-4 month old infant and needed to ask for "pump breaks" during interview days, but honestly, I was a little surprised how accommodating and encouraging everybody *seemed* to be. I think program directors felt, "well, she's already had the kid, gets to be home with him for almost a year, she'll really have her act together when she starts." I'm VERY VERY VERY happy I did it this way. One nice aspect of taking a year off also means that you don't have to go through the match if you don't want to. Another new mom in my class who took a year off arranged her family practice residency outside the match quite early on.

    Baby #2 came during my PGY-3 year, and that pregnancy was MUCH tougher. Multiple hemorrhages, periods of bedrest, limited duty at work, culminating with his early arrival at 34 weeks. I interrupted my training to be home with him for the next 7 months, as he was on apnea monitor and had some feeding difficulties. I will be finishing my residency 20 months later than med school classmates who went into the same specialty (who are now attendings!) but my boys just needed me at home and I am at an incredibly supportive program that allowed me to do this. Little guy #2 is almost 1 year old now and still wake me up to eat 5-6 times a night, so that "3 month period of no sleep" can certainly stretch on indefinitely too... :)

  16. Internship with planned for new baby = dumb idea.Sure, if you're determined enough AND if baby is perfectly healthy AND if you recover physically in your alloted few weeks AND if you have no postpartum depression AND if husband/family can do unlimited emergency child care AND if your internship puts you on good rotations, you can "get through" the year. But why take two such important events in your life and bunch them together, hoping it will all work out. Although we all agree there is no perfect time, some times are asking for disaster. When further along in residency you can always opt out for a research year if needed.

  17. I'm currently a MS4, 9 weeks pregnant-hopefully I'll stay that was for a little while. I've delayed my application to residency and will be maching next year for an number of reasons (my age (29); husband is matching this year and needs to do a prelim year and we didn't want any chance of being seperated, etc.) Personally, I thought that I would need more than 6-12 weeks for a healthy recovery and I didn't want a lot of things interfering with my ability to breastfeed and bond with my baby. After being on rotations this fall and speaking to a number of resident in my choosen field (ob) who have kids; I'm really happy I've decided to take a year off as many of them have had to extend their residency programs after having kids in res anyway. Also, the pressures involved with having a newborn and being pregnant as an intern sound very challenging. Having a 1yo as an intern won't be easy but I expect it will be physically more tolerable. The problems with my plan include, loan repayment issues, having that "gap on the resume," one more year of joblessness, etc. Good luck with your decision!

    One more thing, your feelings and ideas may change when you are actually pregnant- When it was contemplating my plan, I was very very unsure and stressed about the idea of delaying res. Now that I'm actually pregnant and having a lot of fatigue and nausea, I'm so relieved that I'm not matching this year.
    Good luck!

  18. I'm a 2nd year fam med res and have a three year old. A fellow 2nd year (and good friend) has a 2 year old. We both took a full year off (me between 3rd and 4th year med school, her after graduation and before internship). We both agree that it was an awesome opportunity to take time and have time with our first babes.
    If you can, take the time off. Internship, even in "friendly family medicine" is a huge drain. Having a baby is harder, true, but if you can, do one at a time.

  19. If you can afford to wait in terms of your age and your eagerness, I'd encourage you to wait until after internship. Even if you can manage being pregnant and having a newborn during internship, which is a Herculean feat, why would you want to? Both your internship and the birth/early months of your firstborn's life are tremendous firsts in your life. Both deserve and demand your undivided attention. While they can seem to drag at times, the reality is that both are over in the blink of an eye. I had my first child at the start of my 2nd year of fellowship (a research year), my second child at the end of my 3rd year of fellowship, added on an additional 4th year of fellowship to finish up projects that had suffered due to my being on maternity leave so much, and then had my 3rd child after being at my first "real" job for about a year and a half. That was 3 kids in 4 years minus 6 days. It was and continues to be hectic, but the timing allowed me to have a "real" maternity leave with each pregnancy without causing an excessive amount of stress to me or the system. I would second the person who recommended trying to get a research gig for a year during your residency so that you can enjoy the pregnancy and the baby more. Of course, that's all scheming and logic.

    Perri Klass wrote a wonderful piece a few years ago in NEJM about just these issues entitled "So, Where's My Medal?" It is worth reading. In it, she says, "Having a baby isn't something you do for the sake of logic; it's something that happens when the forces of sentiment, emotion, biology, and who knows what else sweep you away." Amen. Good luck with the baby.

  20. The advice written by others is so complete and sound so I just want to add 2¢. There is a time a place for everything. If your heart and body are saying get pregnant..go for it and postpone that internship year. Doing both together is "doable" but less than optimal. You will want to really focus on the baby and there is no guarantee your pregnancy will be simple. Take a year off if you can, and be a mom. There is plenty of time to work your entire life!!! Do NOT tell the interviewers that you want to get pregnant. No, No, No. And best of luck for what will be a wonderful adventure...both medicine and motherhood. I just became a grandmother 24 hours ago!!!

  21. LOL mamadoc!

    Seriously, I would wait. Having had an early pregnancy loss, I understand the almost desperation to get pregnant again. You haven't stated your age, but I'm assuming you are not pushing menopause.

    Yes, you could do it. We all could have done it. But during your baby's first year, you will want to spend all of your free time on him/her. You'll want to ENJOY the mommyhood.

    Funny, just yesterday I was talking to a second year FP resident who is considering stopping and moonlighting as a "licensed doc" so she can spend more time with her infant. I encouraged her to keep plugging through her residency because I think she'd never go back., The grief she feels is palpable. She can't be the kind of mom she wants to be right now.

    I had my son in my third year, and that was as good as it could be during residency. The rotations, in my program, were much more flexible.

    In the end, you'll do what is right for your family. I hope you'll keep us all posted. :)


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