Monday, August 9, 2010

MiM Mailbag: Having kids during med school

Hi Mothers in Medicine,

I love, love, love the blog and use it as a nice way to procrastinate from studying when I need a break. It's medically related, so that makes it okay, right?

I thought I would submit a question with something I am struggling with in hopes that I can get some advice from all the mommy-doctors out there.

I'm currently a rising 2nd year and I would like to have my first child while still in school. However, I am battling with the timing of it all. I realize that the entire process of parenting doesn't necessarily work out as planned, and that we may not conceive immediately, but ideally I would like to conceive in November so that the baby would be due in August since I would like to take off a year to stay home with the baby and the natural break in the summer would be perfect for that.

So, my options are either have the baby between second and third year, or between third and fourth year. I found my passion this summer while shadowing, so I know without a doubt I want to be an emergency medicine doc.

Here is my assessment of the two options for 'baby having'.

Between Second and Third year-

Pros: natural break in curriculum between class and clinic medicine, when I do start back in 3rd year I will be still be sharp in 4th year during my ER rotation for a rec. good letter, starting family sooner (28 instead of 29 if we wait a year)

Cons: Being preg. during 2nd year when the courses are tough, being pregnant while trying to study for the boards (I've heard 'pregnancy brain' can really affect your memory), and being very pregnant (7~8mos) while actually taking the boards (bathroom breaks?), having a 1 year old during 3rd year rotations when time is limited and not your own


Between Third and Fourth year-

Pros: Not worrying about how pregnancy may have effected my board scores, having 4th year coming up which is considerably lighter than the first 3 years of medical school

Cons: Since I would be off an entire year between 3rd and 4th year, I'm worried that I may be rusty on my clinical skills and I really need to impress during the ER rotation which is during 4th year, Being pregs during 3rd year and how this may effect those grades which are more important than preclinical grades.

I realize there is no "right" time to have a baby during this training process, however, I was wondering if I could have some insight from women out there who have been through it and have children now. Obviously, I have no idea the amount of energy and time a child needs, so from women who have been through this arduous process of medical training and know what it entails to be pregnant and to be a mother, what would you do if you were me?

Many thanks in advance.

13 comments:

  1. My opinion is that going through all of third year is not going to be terribly fun with a one year old baby. You're going to be frustrated about how little you see them.

    If you plan to have the baby near the end of third year, you can then take a year off and have one or two core rotations left to get back in practice prior to taking EM. Alternately, is there no way to take EM slightly earlier in third year?

    It's hard to plan these things so precisely though.

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  2. One of my veterinary school classmates gave birth four days after finishing third year finals, took the summer off, and returned to fourth year rotations then residency. Her husband is very supportive and it worked for her. I think it's a matter of personal taste; hard to predict how you're going to feel about it, and important to discuss with your partner.

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  3. Everybody worries a lot about being rusty after coming back to clinics following a year off. My understanding from some folks who have done it is that this is a bit overblown. I'd try to do a couple of rotations before doing EM coming back, but I really don't think this is going to be a huge concern, unless your grades aren't that stellar in your rotation in general.

    I agree with Fizzy though, about trying to do your third year clerkships with a new baby. That would be really difficult. I remember studying or being in the hospital almost constantly during that year.

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  4. Thanks so much for the input, and it's only 9am! The only problem with doing a few rotations before doing my EM rotation is that if you want EM you are 'supposed' to do it as early as possible so that you can secure a letter and apply early.
    I don't think my school has an option to do EM during 3rd year, although if I was pregs they may make an exception? I'm not sure and I wouldn't want to ask unless I was in that situation.

    Fizzy: I know that my plan is very precise and that these things don't always work out like so.

    Outsider: My husband is very supportive and has a job with 'normal' hours, so at least someone can maintain some normalcy through out this.

    OldMDGirl: It's good to know the whole rusty concept may be a little inflated. That makes me feel much better!

    So that's 3 votes for 3rd year.

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  5. I've been reading this blog since it's infancy, but this is the first time I'm commenting!
    I had a baby right at the beginning of 3rd year of med school in 2007. After 2nd year classes, I did one medicine rotation, and she was born on the second to last day, so I had to take the shelf exam 6 weeks later. I took 3 months off by using up most of my elective time, and went back to rotations in the fall.
    Some specific things you asked about that I can comment on:
    Being pregnant during classroom time, in my opinion, is much easier than when you're on your feet and on call for 3rd year. You go home at the end of the day, put your feet up, and relax while you study. As far as taking Step 1 while pregnant--I was 34 weeks and it was not the most comfortable thing in the world but it was do-able. I had more than enough time to get up to the bathroom. And your last concern about having a one year old during 3rd year...nothing can really make the busy schedule and the lack of time with your baby ok, no matter when you have a baby. If it's not 3rd year with a one year old, it's intern year with a 2 year old, or any number of other combinations.
    While everyone told me that there was no perfect time to have a baby, they all told me to just pick a time and you'll make it work. To some extent, I still believe that. But on the other hand, it is seriously difficult to make it work sometimes. I guess that's why we all read this blog, because this is a challenging balancing game and nobody has the answers, but we're all doing the best we can.

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  6. Not having gone to Med School I don't have a lot to comment on. However I do have one thing I'd like to say. All pregnancies are very different and you may not get all of the common symptoms, or you might. I never suffered from "pregnancy brain." The only time my husband says I suffered from anything like that was the first month or two after she was born. Which I believe had more to do with being a sleepless zombie, and less to do with a hormone addled brain.

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  7. I don't remember my third year being all that difficult study-wise compared to first and second for me - maybe I was just happy to get out of the books and lecture halls. I have a good work ethic and made great grades, but there was a lot of stir at the time about overworking medical students so I think we got off a little easy with new rules and regulations. I would check with the third year's experience at your school. I only had to spend one night in house on surgery call, and I spend one week of OB on nights, but other than that I was usually home at a decent hour. Mornings were early on surgery. I did not have my nose in the books nearly as much as the first two years - but I was not a basic science major so maybe that made the first two years harder for me.

    I agree with the pregnancy brain - I was pregnant during residency and it didn't seem to affect my academic performance - maybe energy level, a little, and the physical strain was challenging. Having said that, I did wait to take Step III until I had my daughter because my energy level helped my study effort.

    My first inclination when I read your question was to encourage a break after the second year (I think it is a wonderful idea - you will never get that first year of baby's life back) - it seems more natural. But I get points made above, so I don't know. There's never a good time - is there? You'll figure out a way to make it work. Good luck! Good support is key.

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  8. Having had my three as an attending, I would have to say there is no good time. All the planning may go completely out the window. That said, my vote is between second and third year because you do have that rest time. I remember( not so fondly) hyperemesis followed by LE edema followed by contractions on rounds. And all I had to do was teach and write notes!

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  9. I had my little girl at the end of fourth year. She was born in March, I took vacation in April and had a light month in May where I wrote paper after some research for the month. If I could go back and do it all over again I would have done it in between 2nd and 3rd year since I could have taken time off and enjoyed her more. It was very hard for me to start internship with a 9 week old and I was pulled extremely hard from her at home and of course being an intern. Good luck with whatever you decide. As many have said before there is never a "perfect time" to have a baby and I think we just fit it in when we can and work out the details later!

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  10. Wow! Thanks so much you guys for sharing all of your experiences and for your advice.

    Familydoc- It's so relieving to hear that you took step 1 at 34 weeks pregnant. That's amazing (seriously). Getting that big ole belly under the desk!!!

    Brit- Another HUGE relief that pregnancy brain is not necessarily something that hits everyone. I'm going to consciously try to not have it, mind over mind? I think so!

    Gizabeth- Thanks for sharing. I'm actually not sure about overnight call at my school and that's definitely something I should ask about. And I really do want to take a year for the baby, because when I look at it there is really no other time in my career that I can do such a thing (without a bigger blow). Plus, I really want to get out and get practicing as soon as possible minus the year off with baby.

    Anonymous- Thanks for sharing your experiences. 3 as an attending? Wow, go you! I'll probably try to pop one out in school, one as a 2nd-3rd year resident and then the rest while practicing.

    LtDrMom- during 4th year was an option I also looked at, but since I want to take a year off, sitting out of the match for 1 year was not as appealing as doing it while in school. I feel like at that point I will be so ready to get out in residency that it may make things difficult. But you're right, it seems doctor moms will always be pulled in different directions.



    I've been thinking a lot about this lately and as of now, I think we are going to give it a shot for 2 months to try to 'plan' the birth right for the end of 2nd year. I've also heard it's easier when the baby is younger to be pulled in different directions because a young child can be consoled by anyone (partner, family, etc.) while an older child is able to express that they specifically "want mommy". So, I guess a 1 year old during 3rd year could work. Plus, for the easy rotations I could even be home early (like during psych). And if we don't have any luck this year for our short time trying, then we'll stop until this time 3rd where we'll give it a better effort.

    Wow you guys!!!!! Thanks so much again.

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  11. Can you do a few rotations, have the baby and then return (whether it be year III or year IV)?

    Also, not to be a downer, but I know of someone who got put on complete bed rest early in her pregnancy. Just remember that you may have to extend your training but it is worth it to have a healthy baby!

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  12. Hi Mim!

    I am glad that you are thinking about family now. A number of my female friends from medical school have struggled with getting pregnant, waiting until training was done. I had wanted to do that too, but my father told me, "If you wait for the right time to have a baby, the right time will never come." This is absolutely true.

    I ended up having our 1st child at the beginning of my 4th year of medical school(took step II maybe 36-38 weeks pregnant-really not a problem, you can leave during the exam to go to the bathroom), the 2nd 6 months into internship, and 3rd at the end of my 2nd year of residency. I miscarried during my 1st year of work, and am now pregnant with our 4th, nearly two years out of residency, due only several months into a new job.

    Each child has been challenging in their own way, and not being with them during residency was awful for me. My first child was dx'd with ASD, and the second with PDD, NOS both during residency. I think more than other moms, I had a very strong desire to be with them and participate in their therapies.

    My hours of work have slowly decreased as training went on and now as an attending, I have more freedom with my schedule to be able to be with my kids.

    The advice that most helped me in making decisions about family:

    1. There is no "right" time to have a baby. Don't ever cry or grieve about unplanned/untimely pregnancy(I did multiple times) Scripture says, "Children are a blessing from the Lord, blessed is the man whose quiver is full of them." Psalm 127:5

    2. Don't let what's urgent get in the way of what's important. If you want to take a year off, do it. Fight the urge to succumb to the pressure of others or your own feelings of guilt. Years from now, you will not regret taking time off work, but you will regret not taking time to be with family.

    3. Trust God and pray about everything! Ask in faith and he will get you through whatever life gives you. Prov. 3:5-6 "Trust in the Lord with all your heart and do not depend on your own understanding. In all your ways acknowledge him, and he will direct your paths." Phil 4:13 says, "I can do all things through Christ who strengthens me."

    4. Unless your husband is going to be a stay-at-home dad, get a nanny with flexible hours(can work early, late, weekends, and overnight if needed)

    May God bless you and give you wisdom, Mim // SO

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  13. I just came upon this blog - and wondered what happened?? My baby is 6 mos old and I did Step I about 12 weeks pregnant and had my baby in the middle of 3rd year - took 4 mos off and am not finishing up. ANY time is a good time to have a baby. The current medical education is not set up in a sustainable time frame for many of us wanting to start a family. Remember this is your education that you are paying for. We don't need to justify taking time 'off' for our family even though our peers and mentors may make us feel guilty. Good luck and do what is right for you - you will make a better physician for it!

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