Tuesday, September 3, 2013

MiM Mail: Going from 1 child to 2 during residency

I'm a pediatric intern, wife, and mother to a wonderful 3-year-old daughter. My daughter was born the summer between M1 and M2 year of medical school. I originally thought I might spread the M2 year out into two years, but ended up powering through and graduating on time. In retrospect, everything worked out fine although it seemed hard at the time. I managed to breastfeed her/pump for her first 18 months of life and relished in the flexibility of my M4 schedule to spend lots of time with her. I have a wonderfully supportive husband who works from home and does essentially all the day care drop-offs/pick-ups, middle of the night bed sheet changes when she wets the bed, bath time on evenings I'm working late, most of the household cleaning, etc. We are in a new city for residency. We left a setting with more extended support for one with some but significantly less extended family support in the area.

We are thinking about having baby #2 (have been thinking about it for quite a while)…but I'm scared. We want to have a second child and I'm kind of wishing we had just had #2 during my M4 year and have been done with it. The pregnancy itself scares me. I remember being sooo tired while pregnant as a med student and can't fathom being that tired while working 13-hour intern shifts (or 26 hour senior resident shifts). There are days when I don't have an opportunity to pee the entire day--how does a pregnant resident who has to pee every hour handle that? What if I get nauseous from morning sickness on morning rounds? I'm terrified of the new-mommy fatigue on top of resident-fatigue. And is it actually feasible to pump as a resident? While in medical school, I could lecture-capture from home while pumping and call in sick in childcare emergency situations, I know I won't have those luxuries in residency. I'm also scared of stirring the pot with my daughter, whose world would be turned upside down with a new baby sib and that added element of stress of having a regressing toddler in the mix.

I don't want to wait until after residency to have #2 because my daughter is already three years old and don't want there to be too large of an age gap. Any words of encouragement or advice on when to have baby #2 and how to get through the transition? Are my fears well-based, or should we just take the plunge?

Wanting to grow my family,



  1. Have any other women in your program had babies during residency? I would think things would vary from program to program. In my family medicine residency, back during the 30 hour shifts, the moms that had babies successfully had husbands who did not work, who could bring the kids up for dinner during a night shift, and who didn't mind playing the "mom" role. And our residency was very "pump-friendly" but I know plenty of others that aren't.

    I had both my kids after residency. The second kid really is a game changer. If you need a lot of time to read/study/do research at home, then that will be hard with two young kids. Even if my husband is home and tries to keep them occupied, if they know I'm home it's nearly impossible to get ANYTHING done for work at home. I literally have to lock myself in closets while kids scream and bang on the door to return pages.

    So I'd say make sure your husband is really ready to take on the new life as primary caretaker of two little kids. And talk to others in your program. And good luck!

  2. " Are my fears well-based, or should we just take the plunge?" Yes, and...probably yes. I think you've answered your own question here: "I don't want to wait until after residency to have #2 because my daughter is already three years old and don't want there to be too large of an age gap." If you definitely want a #2, and you definitely don't want to wait...there really isn't a question, right? As long as your husband is on board (not just in theory, but with the reality of likely being primary caregiver for an infant and a 3-4 year old). And you've planned childcare for when you have to go back to work at 6 weeks. I've known lots of residents that went through pregnancies (you don't pee because you're busy...but if you were seriously going to wet yourself, you would find the time to pee) and also pumping (though be prepared that you may not find enough pumping time to keep a strong supply for exclusive BF-ing throughout the entire first year...is this OK?)
    Yes, the second child (I had both after residency) is indeed a game-changer as Jackie stated. Just...a whole 'nother universe trying to deal with 2 kids with different needs to be met simultaneously. Its tough no matter what stage of training you're in. But its a phase and you'll get through it. Its good that you're thinking through the realities ahead of time, I'm sure you'll do fine!

  3. With the caveat that I currently only have one child, I just wanted to tentatively suggest the idea that it is possible to have 1 or more kids during residency without the husband becoming a SAHH, and without extended family in the area. It just costs a lot of money. I have friends who have borrowed money for childcare/gone into credit card debt/etc. to pay for childcare during residency. All have paid it off as attendings years later. Life's about tradeoffs. If you want 2 kids now badly enough, you'll find a way to make it work.

    PS -- It's still way easier with supportive family nearby to help!

    1. We have plenty of money and I still would say wait. Very hard to find other's to watch our kids to the same level of attention we do---even when we are sleep deprived. Maybe hire an au pair but those are not perfect either and you need to give them a room and they can't work more than 40 hours a week.

    2. Actually, it's 45 hours per week. And we do 1 kid with daycare plus au pair because of it.

      Not everyone is a 26 year old resident and has the luxury of waiting until the end of training.

    3. Sorry if my comment came off as rude. This is our second career so I completely understand that not everyone is a 20 something spry fertile resident. Having children is a personal choice. We were forced to conceive before we felt ready because of medical issues and we were grateful for the experience TO conceive. I believe each child is a blessing and truly each specialty is different. Surgical residencies are far different than pediatric residencies however carrying a baby is carrying a baby. And some programs are malignant and there are certain things money cannot buy. If fertility is not an issue and you would just prefer a baby in the next 9 months v. next 30 months I would say wait because it is so hard it's almost impossible to explain but again--everyone is different. To each his own. My cousin just started medical school and just got married--his wife is pregnant with twins and her parents live half way across the world. Everyone has their path to walk and we all have a burden to carry. Good luck!

    4. No worries. I get a little touchy when people suggest that only family members or parents themselves provide adequate care for kids. It's lovely when it works out, but not an option for everyone.

  4. Hi H!
    I'm in a similar situation having taken 1 year off from residency due to medical reasons and a second year off due to factors out of my control. Since we have "an extra year" my husband and I decided to try for #2. I'm terrified to return to residency next year with a 2 year old and a 3 month old but at the end of the day it feels good to have taken control of my own fertility. I'm not sure how old you are but I'm in my thirties and we will never get this time back. With that said I know it's going to be extremely hard and expensive. My husband works remotely 1-2 days per week but not daily. We have no local family support. Training will pass although I know the immediate road ahead will be difficult. Thanks for starting this thread I will be eagerly awaiting the replies you get. Good luck to you!

  5. I would just go for it. I have a 16 month old and am currently pregnant with number 2. I am an intern and had number 1 in med school too. It's not that easy, but its far from impossible. Overall pregnancy with number 2 is harder because there is a little person who needs love and attention so you can't (e.g.) just lie around when you are exhausted and not at work you have to keep looking after number 1. So the whole pregnancy is just slightly harder, although easier in that you just don't have time to be self-indulgent (which I probably did with number 1). When you need to pee, you just pee. You just have to. I travel with a small pack of nuts etc to try and keep the nausea at bay but otherwise just deal with it.
    Having a newborn I am scared about though - and no advice there.
    Oh and I have very little family support and a husband that has an intense full time job. As OMDG said, we just nanny it up. I spend WAY more than I earn on childcare. Such is life and it will be worth it in the end.

  6. I would wait. Peds is only 3 years. Having the second is like having three kids at once. Does anyone have their second at your program? some programs are malignant and won't give you any freedom to take time off, pump, call in sick etc. My ob friend went back to work 3 weeks post partum after delivering at 38 weeks. Her husband works from home and her mom has deep pockets. They want for nothing other than family time. We had our first start of ms4 and our second pgy3. Hardest thing in the world. Wait Wait Wait. It's not worth it. You won't get to enjoy your kids working long hours, being INCREDIBLY sleep deprived (you will hallucinate and the noise of a crying baby will never seem to go away), grumpy and blue about your responsibilities. Just wait until you have more control over your schedule and your oldest is in school. It's my firm belief there is nothing wrong with spacing kids out. Cuts down on sibling rivalry and allows you to really bond with the kids you DO have. It's a personal choice so do what you want but residency is a real kick in the balls (and the face -- sometimes at the same time).

  7. At the end of the day, number two is never easy, nor logical, when you think about it. But we don't have families because it makes sense or because we can neatly fit them in to our lives without changing much. We have them because we want to, because family matters to us. It will never be the 'right time' if you listen to your head, because having a child is a decision of the heart. No gap is the 'right gap', so do what works for you. If you want another baby now and you have the resources to care for two, then go ahead. If you have time up your sleeve and feel the family would benefit from waiting, then don't let the age gap dictate that. There are advantages to having a big gap and advantages to having a small gap. How would you feel if you waited and couldn't fall pregnant with number two? How important is having more children to you and your husband? Medicine will always wait. Life won't. Don't let fear stop you and your husband from having another baby. The fact that you are weighing this up means you are good parents, so whatever you choose, you will make sure the new baby and your daughter come first. We all probably know people who waited for the perfect time and then couldn't fall pregnant. As important as medicine is, life is about family. I hope this helps and I wish you well with your decision.

  8. I agree with Jess. No time is the right time, no gap is the right gap, when you feel you are ready then go for it. I had my first child in medical school and my second during a fairly grueling Internal Med residency. Was it the hardest thing I'd ever done? Yes, by a mile. But did it work out? Yes. I should note that I have a supportive husband, my parents moved to our city to help out when the second baby was born, and we hired a housekeeper. If your program is not supportive of your choices then I would suggest you are in the wrong program.

  9. I am sure it depends on the program and your personal needs and situation, but I would say wait to have #2 until after intern year. At my family med residency (in the days of 30-hr shifts), I got pregnant with #1 at the end of intern year, delivered in R2, took 12 wks off for maternity leave, and came back to a clinic schedule that was blocked from patients twice per day for pumping time. It was a very supportive program. Then, about 20 months later, near the end of my R3 year, I got pregnant with #2. Although I had originally planned to wait until after residency to have children and we had no family in our residency city (and my husband was also a resident at the time), we made it work by the grace of God. Best of luck and many blessings to you! Also, check out Dr. M.I.L.K. (physician Mothers Interested in Lactation Knowledge). This group was a great support.


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