Wednesday, April 29, 2015

MiM Mail: Planning for baby #2

I'm a resident, wife, and mom to one, hoping to have one or two more children. My first was born during intern year, and we're planning for a second during residency. With my first, I ended up with multiple third trimester complications that eventually led to 2 weeks of bedrest and delivery a month early. I've been an avid follower of MiM since before my first pregnancy, and I'm hoping for advice and encouragement from some of you.

I'm in a field that requires a separate intern year and am now working with people unfamiliar with my first pregnancy. All they know is what I choose to tell them. I think my current PD knows I had complications, but not the specifics. Thanks in part to an amazingly supportive PD my intern year, I finished PGY1 and started PGY2 on time. From a residency timeline I'm right on track, and I have some sense of when the "best" times could be to have another baby during my program. We'd end up with about a 2.5 year spacing. Our preference would be somewhere closer to 2 years rather than 3.5+.

My spouse is great with baby #1, does a lot around the house, and picked up a ton of slack during my first pregnancy. It was hard, but we made it through, and my upcoming schedule will be easier than it was last time.

Medically, my odds for the healthiest possible second pregnancy considering my complications are higher if we choose not to wait until after residency. Besides, at that point I'll have written and oral boards and be trying to establish myself in a practice, so I'm not convinced it would be much easier.

In many ways, I feel like I'm between a rock and a hard place. When I think about attempting #2 during residency there's a part of me that wants to believe we'll make it through just fine, but the realistic side of me expects a great deal of physical, emotional, and mental strain. I wasn't deathly ill, but it wasn't fun, and both baby and I could have gotten very sick very fast. I expect to deal with some problems again, but hopefully not all, and hopefully not the one that led to bedrest. I'll be meeting soon with a new OB to talk through everything.

I don't want to sell myself short, and if I feel like having a second soon would risk compromising my training. On the flip side, ultimately we don't want to stop with one kid, and waiting would only compound my risks. Jumping to adoption is not the right answer for us.

Where we are now, we have a lot of support outside of residency. Even if we move after training, it makes sense to have another baby while we're here. I think there would be support from my program, but I don't think it could be as robust as it was with my first. My previous PD was amazing; few could measure up. My peers have verbalized a mutual intent to help cover for each other when circumstances arise including babies, but I haven't gone into details of my first with them and don't care to unless it becomes necessary. I don't see how they could understand what I was up against, or how it would help to talk about it right now. I sure hope I don't need weekly or twice weekly appointments until the last short stretch, but we might end up there again.

I guess I have an idea in my head that if I do decide to pursue a fellowship and don't finish residency on time, I can look for a job for a year, maybe a couple years, and then continue training. I may also be happy without a fellowship. I know people say it's hard to go back to a resident's salary (or worse) after being out for awhile, but we could knock out a lot of debt in a year or two and be in a better place for me to take a pay cut, even with 2 kids in daycare. I don't think the financial side would prevent fellowship down the road if I wanted it.

Anyone have advice for how, when, and what to communicate to my program and my co-residents if we do get pregnant again? Thoughts on trying during residency with high probability for some (manageable) complications vs waiting and dealing with recurrent and possibly worse complications? What else do we need to consider? Anyone else make it through a difficult pregnancy without feeling like you lost your competence as a physician?



  1. I can't necessarily comment on your specific situation but I'm in a similar one. I had a complicated first pregnancy with preterm delivery and am planning for #2 intern year. I figure that pregnancy complications will be disruptive as a resident, fellow or attending. I'm also already in my 30s and know women going through IVF which is also very disruptive at all levels of training (multiple blood draws, procedures, imaging) not to mention expensive Bc it's not usually fully covered by insurance. By waiting, you also risk not having a second child, which you don't seem ok with.

    You owe it to your current PD to tell him/her in a timely fashion if/when you become pregnant again but you don't owe them any details about your first pregnancy unless you want to share. If/when problems arise in your second pregnancy you need to keep your PD informed bc it's good faith. You should work hard, be a good colleague and be grateful for co-residents who cover for you and do the same for them if they need but you don't owe anyone an apology for "choosing" to get pregnant during residency.

  2. I had my first in residency with third trimester complications and four weeks of unexpected bedrest. I just had my second in fellowship last week (fortunately without complications this time).

    I told my fellowship director only minimal details regarding my first pregnancy, and what I felt was relevant for this last one (possibility of bedrest and/or extra maternity leave for a c section), no other details. I didn't really feel compelled to go into specifics with them. Fortunately, my fellowship was very understanding.

    Having kids at any stage of the game is disruptive in one way or another. Communication (as well as a bit of luck and also steering clear of "malignant" programs) is probably the best way to go.

    Waiting would make me nervous. I got pregnant with my first on the first try, so assumed number 2 would be just as easy. 15 months and a second trimester miscarriage later, I finally got pregnant again (and carried to term). If I wanted another and age were a factor, I'd err towards sooner than later, and just deal with the consequences as they arise.

  3. I don't know the answer but it sounds like you've given this good thought and made good decisions (no need to divulge past complications. And hopefully they won't be relevant next time around …). Your program sounds at least not 'malignant'. For me, deciding to add another is hard because my family has been through a lot of stressors recently. But when we are ready, I hope we go for it. Medicine demands so much. You have to remember to live your life amongst it all as much as you can. It sounds like between your husband and surrounding support, and at least the intention of support from your cohort, you are in as good a position as you could hope to be if this feels like the right time. … Good luck!

  4. Thank you, ladies!

    @ 4/29 6:23 AM poster: What extra support and resources do you hope to have in place for #2? You know your intended program, but do you think intern year is better than PGY2? In my situation it was, but if you're going into first year of several at one program, have you thought about trying for a baby second year? It seems like the first year at any program is a rite of passage. For me, PGY2 is where I earn my keep for the remaining years at my program and I'm glad I'm not dealing with an uncomplicated pregnancy let alone a complicated one.

    @4/29 4:03PM poster: How did your residency schedule change with the bedrest? How long were you off after baby, and when did you finish? How did it affect fellowship applications, interviews, and start date? I plan to tell my PD early again (my last PD knew before my own mom), and I'll have to be intentional with updating on complications. I had such tunnel vision after each bombshell last time that I almost couldn't think straight for a few days, and the exhaustion of a brutal schedule didn't help. I'm hoping that having already been through it once we will have better coping skills to deal with it again.

    @ 4/30 1:16AM poster: Thanks for the encouragement! I hope we have the courage to press ahead despite the challenges. Life isn't always perfect, but it sure can be beautiful.


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