Friday, April 21, 2017

Guest post: Two lines

I have become a pee-on-a-stick expert. Ovulation sticks? Done. I have that LH surge targeted with laser precision. Pregnancy tests? I've spent a fortune on negative tests month after month.

Until this morning.

I woke up early to go over my grand rounds talk one more time. I started my normal morning routine, which starts with peeing on a stick, and then moving on to washing my face, brushing teeth, and then glancing at the usually negative test before tossing it in the garbage.

But there were two lines. Two lines! TWO LINES!!!!! I shouted at the fireman to get out of bed and come look. Did he also see 2 lines? "Any line means a positive on a pregnancy test!?" I shouted. "I don't know, it looks faint. You always say I don't know anything about this baby stuff," he replied, sleepily. His thoughts were on the extra 40 minutes of sleep he had left before another 24 hour shift.

I finished getting ready, smoked my presentation, and then took advantage of the freedom of my research rotation to escape the hospital and come back home to reflect. Two lines? I'm pregnant? I'm pregnant.

I'm a pregnant, 4th year orthopedic surgery resident with a husband who works 24-48 hours at a time. Our closest family is 3 hours away and I have no idea how we are going to do this. But there are more pressing, immediate issues to think about. I start a joints rotation in 2 weeks.

This presents a unique issue for mothers(to-be) in medicine. Do I give up my privacy, tell my program that I'm 4 weeks pregnant and I wish to be excused for cementing in all the total knee cases? If I do step out, who will do that part of the case? What if I miscarry? Do I want to have that conversation with a bunch of gray haired old orthopedists? Do I read the literature (again) and tell myself that it will likely be fine, scrub the cases and keep this wonderful miracle to myself until I am confident in my pregnancy? When I put on double lead aprons, will my secret give itself away before I even have a chance to make a decision about how to tell everyone the news?

I will only be the 2nd female resident in my program to have a baby (in addition to 2 former hand fellows), and that was at least 5-6 years ago. Until 2 years ago, the words "maternity leave" did not appear in our vacation policy. My program is considered "female and family friendly", but just because we have a larger number of female residents, and the male residents all have 3-4 kids each, doesn't mean they are ready for this.

What would you do? How did you announce your pregnancy at work?


I am a 29 year old, 4th year orthopedic surgery resident married to a fireman/paramedic. We live in the midwest and, aside from our two 4-legged children, have been trying to conceive for the last 6 months.


  1. Congratulations!! I love that you get to call a fireman for a test confirmation that made me lol. I don't really understand the comment about cement (assume toxic fumes bad for breathing?) but I would hold onto that info until you hit second trimester if it is safe for the baby. I have friends that told too soon and then miscarried and it became public and they felt very vulnerable. Public tears, being hurt when attendings told them to suck it up basically, you name it.

    I would hire help. Go into debt hiring help if you need to you can pay it off later. And you will find if you look there is lots of help to be hired. My nanny during residency - I had two kids (just day nanny not night) was invaluable to my accomplishments there (chief, finishing without a gap except for leave, getting great job, etc.).

    Big hug and good luck to you!

    1. And you will need a night nanny! I'm just a pathologist. My best friend is a opthalmologist and her husband is a flight medic and they need night nannies with her call and his shift work. Their kids are older now, so they have nannies on call if she gets called in.

    2. Could also do day care and an au pair, but yeah, you'll need night coverage. I don't know the risk of cement - I know other women who've been concerned about it and have revealed during their first trimester, but everyone's risk assessment is different...Mazel tov to the OP!

    3. Thank you for your comments! The cement we use in total joints has been shown to be teratogenic in animal models, but no real evidence in humans. Generally anesthesia and nursing staff are not assigned to total joint rooms when they are pregnant, but as a surgeon I have to make the call myself. So I either out myself very early or expose myself to a possible teratogen (again human evidence is lacking and almost reassuring based on serum levels obtained after total joint cases). Very tough call!

    4. Can you switch rotations with another resident and limit who knows? In general, the earlier a PD knows about a pregnancy, the better he/she can plan for future leave, etc. Certainly up to you and comfort level about when to tell; I think I would choose to tell earlier vs later (and to least people as necessary) if potential occupational exposures are present. Good luck and all the best.

    5. I'm unable to switch rotations as this is the last rotation of 4th year and the same rotation is required again in 5th year. I've just simply told them that I will be leaving the room during cementing. My PD was very supportive and then old, gray haired joint surgeons just gave me blank stares!

  2. I feel for you. I am an anesthesiologist, it is hard to decide what to do. On the one hand, you don't want to disclose too early because miscarriages happen and then a lot of awkwardness ensues (I know from firsthand experience). On the other hand, the time of pregnancy that teratogenic exposure is most likely to have a negative impact on a pregnancy is early in the first trimester. During all my pregnancies, I did my best to protect myself/baby throughout, but particularly early on regarding radiation exposure, nitrous oxide exposure, total joint cement, and patients in droplet precautions/isolation. Yes, as you say, the evidence is mostly reassuring, but you also have to ask yourself how you will feel if the unthinkable happens and you miscarry or have a baby with congenital anomalies- will you continually be beating yourself up/wondering "what if I hadn't...." or will you be able to accept the outcome either way, knowing that in most cases of miscarriage and congenital anomalies there was nothing the mother could have done to have changed the outcome, and move forward. That is something each of us must answer for herself. When you know the answer to that, what you need to do with respect to your training program will become obvious. Best wishes for a successful pregnancy, an understanding program director, and supportive co-residents!

  3. Congrats x 2 lines! Do what feels right, double lead and all. Could just be the new fashion. But seriously, hope you don't fret over that part. Be well!

  4. Congratulations! I would tell early and protect my little fetus. After a healthy baby and then a miscarriage I take my pregnancy health very seriously. I agree with the commenter who said to get great help. I think an au pair Or a live in grandparent is an excellent idea for the first 2 years. Or would dad be interested in staying home or working part time for a while? Residency even with a husband who was a student w a relatively flexible schedule was insane. You need a seamless child care set up w back ups for your back ups.

  5. Congratulations!! I'm an anesthesiologist and faced the same dilemma. I told early and was unapologetic. I worked with my PD ago rearrange rotations so I looked proactive but also did everything I could to protect the little bean. I asked for their help in keeping things as quiet as possible, and thankfully they attributed most assignment swaps to "generic scheduling changes" when the emails circulated. It bought me time- at least until 10 weeks.

    In the end, rotations can be rearranged, but you're the only one who can protect your little one. We shouldn't have to apologize for that or take those risks in the name of looking strong. Hang in there!! And good luck trailblazing. You can do it!

  6. Just a medical student here but pregnant with number six. I have extreme hyperemesis gravidarum and just got started on TPN and homecare after a week in the hospital. Hopefully, you have a safe and healthy 9 months. So much can happen. Do what is best for you and your new family.

  7. Congratulations! It is so so exciting to see that positive test. I would echo a lot of what has been said. But, for me, when it came to exposing my peanut to some kind of harm, even if I made the decision ahead of time that the exposure was minimal to none, I couldn't do it when the time came. My protective maternal hormones over-rode all reason. I chose to tell early... which at my job meant 6 weeks. They kinda knew already though because I was constantly drinking ginger ale and eating muffins...
    - Momma-doctor with a 15 month old and ophtho husband, pondering #2...


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