Materni-tine

It was the best of times and it was the worst of times to have a baby. 

For starters, I don’t want to be a pregnant healthcare worker in a pandemic again. No thank you.

We tried to induce Baby Girl early in November when the COVID was really hitting the fan here in the Midwest and we didn’t know if it would get worse. Didn’t matter, she didn’t budge. She ended up (as her older brother) needing a for-real induction a week after her due date. After the delivery, we struggled with a retained placenta so it seemed like the never-ending pregnancy - even though we had a baby, we still. weren’t. done.

There are definitely pros and cons to taking maternity leave during a pandemic. It has been so nice to keep my entire family at home for twelve weeks, although twelve weeks at home with a fussy baby and a three year old with minimal visitors has been trying at times. I am somewhat of a germ-a-phobe with small babies even in non-COVID times, so COVID gave us an easy out of crowded holiday family gatherings. It did get lonely. We made a grandparents-only visitation rule which worked out great until one side went south for the winter and the other actually came down with COVID so stayed away. I had to be intentional about Zooming everyone from college roommates to high school besties - and I definitely found some solidarity in their loneliness as well. It’s hard for everyone here as winter in the Midwest doesn’t really lend itself to outdoor socially distanced gatherings. My husband and I don’t feel like we’re missing out on anything by staying at home with our kids - because that’s what everyone else is doing too.

I will be ready to go back to work in the next couple weeks. I’m a little nervous about jumping back in at full speed with an extra little body to coordinate, but I’ve decided to “give myself grace” (a phrase I stole from one of my patients) and remind myself that it will be messy and it will still turn out OK. I got my second COVID vaccine which is reassuring. I did decide to vaccinate and continue breastfeeding which is consistent with AAP/ACOG/Academy of Breastfeeding Medicine guidelines. The doctor in me reviewed the evidence, weighed the risks and benefits, and made the decision to vaccinate. The mother in me called my mom immediately after my first vaccination to get reassurance I was doing the right thing. 

This is how I know I did maternity leave right: I rewarded myself with a post-COVID vaccine haircut (10+ inches gone! Hello mom cut!). My hairstylist asked what I’ve gotten done during my maternity leave and I couldn’t think of a single thing outside of snuggles and legos. And I wouldn’t have it any other way.

Kicks

Boards, wards and...umbilical cord?

This is going to be one long rambling post. I know I've been mia (sorry KC). After finishing first year I just didn't have anything to write about. All I wanted was time to myself and with my family. Then second year came and went. I was able to stop pumping at lunch and ate lunch like a normal person (read: in the library, eating over my laptop, looking at slides). During winter break this year, we went on our usual family vacation to visit my in-laws and I spent two weeks loving life. I felt rejuvenated and was ready to attack the second half of 2nd year plus everyone's favorite, Step 1. Yes, I can do this, I am awesome and wonderful and multitasker extraordinaire. Want to see my color-coded Excel spreadsheet with my study schedule?

A few days into January, I felt funny. Funny, not like haha funny but rather oh shit I might be pregnant funny. I only had an expired cheapo Amazon pregnancy test. I don't think the second line could have appeared any sooner. It's just faulty, it's expired anyway (note: clearly scientific brain was not working at this moment.) My poor husband ran to CVS at 10pm at night and got me two real pregnancy tests and the first one I took turned positive just as quickly as the expired one. And then, I cried. We both didn't know what to say the rest of the night. We have two kids, we're living in student housing in a 3 bedroom apartment. I'm a medical student, staring down Step 1 and going onto the wards. He works full time and is doing a part time MBA. How would this even work? And for the next few days we honestly didn't know if we were going to go through with it and I found myself dumbfounded that I would be in this position, thinking about termination. Me, pro-choice advocate, having to decide for myself what my choice would be. I'll save you the drama and the back and forth, but long story short, we decided not to go down that route and we warmed up to the idea of having 3 (and by warming up, I mean we've accepted it and we're now excited but have no idea how we are going to deal with it come September). But can I just say how amazingly privileged am I to have been able to make a choice for myself, about my body? And equally important, privileged enough to have the resources to actually support another child. End political rant.

My first trimester was a blur of keeping up with school and keeping down my food. I had a meeting with my Dean and asked about what would happen to my third year "if one was to get pregnant." Luckily I was able to get a relatively decent rotation schedule and I start medicine during my late second trimester and finish with family and ambulatory before I go on leave. I just have to take my family shelf 2 days before my due date; I've already told my ob not to touch me during the month of September. I finished my last block of second year, which signified the end of my preclinical years. Somewhere along in there I had an NT ultrasound and my lovely doctor indulged me in a potty shot that revealed a penis, which after two girls, was amazing and surprising. I started studying for Step just as my second trimester began and the fog of nausea and fatigue magically lifted as if it was meant to be (but really, thank you placenta).

Alas, after weeks of studying, not seeing my family ever and having to rely heavily on the support of my husband, my mom and my nanny, I sat for the exam with baby belly, braxton hicks and stretchy pants with no pockets (so they don't make you turn them out during security checks!). I definitely felt a few kicks during the exam, cramped up a few times, but surprisingly 7 hours of testing with a fetus sitting on my bladder went by pretty quickly. And now, I have a few days off before 2 weeks of bullshit pre-wards orientation that are mandatory and then we're off to the wards.

I received an email today from the school letting me know I can't go to one of my doctor's appointments during said bullshit pre-wards orientation, that it's against policy. Because, you know, from 7:30am-5:30pm they're going to keep us prisoners with no breaks, no time for lunch or for me to slip out and see my doctor across the street. That I can do my glucose screen and prenatal check at another time (read: while I'm on call. On internal medicine. At the county hospital. An hour away from campus.) because that makes so much more sense. What bothers me most is this. I don't expect any sort of special treatment. Never in my 2 years at this school have I lamented about being a parent in medicine. I've never asked about more time for studying, I've never been absent. I haven't even taken a sick day. I've passed every single one of my exams and I've always made adjustments on my end to make things work on their terms. My school has ironically created a program called Parents in Medicine. Whoever goes to these events I'm not sure. I don't really know what the program actually is because if you're truly a parent in medicine, you don't have time to go to these things. While I appreciate that they're thinking of us, they're really not thinking of us the right way. We don't need to have events to talk to other parents in medicine and commiserate together about the system. Sure, having a fun family day is nice, but I can do that on my own. What we need is academic support and administrative support. I need to be able to go to a damn doctor's appointment, not have a 2 hour get-together in a park that I can't even attend because I'm studying. I need someone to answer my email that I sent out months before the start of said orientation about scheduling a doctor's appointment. End pregnant-lady hormone-driven rant.

Drama aside, I am excited to get on the wards and finally be closer to "practicing" medicine, but I'm also slightly terrified. I'm afraid of looking dumb, looking too pregnant, looking dumb and pregnant. Being away from my family and missing important events. Oooh and giving birth on the wards or during my shelf exam because I insist on finishing. Ironically the first rotation I'm on when I'm back from maternity leave is ob-gyn, so essentially I'll deliver baby boy huffing, puffing and screaming and then join the team a few weeks later - hey guys, remember me and my vagina? I'm already done with my birth plan. It reads like this: "No medical students please." Sorry guys, but let's be honest, it will be hard to pretend I don't know you.

Hopefully I'll have some time to write about being pregnant on rotation. I'm sure I will have some lovely stories to share.

Let’s be like Sweden...or Why doesn’t anyone talk about paternity leave?

Hi everyone, I’m Anna Plasia.  This is my inaugural post for MiM!   A brief introduction: I am a pathologist with a new baby, but I've been reading MiM since long before I became a mom.  I'm married to my best friend who also happens to be a father-in-medicine.  I'm honored and excited to be part of the MiM family!

******

I have to admit that I was reluctant to get pregnant.  I was happy, and I didn’t want anything to disturb that balance.    My husband and I are both physicians, and our relationship up to that point had been that of equals.  Obviously there are things at home that one or the other of us has taken over due to interest or entropy, but overall our relationship was egalitarian.  And honestly, I didn’t really see examples around me of parenting relationships that were what I hoped for.    My own parents were both professionals, but it was my mom who stopped working for several years when I was born and it was my mom who managed all doctors appointments, birthdays, shopping, cooking, cleaning, etc.  I was sure that my parents’ relationship must have been similar to ours in the beginning -- but becoming parents made them became so...traditional.  So is having kids just inherently unequal?  Obviously men can’t actually have the baby, but are women really genetically better at managing doctors appointments and birthdays and cleaning, or is there something structural going on that makes things turn out this way….every time?

It turns out that the seeds of parenting inequality may be sown as soon as the baby comes home.   According to a report produced by Boston College Center for Work & Family in 2014:

When we ask why it is the case that most men aspire to be equal partners in caregiving but often fail to meet even their own expectations, there can be many possible explanations for this shortfall. One cause that seems clear from our work and that of other researchers is that this performance gap begins in the very first days following the birth or adoption of a new child, when the disparities between the experiences of mothers and fathers emerge immediately. In our research, the majority of fathers take only about one day of leave time to bond with their new children for every month the typical mother takes….During that time at home, fathers are seldom “flying solo” in caring for their newborns (Harrington et. al, 2011).  

It makes sense - - if mom is the only one home with the baby for the first three months then of course she is the one who knows the most about baby.  She knows what baby eats, what soothes baby, what baby wears.  When dad comes home from work he’s stepping into mommy territory.  When baby needs soothing it’s just easier for mom to do it because she already knows exactly what to do.  And if mom has been off of work for a few months then she’s definitely the one getting up at night with baby.  When she goes back to work she will continue being the one getting up with baby, leading to exhaustion, burnout, bitterness, and curtailment of professional duties.

So the question then obviously becomes what happens when men take off their own version of “postpartum” time? In several Scandinavian countries (see Iceland, Sweden, and Norway) fathers are provided with paid paternity leave that they must use or the time is lost.  In Germany and Portugal mothers get bonus time if dads take their allotted time.  It turns out when men take more time off with their new babies the benefits last for a long time.  A survey of parents in Iceland which looked at how childcare duties were divided both before and after a paternity leave policy was implemented found that “there is a direct correlation between the length of leave taken by the father and his involvement in care afterwards.”

My husband and I both agreed that equality in parenting likely begins in the first weeks...so my husband decided that he would take two months of paternity leave.  We are lucky that both of our jobs were covered by FMLA, and we did not fear permanent professional repercussions from taking time off.  But this is definitely the exception, not the rule for physicians.  This decision came at a significant financial cost as both of us took unpaid leave, but we decided some things are priceless - money be damned.  Because it’s unusual for a man in the US to take off a significant amount of time for a new baby, no one could wrap their head around it.  The reaction was...confused.  “Wait, did you say two weeks - or two months???”  No one had ever heard of a father doing this...especially not a physician with an “important” job.  No one tried to dissuade him from doing it, but it was definitely seen as an unusual request.  I am so proud of him for sticking to his guns...honestly it takes courage for a man to buck the trend.

My husband’s extended leave was one of the best decisions we made about having a baby.  We spent the first month at home together.  I can’t imagine being left at home alone with a new baby a week or even a few days after giving birth.  That first month we woke up together for every nighttime diaper change and feed.  Those first nights are long, lonely, and dark, and I can’t imagine going through them without my best friend beside me.  At the end of my leave, my husband took his second month off, and it made the transition back to work so much easier.  Every morning I left our baby with my husband - who knew what to do since he spent that first month at home.  There was no mommy guilt about returning to work with a 10 week old.   And now I really don’t feel like one of us is the primary parent - we are both just parents.

Unfortunately, our experience is not the norm for physicians.  As a physician, unless you are employed by an academic center or a large hospital, your job is often not covered by FMLA.  Many physicians are employed by private practices with fewer than 50 employees or are self-employed and cannot afford to put their business on hold for an extended period of time.  I was told up-front at several (private practice) job interviews that I would only be able to take vacation time for maternity leave.  If it is this hard for physician moms to take medically necessary maternity leave, imagine how much harder it is for physician dads to take off extended paternity leave.  At the same time I am sometimes surprised when I hear of physician dads who take off less time than they would for a vacation when their partners have a baby.  Obviously there needs to be a shift in both the cultural expectations surrounding paternity leave as well as the law in the US before this becomes a more commonplace occurrence.

I also realize that we are very privileged that we could afford to both take off time from work.  The sad truth is that for many Americans this is not a choice they can afford to make.  Ours is the only developed country in the world whose government does not guarantee any paid leave to new parents (source).  Due to exclusions built into FMLA, only 60% of workers are eligible for the unpaid leave guaranteed by FMLA.   Only around 25% of US employers offer paid maternity leave, and even fewer offer any paid/partially paid gender neutral family leave (which includes paternity leave).  It is the lowest paid members of the workforce who generally have the least access to paid or unpaid leave.  And since family leave is usually unpaid, fathers are even less likely to avail themselves of it as they are often the higher earners (source).   Most families can barely scrape by on one salary for any amount of time, never mind three full months.  Having an egalitarian paid parental leave policy in the US would go a long way toward making parenting a more equitable experience.

Did anyone else’s partners take off extended paternity leave?  How was the request met?  Do you think this is viewed differently in medicine than in other fields?

The Return From Maternity Leave: Rusty or Rested?

This article on KevinMD was published a week or so before the end of my maternity leave. As I read it, steam emanated from my ears. How dare the author insinuate that physicians lose their technical skills from taking time off equivalent to more than a mere weekend? What about those who must take prolonged time off for sick leave? And what about maternity leave? Are all physician moms, by the sheer reasoning that they had babies, now deemed incompetent?

It goes without saying that we physicians are humans who need adequate time to heal physically in order to perform well mentally. We all need vacations (longer than a weekend) to help stave off burnout, and we all become sick from time to time. During my training and career as an anesthesiologist, I have taken significant periods of time off for vacation, maternity, and sick leave, and yet I've never had a problem integrating back into the basic flow of my job. In fact, on my first day back to work after three months of maternity leave, I had a patient go into anaphylactic shock in the OR - a very rare and deadly event. End tidal CO2 dropped from 37 to 10 and blood pressure was 50/30, but once I identified it I knew exactly what to do. I counteracted the reaction and saved his life with the fortunate and timely assistance of a couple of colleagues who I immediately called into the room (having extra hands is obviously essential in these kinds of situations).

I recently posed this question of competence to physician moms in an online discussion group. Most respondents agreed with me but cited other issues they had returning to work. Some had to regain their prowess with the EMR, others stated that they had a little trouble multitasking, but all felt confident in their abilities to do their required work tasks. I would say that the hardest part for me has been transitioning each day from Mom to MD and back to Mom again. Preparations the night before a workday seem endless, and morning routines take longer than they used to. Picking up my daughter from childcare after work increases the commute time and anxiety depending on how late my OR day has become. I have yet to be the last parent to pick up their child at night, but I'm sure there will be a day like that sometime. Evenings go by so quickly, and I feel I have barely seen my daughter before bedtime comes. Add in being a part-time physician, and suddenly I feel what some moms warned me about: not enough at work, not enough at home.

So Mothers In Medicine, I ask you: how did you feel returning to work after maternity leave? Rusty or rested? Share your experiences here.

MiM Mail: Share your anecdotes about pregnancy and maternity leave

Hi fellow mothers in medicine, I'm currently a resident and pregnant with baby #2. I must say that the attitudes I have encountered throughout this pregnancy from my attendings and peers have been discouraging. I'm working on writing an op-ed piece about attitudes toward pregnancy and maternity leave among US physicians and would love to have more quotations and anecdotes from your experiences. Positive and negative comments are welcome (please comment below)! Sadly, mine have been mostly negative. Thanks so much!

MiM Mail: Maternity leave policies during medical school

Hi Mothers in Medicine,

I am a medical student, a mother, and I am working with a team at my university to further develop its policies on maternity leave and flexibility for mothers in the medical program. Currently women have to withdraw from the year and repeat it the following year, or are allowed only a few weeks off after the baby is born. Surely this can be improved! Part of my role in this initiative is to research the policies that other medical institutions have in regards to this issue. If you went to a medical school that had a great policy in regards to taking time off, being flexible etc would you mind leaving the university information and possibly a contact in a comment on this post?

Many thanks,
A.


*Anyone is also free to send mothersinmedicine@gmail.com your contact information to be forwarded if you don't feel comfortable leaving it in a comment.

Guest post: Having Babies during Residency: A View from the Bridge

This post is in response to our MiM Mail: Residency limit for leave and having children posted in November.

The problem of maternity leave for residents goes well beyond the good will, or lack of it, of training directors and local programs. Different specialty boards establish minimum standards for residents to be board eligible, and these usually involve specified upper and lower limits of time spent in particular areas. Stipends come from multiple sources and are tied to the work that the resident does, which makes it difficult to set aside money from one year to pay for time doing make up work in another. When a resident goes on leave, other residents have to pick up her responsibilities, and they will not receive compensation for doing so. At the same time, they may not violate duty hour limits.

Program directors, of which I was once one, have to figure out how to create maternity policies that do not violate minimum requirements, do not unduly burden other residents in the program, do not violate other regulations and still acknowledge the legitimate needs of the resident who requests leave. When I became a program director, my youngest child was 4, and the issues of maternity leave were still very fresh in my mind. My first thought was to ask the department to hire a PA or master’s level nurse who could float to cover the clinical responsibilities of residents who took leave. That went nowhere, though I still think it would have been feasible and fair. I then tried to get the program directors organization to survey its membership to see what different programs were doing. The push back was immediate and negative. Programs with generous leave policies were reluctant to publish them, for fear that residents would select them to take advantage of them, multiplying the headaches of trying to make accommodations. Many programs had no policies at all.

I am sad to see that so little has changed in the last eighteen years—soon, my daughters will be the ones who have to deal with maternity leave. Change is unlikely unless more women become program directors and choose to work on modifying the policies of various specialty boards. The family practice board position (see MiM Nov 10, 2014) is one that others could adopt. It suggests that programs might create some creditable elective time that could be spent reading or doing some other scholarship from home. Women should be allowed/encouraged to schedule the more taxing rotations early in pregnancy (and I would suggest also front loading as much call as one can). It is still up to the program how much leave to allow and whether it will be paid or unpaid. The AAFP also leaves unanswered how to deal with what may be competing demands of the law in a particular state and the requirements of a specialty board.

In the end, women physicians cannot expect to be treated more fairly and generously than other women. Having a child during training will never be easy, but we should be mindful that we are generally privileged. We may have to delay some phase of education, or prolong it by working part time, or even chose a specialty or a position we would otherwise not have done, because of having a child. Compared to the pregnant UPS driver who gets fired, or the Walmart worker who has to stand on her feet all day, or the mother who can’t work at all because she can’t afford childcare, we are lucky indeed.

-juliaink

Question: Maternity leave

Lately every night I'm on call I seem to be the magnet for pregnant patients - trauma, acute abdomens, appys, choleys - you name it.  During my last call as we talked about my pregnancy magnet, it lead to a discussion about having babies during residency.  We happened to be a diverse group of providers with a diverse and international training background. The take away from the discussion was basically that in the US we don't value new moms, dads or babies.  Those who had trained elsewhere (in surgery) seemed to feel that it was just natural to expect residents to take 4 months, 6 months, or 1 year off (mom or dad).  Meanwhile we all told stories of post c-section residents NSAIDing their way through full operative days 4 weeks after giving birth.  We talked about how broken your body can feel so soon after giving birth, both mentally and physically.  We talked about those itty bitty 6-week old babies in daycare.

So, for those of you who have trained elsewhere in the world:

What is the attitude towards new moms and dads in other countries with more flexible and lengthy maternity leave policies? 

Are residents looked down upon for taking leave (like they often are in the US)?  

Does a culture of more family centric leave create a more equitable distribution of gender roles in the home and the workplace? 

I'm just wondering...

MiM Mail: Pregnant and joining a new practice

Hello,

I've stumbled across this page from time to time and have found it very supportive and informative.

I am a soon-to-be graduating neonatology fellow in the south.  I have one son who is almost a year and a half.  I am married to a very supportive, non-medicine type husband.

A few months ago, I accepted my first position as an attending in a private practice, community hospital setting to start a month after I graduate from fellowship.  I just recently found out that I am 7 weeks pregnant with our second child.  While my first emotions were excitement and joy, very shortly after came apprehension and guilt about joining a new practice while pregnant.  I am know I am not the first, and will certainly not be the last, to be in this position but I would like to hear from other moms in medicine about their experiences with this.  When should I tell my new practice that I am pregnant?  As soon as possible or just show up to work 20 weeks pregnant and tell them then?  How and when should I broach the subject of the length of maternity leave?  I would really appreciate any advise or insight from other moms in medicine.

Best,
Anonymous

Guest post: Maternity leave, or lack thereof

I am a psychiatry intern currently about to have my first baby towards the beginning of my second year.  I feel so blessed to have this baby, who we recently found out is a girl.  I am not the emotional pregnant lady everyone speaks of--just so so happy about our family's future.  It took me a long time to decide to do psychiatry, and when I wasn't sure if I would have kids in residency, I thought of ob-gyn.  Now, seeing how accepting and supportive my program has been of my pregnancy, I am happy with my decision.

But, there are a few things they can't change, and they have made that clear to me.  For example, if I want to fast-track into child psychiatry, which I do wish to do as the fourth year curriculum at my program isn't ideal, I absolutely cannot take more than 35 days off during my second year.  This includes all vacation and sick time.  After some deliberation with the program director, we have come to decide that I will be taking my four weeks of vacation, plus 10 days sick time, to make a total of 6 weeks maternity leave.  This leaves me with 5 days of baby sick time or emergencies for the entire remainder of my second year.

While I am okay with this scenario, and actually it's more than I expected to have in residency, I grow more and more bitter towards the field of medicine.  Family and friends are always so shocked when they hear about the above "maternity leave."  My friends in finance always fire back with, "What! So-and-so at my job got pregnant and had 4 months paid maternity leave, without using vacation."  Gosh, wouldn't that be so nice.  When MIL heard about the maternity leave, she couldn't believe it.  Her response was, "But that's not fair!"  Who's to decide what's fair?

I am beginning to think more and more about simply extending the residency and doing a fourth year as much as I don't want to.  It's an easy call free year and I may like to have the time to spend with my little daughter.  However, with looming debt over our heads, I would really like to be able to make an attending salary sooner.

Some that read this post may think, "Wow you are lucky, that is a great amount of time!"  But I don't feel lucky to have to pass my baby on at 6 weeks.  I don't feel lucky that I'll be taking a lot of call while my baby is an infant.  Or that after much hard work, I still have to squeeze pennies to buy baby stuff.

Does anybody else agree that medicine just sucks for motherhood?

This looks like more fun than it is

I remember in the last few weeks of my pregnancy, it took every ounce of my strength to drag myself to work every morning, between being sleep deprived and having pain in every joint that was capable of feeling pain. I hung in there because my maternity leave was finite and I wanted to spend every moment of it with my baby. So that meant coming in to work until the bitter end.

But it turned out I wasn't the most miserable person around. In fact, it never even occurred to me that there might be people out there who were actually jealous of me and my thirty-pound belly.

I discovered the truth one evening, while I was sitting in the office I shared with my swingin' single male co-resident. We were complaining about our workload and suddenly he blurted out:

"I wish I were pregnant."

I had never been so shocked. Immediately, a range of angry replies ran through my head: What part of pregnancy would you like? Would you like to carry 30 extra pounds around with you everywhere you go? Would you like to have to wake up 10 times a night to pee? Or would you just like to go through a painful labor possible ending in a major abdominal surgery? What part of being pregnant appeals to you the most??

I didn't say any of that though. My reply was, "You don't really mean that."

He quickly said, "You're right, I don't."

Of course, what he really meant was that he wanted to have a six week maternity leave. Except what he really meant was that he wanted six weeks in Bermuda.

To many people who have never cared for a newborn before, maternity leave seems like just that: a vacation. And those who cover for you when you're gone get resentful that they have to work harder so that you get a six week vacation, while all they get is a measly 3-4 weeks.

Comments like the above fed into the extreme guilt I had surrounding my maternity leave. When I came back to work, I was afraid to even talk to anyone for months because I assumed all the other residents hated me for getting a "paid vacation".

And even though it's been over a year since I returned from leave, I still haven't completely left those feelings behind.

Childbearing in Surgical Residency

My intent was not to make such a serious posting, but I did not succeed.

After 8 years of surgical residency and fellowship, I am happy to report that our lives are returning to some sort of “relative normalcy.” Stress the word “relative” as most would not describe it anything close to “normal.” Life as a junior staff surgeon involves frequent call, occasional emergencies, and the ability to pick up slack for my senior partners. But my life now carries with it innumerably greater amounts of flexibility than life as a resident or fellow.

I now have a small teaching group of 2 female medical students in their first year of medical school. They “shadow” me in clinic or the operating room once a week. Although both are interested in what I do as a surgeon, inevitably they are most curious about my decisions and experiences with childbearing and family life. I tell them about training. I tell them that it is hard but that family life and motherhood are great and well worth it.

It was harder than what I tell them, especially as most of my training was before 80-hours and “80-hours” is often still theoretical in surgical training. All medical training is difficult, but surgical training is perhaps the hardest. Finding the balance between family life and work duties is hard for all surgeons, particularly for women surgeons in training.

The “ethos” of surgery remains principally masculine and rigid. Surgeons are supposed to be particularly strong, not to complain, and to go along with the “status quo”. While this may sound backward and negative, paradoxically in many circumstances I find the first two of these qualities admirable, and I still believe surgery to be one of the most exciting and rewarding career paths that anyone could choose.

As most parents will testify, childbearing is one of the less challenging aspects of parenting. But decisions around childbearing and the time with your newborn are important shaping experiences.

The concept or image of a pregnant surgeon, whether or not in training, is still a foreign one to quite a number of surgeons, some of whom feel free to share their opinions. The decision and process of pregnancy for women residents (I suspect in a number of medical fields) produces anxiety and (both subtle and overt) comments. I have seen female residents leave surgical residency either for another medical specialty or leave medicine entirely as a result of issues surrounding childbearing. Two of my female resident colleagues “decided” to return to work only a few weeks after giving birth because one had been placed on bedrest before giving birth and the other was told two weeks was all the residency program could bear. Female residents that take full time for maternity leave often “owe” additional months (as it might be in other training programs) but also often suffer palpable resentment from fellow residents.

This is, in part, because typically the decision for a female surgical resident to have a child directly impacts the entire training system. And surgery, worse than most other medical sub-specialties, has not found solutions to address these issues. Most surgical training programs suffer from more limited people-power. When one person is not performing optimally or is absent for any reason, the entire team feels it. The call schedule might change from every 3rd night to every 2nd (of course, illegal under current regulations). This issue is perhaps the worst in some of the sub-specialties where the entire training program is composed of a handful of individuals. Interestingly, several of my female friends who have entered small private practices after training also experience similar pressures as childbearing would impact their partners' lives significantly.

Issues of maternity leave, parental leave, and time for other parenting duties in most residency training programs have not been traditionally prioritized. Not surprisingly, fields like surgery which have been slowest to find solutions and to transform their ethos feel much-needed pressure to start making changes -- as women now make up over half of graduating medical school students nationwide.

Personally, I “timed it” well, having my daughter during my years in research during residency. My 4-year-old daughter is beautiful, well-adjusted, and a great kid. And my husband and I have found a satisfactory parenting balance that works. I am extremely lucky, but I would like for my experience to be less of the exception.

Maternity leave for medical mothers

The association of directors of residency training in psychiatry has just started surveying program directors about their ATTITUDES toward maternity leave for residents. Years ago, when I was a member, I tried to survey them to find out what the range of actual policies might be, but no one wanted to disclose this for fear, I guess, that women would choose programs with better policies. Still, this punt is a form of progress, and the day may come when young women may have that kind of information, and not be penalized for making use of it.

Since I have changed to medical student education as my professional focus, I have become even more concerned about this issue. My first year in the job, an excellent student failed her clerkship exam about a month after delivering her first child. This led me to research the issue of "motherbrain"--cognitive problems women report after delivery. (I recall my pregnancy friend describing it as "someone took my brain out, administered a few swift kicks, and replaced it rotated 45 degrees.") Although the problem is one women commonly report, the research on it, like earlier research on perinatal depression, has been dismissive. Because the studies all exclude women with depression, severe insomnia, or medical complications, they have not found "objective" evidence of impairment on a limited number of tests.

Research or not, cognitive impairment (poor concentration and short term memory) may be a significant problem for women after delivery, lasting an unknown period of time. While I don't want to discourage anyone from working and demonstrating that mothers can be competent professionals, inadequate maternity leave and too early return to work is not a trivial problems. Students may fail their exams, and the rates of human error, already too high in medicine, may be affected as well. If I thought the information would be used in a non discriminatory fashion, I would be advocating for more attention to research in perinatal cognition. As it is, I try to warn students and residents not to underestimate the impact of childbirth, and to take adequate leave, even if it requires financial sacrifice or prolongs training.

Has anyone else been concerned about this?