Megan Fix, MD

Disclosures

March 12, 2009

Question
What happens to a resident if she gets pregnant in the middle of her program? Is it possible to have a baby and still be a good resident?

Response from Megan Fix, MD
Attending Physician, Maine Medical Center, Portland, Maine

The answer to this question is an emphatic yes! It is absolutely possible to be pregnant and still be a good resident. The key to making this work is to know what challenges you will face, to plan ahead, and to make sure that you take care of yourself and have good family support.

Forty-four percent of 101,044 residents in 2006 were women. This compares with 34% of 43,977 residents 10 years earlier.[1] Some estimates show that up to 44% of female residents will have their first baby during residency.[2] This means that there are many women having children during residency.

Although getting pregnant during residency is common, it is not without challenges. A review paper by Finch[3] highlights these challenges, which include on-call responsibility, sleep deprivation, tiredness, long and unpredictable work hours, difficulties with childcare, and breastfeeding problems. In addition, colleagues may feel an increased burden when covering for your maternity leave.

A review of the literature suggests that there is a trend toward increased risk for adverse events in late pregnancy for residents, such as preterm labor.[3] A woman may also experience significant conflict over the competing demands of being a mother, student, and physician.[4]

Still, despite the challenges of motherhood in residency, the rewards are great. Ask any mother how wonderful it feels to come home to a smiling child at the end of a long day. The key is to anticipate the challenges and to plan accordingly.

First, you need to find out about your residency program's policies. Many programs have written parental-leave policies to improve the experience of parenthood during residency. This is not universal, however. Some specialties, such as pediatrics and family practice, have detailed and specific family-leave policies for residents.[5,6,7] Emergency medicine, however, allows individual programs to define family-leave policies.[8]

Family leave policies can vary significantly. A survey of teaching hospitals suggested that the average maternity leave is 6 weeks.[9] Other programs give residents up to 12 months.[10] I encourage any resident who is even thinking of getting pregnant to determine the exact details of the program's leave policy. If none exists, you should be proactive and work with your program director to develop one.

The American Medical Women's Association offers this statement about pregnancy in training[11]:

  1. Every residency training program and medical school ought to have a written pregnancy/disability leave policy.

  2. Maternity leave should be at least 6 weeks, in addition to other scheduled leave (vacations, conferences, etc).

  3. Although pregnancy and childbirth are not a disease process, they do require a period of healing. Therefore, maternity leave should be covered by disability insurance as required by Federal law.

  4. All medical schools and residency training programs should publish and distribute maternity leave policy to all applicants.

  5. All women physicians or medical students have a duty to notify their residency training director or school about their pregnancy status as early as possible.

  6. Residency training directors should respond in a responsible and respectful manner and encourage faculty and house staff to do the same.

  7. At a minimum, residency training programs must be in compliance with the Pregnancy Discrimination Act and state disability laws as those laws apply to pregnancy-related disabilities.

Next, you should make preparations for returning to work after your parental leave ends. One study interviewed 21 physicians who had become parents during residency.[10] The authors found that although most colleagues were supportive during pregnancy, re-entry to work was the most stressful. They identified several areas to consider: planning and scheduling rotations to allow maximal flexibility; ensuring breastfeeding access at the hospital (refrigerators and privacy); arranging for academic activity during parental leave (ie, attending conferences), which provides an important connection to peers; and maintaining clinical skills while away.

During this planning process, be sure to communicate your goals clearly to your program director and colleagues, as well as to your family. Some residents find it helpful to have a parent or close family member stay with them after the baby is born. Others assume nontraditional parenting roles or have the nonmedical parent work part-time. Again, make sure that you communicate with your partner about your parenting goals to enjoy the smoothest transition once the baby is born.

Finally, it is paramount to keep yourself healthy in mind and body throughout the process. To emphasize this point, I'd like to quote Dr. Casey MacVane, a fantastic physician who has balanced motherhood, chief residency, and her second pregnancy all during her third year:

Making time and a concerted effort to eat well, exercise and be with my husband and son were essential to staying happy and feeling good. If you let all this go, it makes [pregnancy] impossible. It seems harder than ever to do this, but it is essential.

You absolutely can be a great physician, resident, and mother. If this is in your future, my advice is to plan ahead, know your policies, communicate with your program director and partner, and take care of yourself in the process. Best wishes!

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