“I have some news to tell you,” I texted my friend.
“Are you pregnant?” she replied.
“No, I’m going to try for medical school,” I wrote back, not at all surprised by her response since I had heard it so many times.
“Oh,” she replied, “I really thought you’d be pregnant by now.”
As I announced my decision to pursue medical school in my mid-twenties to friends and family, I could see their brains making the calculations: a year of a post-baccalaureate program to complete the slew of prerequisite requirements, a year off to apply, four years of medical school and three to seven years of residency and fellowship training. The math did not add up; how did this leave any room for “the babies,” especially since my husband and I had been married for four years already. How much longer could we wait?
I was not sure myself. I spent hours on Student Doctor Network and other sites trying to find out how doable it would be to have children in medical training. Nothing made me feel better. Every point of time along the path sounded impossible.
If I had a baby the first year, what would I do about mandatory anatomy labs and the resulting formaldehyde exposure? In second year, I would be pregnant during Step 1, which seemed equally unworkable. Third year would mean being pregnant on rotations, and fourth year on residency interviews. If I became pregnant during residency, I would have to juggle working 80+ hours while pregnant and then nursing. As an attending, I would have more responsibility and could be penalized for taking leave due to my salary’s dependence on productivity. It also did not help to see the shining photos of Instagram doctor moms who seemed to have immaculate homes and four babies on their hips. My life was not that put together on any given day, so I had doubts I could pull this off with a baby.
Then it hit me: you know what else seems impossible? Medical school. The amount of material you need to learn in such a short timeframe. Memorizing all of First Aid for an eight-hour board exam. Despite these seemingly unachievable undertakings, we put our heads down and start chipping away at the work before us. We want to be doctors. This goal is non-negotiable. The conversation is not about whether we should do it but how. We bend our lives to fit around this goal.
Having a family, for some of us, is also non-negotiable. We want to be moms, and we have the right to pursue more than just medicine. So let us flip the script in our mind. Our mindset should not be a question: “Can I have a baby during my training?” Instead, let us decide, “I will have a baby during my training, and this is how.” Own it. Do not apologize for it. Just as we bend our lives to fit this goal, medicine must also bend itself to fit our goals. Our childbearing years are short, yet our careers are long. It would be wise for medicine to work around these years to secure the talent of its female trainees for the long term.
Let’s consider how to have a baby in medical school and pursue motherhood in training. Here are ten tips to make the seemingly impossible, possible:
1. Determine if you are ready to have a baby.
Do not wait for when your training timeline is ready for you to have a baby.
There will never be a time in your medical training when it will be convenient for you to be pregnant, nursing, or raising a family. As physicians-in-training, we know that pregnancy and fertility are precarious. Children may have special needs. All children get sick, which means scrambling for care at the last minute when the daycare calls you to pick them up. There is no magical time during your physician career when it will be easier to take on the inconveniences inherent to parenthood. If you are waiting for permission to have a baby, you will not find it.
Give yourself permission to accept the risks and joys of parenthood. Proceed confidently.
2. Inform your program about your plans.
Do not apologize or ask for permission. Know your rights.
If and when you have decided to have a baby and if you are comfortable, reach out to your Dean or program director to let them know your plans. Again, this is not to ask permission. Instead, use the conversation as an opportunity for information gathering so that you can plan to the best of your ability (while still recognizing that you can’t plan for everything).
Here are some questions I asked my Dean:
- What support structures are in place for when I have a baby?
- Are there school- or hospital-sponsored daycares?
- What is the process for taking a year off? Can I do research during this time
- What flexibility can you give me if I decide not to take a year off? For example, can I take a couple of blocks off during my third year and start my rotations a bit later than my classmates? In the preclinical years, can I take a block off and complete the requirements during the summer break?
- How can we rearrange my schedule in case I give birth early or have an unexpected medical issue?
In these conversations, be sure to know your rights! Under Title IX, your medical school must accommodate your pregnancy and pumping, if you so choose. As COVID-19 has shown us, the timeline for completing medical school requirements are not set in stone. Rotations can be moved around or completed at a later time than your classmates. Lectures can be attended remotely. Respirators can be provided for anatomy lab. Your school should be creative about helping you reach graduation.
3. Gather your “tribe.” You cannot do it alone.
It is difficult to raise a child on your own, especially within medicine. You need a “tribe.” This can be made up of your partner, local daycare, a nanny, and/or family and friends.
If you have a spouse or partner, engage in conversations early on to set realistic expectations. Most likely, your partner will have to take on the bulk of the childcare given the inflexibility of our career choice. If your significant other is also in training or works a demanding job, you will need serious discussions about how to balance two careers. My school allows for using a year off in blocks of months at a time, rather than all at once; ask your school if this is possible for you. Perhaps you both take a year off in six-month increments, alternating the time spent at home with the baby. Maybe you need to invest in a live-in nanny. Regardless of the solution, do not fall into the trap of assuming roles based on gender! Encourage your partner to also take leave. All working partners, regardless of gender, are afforded twelve weeks of leave (albeit unpaid) to bond with a baby under the Family and Medical Leave Act (FMLA).
Daycare is expensive and can easily surpass your rent costs. Prior to getting pregnant, I called local daycares and the hospital daycare, which is subsidized by my university, to get a sense of the cost. My husband and I started to put away the estimated monthly daycare costs for about two years before our daughter was born. It proved to us that we could manage the price and created a financial cushion for the years ahead. In our case, it helped fund my husband’s unpaid portion of paternity leave. If both of you are in training, talk to financial aid about increasing your loan amount to cover daycare costs.
Another option to consider is a nanny. Nannies are more expensive than typical daycares but can offer greater flexibility in medical school. Home daycares are another alternative; they tend to be cheaper and smaller. We ultimately chose the option of home daycare because it was closer to our apartment. Our runner-up was the subsidized hospital daycare due to its expanded hours and proximity to the hospital.
Be sure to place your child on the waitlist immediately after you get the positive pregnancy test (or if you adopt, the moment you hear the news of a placement). Unfortunately, waitlists are also expensive so prepare to shell out hundreds of dollars for the process. If you decide to go with a home daycare, know that the spots are limited; word of mouth or neighborhood Facebook groups and listservs can help you find these daycares and know about any openings.
Family and Friends:
Another option is to have family and/or friends help create a support structure. This can allow for tremendous cost savings while also giving you the flexibility you need. Moreover, it encourages bonding between your baby and family. Start the conversation with your family now. Would they be willing to help with the baby? Can they take care of the baby during stressful pre-exam times? Can they help with call nights? Even if your family is further away, think creatively. Perhaps they can fly in during particularly stressful times.
4. Plan to take a standard maternity leave. Do not assume you need a year, but if you do, take it.
I felt that the consensus online was to take a year off medical school after giving birth. While I was pregnant, particularly in the time of COVID, this seemed to be my school’s preferred option. However, this was not my school’s decision to make. I ended up asking for what I wanted: twelve weeks off for maternity leave. In order to take this time off, I had my baby during my third year, which was more flexible than my first two years of medical school. My Dean told me that all students get 20 weeks of “flex/vacation” time that can be used throughout the third and fourth years. The plan was to use 12 of the 20 weeks for my maternity leave. This would mean that my fourth year would have fewer vacation weeks, but I was fine with this trade-off.
Of course, I also had the option of taking a full year off. Luckily, my school also had some flexibility with this. They would have allowed me to take it in monthly increments so that I could spread the year out however I wanted. For example, I could take four months upfront and then take the remaining months at a later time (perhaps to have a second kid and take another maternity leave).
During my maternity leave, I realized that I was accomplishing quite a bit of my research project with my baby sleeping on my lap, so I was able to ask the school to designate some of the time as “research weeks.” At the twelve-week mark, I felt ready to return. My husband took over baby-duty by exercising his right to twelve weeks (partially unpaid) of FMLA (see step 3 on how to save for this).
Personally, I would not have been happy taking a full year off, but everyone is different. Do not assume how much time will feel “right” for you prior to having the baby. Keep your options open and consider working with your school to have multiple plans in place that may include a year off, a year off in monthly increments, a research year, a dual degree, or several weeks off that will allow you to graduate on time while also taking some time to adjust to motherhood.
5. Reconceptualize time.
During my maternity leave, I read “I Know She Does it: How Successful Women Make the Most of Their Time” by Laura Vanderkam. This book helped me to re-think time. Often, we think about the time we spend away from our babies but not enough about the time we spend with them. Even when we dedicate 70 hours a week to working and studying, that leaves 98 hours to sleep, eat, and spend time with family. I have started to think of my time more holistically. Demanding months like my Medicine and Surgery clerkships may be balanced by elective and research months that require fewer hours than even the typical nine-to-five job. Furthermore, by having my daughter in my late twenties and not during my forties as an attending, I have added ten extra years of time with her. Time that I hope will allow me to see weddings, graduations, and grandchildren.
On a smaller scale, I find it helpful to go to bed earlier around 8:30 p.m. and wake up around 4:30 a.m. to study before heading to the hospital. This leaves my evenings free for baby time.
6. If you are taking a board exam, sign up for accommodations.
While I was pregnant, I did just fine in all my courses while carrying my baby and was in the process of diligently preparing for Step 1. I joked that I had “two brains,” which gave me more intellectual power.
But it is important to know that Sophie Currier won us the right to have pumping and breastfeeding accommodations while taking our Step examinations. These accommodations allow for extra break time to pump or use the bathroom and stretch during pregnancy. You will need a letter from your provider documenting the need for accommodations and your due date. I wrote a detailed letter about the risk of prolonged sitting in pregnancy, given the increased risk of DVTs, back pain, and frequent need to urinate. This sped up the process since my midwife just reviewed the letter, signed it, and placed it on letterhead. If you need a sample, email me. NBME also allows you to bring a pillow as a personal item exception, so don’t forget to make yourself comfortable.
In case you are wondering, I did not end up taking Step 1 pregnant because of delays caused by COVID. However, I feel that I would have been able to take it in my second trimester with no issues. My third trimester would have necessitated many more bathroom breaks but would still have been doable. From my estimates, even pumping would be doable with the extra Step 1 accommodation time.
7. Pick a health care provider close to school.
Make sure to pick an OB/GYN near your classes or rotation sites to make your treks to prenatal appointments more convenient. I decided on a private practice obstetrician rather than an academic practice to ensure that my classmates or future residents would not be involved in my care. My obstetrician delivered at my school’s academic hospital, making it the best of both worlds. My medical school classmates did not participate in my labor and delivery, but they did visit us on the postpartum floors. My daughter was the most popular baby on the wards!
8. Reach out to your insurance company.
Prior to medical school, I worked on the issue of the Affordable Care Act (ACA) as a federal service fellow, so it was always important to me to understand health coverage and to avoid surprise billing. I was able to find an in-network OB/GYN provider who delivered at the hospital affiliated with my school. I triple checked my required co-pay for the delivery, and we set that amount of money aside in our Flexible Spending Account (FSA) the year prior to giving birth. It gave us peace of mind to know that we were covered and had the money set aside when the time came. We also saved money with the tax benefits of the plan. If you do not have access to an FSA, it still makes sense to set that money aside to avoid a large bill upon returning from the hospital.
Under the ACA, women also have access to free breast pumps. Reach out to your insurance company around the third trimester to find how to obtain it.
9. Plan for the worst.
Given how much I depend on my husband to help care for our daughter, we knew that we needed term life insurance. In my second trimester, we started looking in earnest for coverage for my husband for the next ten years. We started with a simple question: if something happened to my husband, how much support would I need to complete my medical training? We then calculated the amount that a live-in nanny and daycare would cost (we figured I would need both) and went from there. I was also able to get myself insured by the American Medical Association in case something happened to me.
10. Lastly, it is all about priorities.
Let us be brutally honest. You can’t be June Cleaver at the same time as a physician mom. You won’t have a perfect house. You’ll miss out on some milestones and bedtimes when you are on call. On the flip side, you may say no to projects and opportunities in order to protect time with your child. You can’t have it all — at least not all at once.
Sit with yourself and reflect on what you want out of life. Reflect on what you value and what you can let go of. For me, I decided to give up on pumping. I did not want to miss a second of rounds; my learning was too important, and my baby was just fine with formula. My weekends are still spent preparing for shelf exams and practical exams. And my husband spends the bulk of his time caring for our daughter so that I can invest in my training. I have decided: I will not let having a baby make me any less of a practitioner. My future patients deserve my dedication. But just as importantly, I will not allow this career choice to forfeit my having a family.
Ultimately, being a mom-in-training has its challenges but is far from impossible.
Sometimes the Instagram doctor moms do a disservice by not highlighting the tribe that helps support their ambitions. Do not be ashamed to ask for help. For some reason, modern society has decided to place the bulk of childrearing on the shoulders of women; however, it was never meant to be a solitary pursuit.
Embrace your career, motherhood, and the support structure that enables it. Own it. And whatever you do, do not apologize.
Image credit: courtesy of the author.