Medical Training and Childbearing: Finding the Path

 Jennifer Leiser   By Jenny Leiser, MD

As the mother of four adult children, I am often approached by young women considering medical careers. They wonder about that elusive work-life balance. They feel uncertain about whether there is room in their future for a family and a demanding career.

The culture of medicine is undergoing many changes. Studies show younger physicians (male and female) are less likely to accept older norms of working many hours and being absent from home and family life.  Women wonder about the physical demands of pregnancy and childbearing while in training. Their partners often want to participate in the care of their young families.

The primary childbearing years are in the 20’s and early 30’s. Medical training generally takes place in the same decades of life, and consumes 7 to 13 years of that time period. It is illogical to assume that childbearing and medical training will not occur simultaneously. As we place a high value on equal career opportunity for all, we need to adapt to meet that goal.

Cultural changes take time, and are uneven in their spread through society. There is always some trepidation when approaching your program or medical director to say “I’m pregnant.” What kind of attitudes can students and residents expect from the leadership of their programs?  Sometimes the response is warm and supportive. Other programs may not be as far along the cultural change continuum. Pregnancy may be seen as “optional,” with the unspoken assumption that the pregnant person has somehow been irresponsible. The harried program director may not want to deal with alterations to the schedule and is disapproving. Leaders of traditionally male-dominated specialties may react more negatively.

I believe that leaders should assume women will become pregnant, go on leave, and return. Partners of pregnant women will also go on leave and return. Since we expect this to happen, we plan for absences from the program and have procedures in place to balance the work that we need to get done.

Medical students and residents are entering a profession that places high value on hard work, not letting others down, and pulling your own weight. They naturally want to be seen as positive team members in their programs. So what can trainees do to empower themselves in this time of cultural transition? Here are my suggestions.

Do not allow outsiders to make your decisions on whether and/or when to have children.

The authority for that decision rests solely with you and your partner. Others cannot take your authority away unless you let them. So don’t let them.

Accept the reactions you get in an adult way, and do not take them personally.

Program directors have heavy responsibilities. You may get a negative reaction that is really about something else on their plate. Other residents may view your absence negatively if they think your absence will add to their workload. These are natural emotions. They provide an opportunity for you to engage in positive action. Planned or unplanned, pregnancy is one of the most important events in your life, and you do not owe anyone an explanation of how it came to be.

Help your program create the solution.

You will meet less resistance if you come prepared with a plan for how the work can get done. For example, offer to take extra call during your second trimester, when most pregnancies are a bit easier. When you get back, make it up to the other residents who covered for you while you were gone.

No guilt, blame, excuses, whining, or entitlement.

As human beings, we indulge in these negative emotions from time to time. Better to accept responsibility for your choices and their consequences.

Take the long view.

In five years, your residency class will have scattered. Your child will go to kindergarten. No one will remember that they took an extra weekend of call for you. (They will remember if you have indulged in blame, whining, or entitlement.)

Pay it forward.

Cover for others who need time away. Encourage the intern coming after you. Expect that solutions will be found. When you step into a leadership role, create a supportive culture.

Be in the present.

Work hard while you are at work, and love what you do. Then forget about it and go home to your family. There are not that many chances in life to experience the joy and intimacy of young children growing up.

It will all be fine.

My career has been a grand adventure, and so has being a mom. My kids grew up in spite of everything and turned out great. I wouldn’t change anything.

Jennifer Leiser, MD currently serves as Chief of the Family Medicine Division of the University of Utah School of Medicine.

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