Heart of EM, Workplace

Motherhood in Residency

I was racing my kids out of the house this morning to try to make it to work on time.

My son's shoes, wet from the shortcut through the morning grass, slipped on the edge of the sidewalk. He tore up his knee on his way down. I gathered him up and we marched right back upstairs for a quick appointment with Dr. Mommy. My little man was still limping when I dropped him off at daycare. I was late to work.

"I don't know how you do it," they all say.

I have heard this phrase so many times over the past 2 years. To many residents, having a baby or raising kids on top of the stress of this professional phase seems impossible. Having children was never a question for me. I come from a big family and am the second-youngest of 5 siblings. My husband and I were ready to start our family as soon as we were married. Delay was not a sacrifice we were willing to make. We knew we would face challenges during residency, but we looked at it as a temporary investment in our future.

I started intern year with a 9-month-old, and 6 months into the year found out I was pregnant with our second. I am very fortunate to be in a program that has been supportive and accommodating to my journey as a Mom. Our PD was open to helping me design whatever maternity leave I decided was right for me. I have been able to breastfeed my daughter for a year despite working odd hours, rotating in and out of ICUs, and facing COVID.

I have gotten to where I am one day at a time, with a lot of help from others. Along the way, I have learned a few things about successfully balancing life with residency. I offer this advice with the added warning that it will take dedication and resolve. The To-Do lists are draining but the rewards are priceless.

Checklist for Pregnancy & Parenting in Residency

Have a support system.
This is requirement 1, 2, and 3. I would absolutely not be able to manage everything on my plate if my husband wasn’t incredibly supportive and involved. He constantly steps up and co-manages our household. He wakes up early with the kids to let me get an extra hour of sleep. He does laundry, sterilizes pumping parts, packs lunches, and the list goes on. He never complains. He is a saint.

You will need extra help apart from your spouse. My husband and I have no family nearby. Luckily, I matched to Stony Brook with 15 other amazing people who I am very grateful for. I occasionally have to ask my co-residents for emergency and non-emergency childcare, and someone always offers to help. I don't think they realize how much it means to know that I always have a backup plan.

Announcing a pregnancy and insisting on breastfeeding may put you in a seemingly vulnerable position because it is simply not the norm. Add to the fact that women remain a minority in EM and it can be even more uncomfortable. Our department is no exception to staffing ratios, but the female core is fierce. I was confident they would rally for me if I ever needed it – which I didn't (the men here are pretty great too). But, knowing these women are present and waiting is another blessing. 

Pregnancy is not a handicap.
It is amazing and beautiful. Some pregnancies are harder than others. I was blessed with relatively easy pregnancies. I got through the early days with a package of ginger candy and the later days with my trusty compression socks. 

Whatever your experience, try not to ask for or accept special treatment unless necessary. Appreciate the attendings who make a point of getting up to put the discharge papers in the rack themselves, but don't expect it. You are capable of performing your clinical duties at the same level as your peers even while being very pregnant. 

Don't ask for permission.
I told my PD I was expecting at 8 weeks. I knew I would need accommodations and thought it was important to be forthcoming. I had no reason to be anxious because I had made a personal choice and knew I was capable of managing residency as a pregnant woman and later as a mom of 2.

So telling – not asking - is the best advice I can give to a resident who is planning a maternity leave or trying to breastfeed. In addition, plan ahead and communicate. This is your journey, but remember you are dragging all of your peers and supervisors along with you. Understand you will be inconveniencing your colleagues, so do your best to minimize the impact. Contact your off-service attendings ahead of your rotations and tell them exactly what you will be doing and when. Use judgment about when it is reasonable to leave your shift.

My approach in the ED was to try to see several patients back-to-back right before I had to go pump. Then I would use the phrase "I am going to go pump. I will be back in 30 minutes." I would write the charts of those few patients while I was pumping. I never once asked for permission. This worked for me because I was tactful and reasonable about my needs. On rare occasions, I truly could not get away and I had to be OK with that. There were clogged ducts and an episode of mastitis, but they were few and far between.

I would also tell you to remember that breastfeeding is not embarrassing. Pumping technology has made it possible to wear cordless, hands-free breast pumps under your clothes while you carry on with your day. They are not discreet, and you will be the subject of lots of double takes, but this was a lifesaver during my critical care shifts and in single coverage zones. Not many people can say they have intubated and placed crash central lines WHILE pumping to feed to their baby. I am pretty sure this is how I earned my SuperMom badge. 

Prioritize your responsibilities.
As a medical student, I listened to a short webinar on being a female in EM. One of the facilitators who was a PD said something to the effect of – "As a Mom and a physician, you will not be able to do everything at 100% of your ability. But you can do everything at 80%. If you can accept that, then you can do it." I was pregnant at the time and took this straight to heart. If you are like me, you have always been an overachiever and are maybe a bit competitive. You will have to learn how to accept and forgive yourself for a lack of perfection.

Having a clear distinction between work and home can be helpful. Do your best to finish your notes and clinical tasks before you leave the hospital so that you can make the most of the couple of hours that you can see your family that day.

FOMO will be real. I follow our group chats closely and always want to say yes when my peers are planning something fun or meeting up for a spontaneous happy hour. But alas, bedtime is 8 pm sharp.

You will learn to choose what balls have to be dropped. Do your best. Apologize when you fall short, but do not make excuses.

No Judging.
I am not a perfect mother, wife, or resident. I don't spend enough time with my kids. Sometimes they go to daycare just so I can sleep. My husband and I never go out. I sometimes need reminders to complete administrative tasks for work. I haven't stepped foot in a gym. But – my toddler says please and thank you, he tells me he loves me – as does my saint of a husband, and I was given the privilege of being elected chief by my peers and faculty. I can't be doing too bad, right?

No judging also applies to your peers. Don't fall into the trap of minimizing the experiences of your peers by comparing them to your own. Life as a working mom is tough, but it was a choice. Your peers may not have the same responsibilities, but it doesn't mean they can't also be tired or stressed. I make a point of never negating a complaint by playing the "I have the same problems plus 2 kids" card.

On that note, no complaining. Remember why you are doing all of this. You are a badass Woman/Mom/Doctor. You will rise. You will tackle each day as they come. You will survive. And you will love your new normal.

Editor's note: This post appeared first on The Morning Report blog run by Stony Brook Medicine Emergency Department.

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