Is there truly a best time to be pregnant, have a baby, and care for a newborn during a medical career? I’ve done the groundwork by having a baby in residency and two more as an attending. Here is what I found out along the way.

Is it even possible to have a baby during residency?

It was the end of a 24-hour call – I’m guessing similar to the ones most physicians in residency experience. Zero sleep, several high-intensity and stressful patient care situations, and a few graham crackers and ginger ale from patient waiting areas throughout the day to keep you going. When the call ended, the right thing to do was to lay down and get a few hours of sleep prior to driving home. However, your baby is waiting, and you haven’t seen her in 24 hours. You pumped milk in between admitting patients from the ER and a quick add-on surgery. You are desperate to get it home to see your child, so you rush out the hospital doors after carefully signing out to your oncoming resident.

Once home, you can’t wait to see your baby, your everything. Instantly, all stress evaporates and her belly laughs melt away the last 24 hours. Your husband gives you a quick kiss, hands off the baby that kept him up all night teething, and immediately heads out to the gym for an hour of his own much-needed downtime before starting his workday.

You lay on the floor to play with her and arrange pillows and toys surrounding her while you rest your head…just for a moment. The 24 hours of no sleep catches you and you realize you fell asleep on the floor next to your baby with no one else around. It scares you. Luckily, she hasn’t learned to crawl yet and is still content playing with toys. Exhaustion and exhilaration fill your days as a new parent/resident physician.

Time is lacking. Love is not. You will likely have to put your baby into childcare sooner than you would like. Six weeks maternity leave is pretty standard (but expect to use all of your vacation time for the year to cover it). You will also need to factor in additional calls before or after your baby is born to make up for the call you miss during leave. Your fellow residents will help by picking up the extra calls in your absence and will appreciate your reciprocity. As uncomfortable and painful as it is to take additional 24-hour calls while you’re pregnant, I highly recommend this instead of waiting until after the baby is born. Until maternity leave policies change in the US, this is what can be expected with having a baby during residency. More than six weeks off will likely involve adding time to your residency training. I actually agree with this as the high-yield information/learning obtained during residency will sustain your whole career; missing a large portion of it may put you at a disadvantage.

In the end, you will miss a few of the early milestones but will be reassured knowing that you will be available more in the future as an attending physician as your child grows older and is able to form memories of your time together. Plus, the days fly by as you are invigorated by your interesting days as a resident, while also knowing your life outside of the hospital is quite rich.

Your child will not suffer long-term consequences from you not being the one giving all the bottles during the day and tucking in for naps. You will be able to finish your training on time and have colleagues and program directors to help you cover the patients who need to be cared for in your absence.

The one person who may suffer a little bit is you. It’s hard to be away from your newborn while working 80 hours per week. So, why not wait until later to have a baby? Well, read on…

Yes, it is acceptable to plan your life and think about money

You may think this is backwards, but it actually makes more financial sense to have a child during residency than as an attending. I definitely don’t recommend finances to be the sole reason for having a baby during residency, but if you were thinking it didn’t make financial sense to do so, it may give you something to consider. We’re getting practical now. I personally didn’t factor in any of this when starting my family but realized the impact looking back.

You will be getting paid while on leave as a resident (covered through your accrued vacation time). You will have access to excellent health insurance coverage. It is not uncommon for your entire pregnancy and delivery to be covered by a $20 copay as a resident. Don’t expect this as an attending; if you aren’t seeing patients, you aren’t getting paid. It may also be difficult to find enough colleagues to help you cover your patients if you are in private practice. Most large employers will have some type of leave policy, but few will pay your salary while out.

As an attending I was able to take 12 weeks of leave, but it was unpaid. If you evaluate lost wages and earning potentials pragmatically, you actually come out far ahead by having a baby during residency. As an attending, you may be making 5x the amount of a resident, and 12 weeks unpaid leave is quite different than when a resident. When you don’t work as an attending, you don’t get paid. Why does this matter? Well, most of us right out of residency have six-figure medical school loans we need to repay as quickly as possible. Of course we don’t want money to be a factor in family planning, but sometimes it is, and it’s better to understand the consequences upfront.

The flip side to this is that, as an attending, you will have more income at your discretion. That income could provide a higher quality of childcare, and as mentioned earlier, help you enjoy more time with your newborn.

Why do we hate the term “advanced maternal age”?

Lastly, but perhaps most importantly, is age. In a recent discussion with other physician moms, more than half had gone through costly infertility treatments to complete their families. Some spend close to $100,000 for these treatments. Most of us in medicine are very driven people, who enjoy the rigors and challenges of our careers. We work diligently to make it through to the “light at the end of the tunnel” once the 8+ years of medical education is complete. However, once we can finally start to focus on family, children, and an existence outside of the hospital, we may have lost more than realized.

Far too many women may have missed out on their prime years of fertility by putting off childbearing. By the time medical school and residency is complete, most of us are approaching 30; add on a few years if fellowship is considered.

While 30 years old is likely not an age-related fertility concern for most, if you plan to have more than one child, it definitely could be. Around age 35, fertility starts to decline. In addition, if you do get pregnant, you are considered “advanced maternal age.” There is a higher risk for gestational diabetes, hypertension, chromosomal abnormalities, and miscarriage. Suddenly, you may find yourself longing for a second child, a sibling for your growing toddler, or a much-anticipated first child, but the answer may not come so easily. Physicians are fortunate to have stable incomes that allow us the opportunity to seek fertility treatments when needed. Ultimately, you will likely be able to complete your family, but it may be a long, financially, and emotionally exhausting journey through fertility treatments – and not the route you expected.

What really matters most?

Ultimately, the decision whether or not to have a child is very personal, and not every female physician desires this. However, the majority of female physicians do eventually become mothers. Our lives may become busier, but the dedication to medicine and our patients does not waver from the act of having a child. In some ways, I became a better physician after my own childbirth experiences.

The right time to have a child will be different based on personal values, support systems in place, and emotional readiness. But, perhaps we can help each other by being honest and open about what it is like to have children during a medical career. This way we can each determine the right time to expand our family, independent of pressures and expectations from outside influences.