Being a medical student is tough, applying for a competitive residency spot is tough, and being a new mother is also very tough. I am one of the lucky women to do all three at the same time. I had my child early August of my fourth year of medical school. The fourth year of medical school is a great time to become a new mother. The schedule is more flexible, there are fewer exams, and there’s usually some built in time off for interviews that you can use as time with your little one as well. I want this article to provide some practical tips for new mothers in medicine and particularly during the time of flux that is residency interview season. I also hope that this inspires those that want kids but are waiting for the “perfect time” to dive right into parenthood anytime. Here’s a bit of my story for some reference. I knew I wanted to have kids when I met my husband. Before that, I was far too selfish. We honestly debated having a child before medical school even started. We had already been married a few years, and it seemed like a good time since I could take a few months off. However, we decided to hold off a bit longer. Then just after taking USMLE Step 1, we brought up the conversation again. It seemed like a good time. If I had a child at the end of third-year, my husband could take off time and come with me during my away sub-internship rotations. So we began trying. And just like that — the first month, I had a positive pregnancy test. It was an unbelievably happy time. Then as quick as it happened, it was over. I began bleeding and had a spontaneous abortion (miscarriage) early in the first trimester. I had never felt sadness like this before. It felt as if I was the failure. My body could not do what was necessary for a pregnancy. However, we were on a time crunch because I felt I could not have my due date anytime near interview season (October-January of fourth year). I became obsessed with my ovulation timing, and we went months without results. It was finally the last month we had agreed to continue trying, and I was worn down. I even caved and had a glass of wine. Then to my surprise, it happened again! Positive pregnancy test! This was December of the third year of medical school. Of course, I was again elated, but I was wary of letting myself be too excited until we were in a viable timeframe. For the sake of keeping the story on the shorter side … the rest of the pregnancy was relatively uneventful. I was induced at 39 weeks because my creatinine had bumped. Delivery was uneventful, and I had a beautiful baby boy during August of my fourth year. Then eight hours after delivery, my labs came back and revealed HELLP syndrome. This just basically kept us in the hospital an extra day and made me feel terrible, but I had a happy, healthy full-term boy, and so I was delighted. Tip #1: Be open about your fertility or pregnancy struggles because, most likely, many people you know are going through or have gone through the same thing. I got some much support when I finally opened up about my miscarriage. I had worked my schedule so that I completed my home program sub-internship right before my son was born (I actually had to miss one or two shifts). Then I had one month completely off. I did not do any away rotations since I was quite pregnant. This was a bit unusual for emergency medicine, but it all worked out. After the one month completely off, I had a case writing elective that I could do from home. Then I did a tutoring elective, which had flexible hours. Then I had two months off for interviews and finally a month of facilitating problem-based learning for the underclassmen. My husband’s schedule also was geared towards when I would have off too. He initially only took two weeks off for my sons birth and then went back to work until February and March when I went back to full clinical rotations. Tip #2: Stagger your leave time with your spouse if possible. See the chart for our schedules: Less than one month after to my son’s birth, our residency applications were due. I did most of the work beforehand, but that still left me with editing and getting my letter writers and other supporting documents squared away with a newborn. I even took my composite picture just one week after delivery. It was not my best photo, but at least my giant belly was gone. Tip #3: Sleep when the baby sleeps. Be productive when he/she is awake. At least during that first month. My strategy for scheduling interviews with an infant was to take him with me. So my husband ended up working mostly weekends (he’s a paramedic) and then traveling with me to most of the interviews. There were a few interview days that we had to elicit help from others, and I did go to a few by myself. My mom went to Wisconsin with me. My dad went to St. Louis with me, and my mother-in-law watched our son while I interviewed at my home program. Tip #4: Call for help! Use the resources you have! I guarantee many family members will be fighting over a day with your bundle of joy all to themselves (they may not ever do it again after battling fussiness all day, but oh well). Pumping on the go is quite an experience. I am not here to tell you how long to breastfeed your child or even that you have to breastfeed. I did, and here’s what I learned from doing so while traveling for interviews: I had gotten some advice that I should not let a residency program know that I was a mother. As if somehow that would be a red flag on my application (it still makes me mad when I think about it). Instead, I put it on the application that parenting was a new hobby of mine, and one of my letter of recommendation writers mentioned it too. I still got all the interview invites I wanted. So then when it came to pumping on the interview trail, I felt comfortable asking for time and space during the day to pump. I would send out an email (see below for my exact wording) about two weeks before the interview and explain my needs. I came fully prepared without the need for a refrigerator (I had a great cooler) or even a plug (I had battery powered pump options). These requests would not be unreasonable. Usually, the accommodations were a faculty member’s office that wasn’t being used that day. Some programs had official nursing rooms too, which was nice. Either way, it was feasible during the interview day for me to pump twice. I was also very fortunate to be a quick pumper as my son was a speed feeder. Tip #5: Be open about motherhood while applying to residency and jobs. If a place doesn’t want me because of my family, then it probably isn’t the best fit. Tip #6: Pump if you need to pump! Whether that’s work ( I still pumped during ½ of intern year too) or an interview day — just take the time to do it. My pumping email: Thank you for sending out the itinerary for _____ interview. I am emailing because I am a nursing mother and would like to pump twice during the day. It usually takes me 15 minutes start to finish each time. Is there possibly a time and place during the interview day that I could pump? I look forward to meeting you on ____! Then there was the challenge of travel. If I were driving, I would pull over every three hours and pump using my battery powered plug. Again, the good-quality cooler came in handy here to store the milk and the pump pieces. For flying, you can travel with more than four ounces of liquid if it’s breast milk (despite TSA rules for carry-on liquids). They do have to run a fancy test on each bottle over 4 ounces, but it’s quick. Many airports have pumping rooms or even a family bathroom you can find a plugin if need be. I even had a quick layover, so I had to pump during one of my flights. I just used my nursing shawl and warned the poor passenger next to me. He was totally understanding since he and his wife had five kids! Tip #7: Only wash pump parts one time per day if you can keep them refrigerated. I would put mine either in the fridge or in the cooler with the fresh milk. Then I would wash them once I got to the hotel, home, apartment, etc. Tip #8: The gear you need for pumping on the go: the pump, a high quality cooler that will keep cold for 12-24 hours, ice packs, battery operated pump plug (I had a Spectra pump but the Medela battery plug worked for it), paper towels, nursing shawl, Ziplock bags for pump parts, hand pump for back up, spare batteries, milk storage bags or bottles. All in all, I had a great experience traveling and bonding with my son while applying to residency. He and my husband came with me most of the time, so I think I actually got to see him more. Don’t get me wrong, we were all exhausted! No one slept much in the hotel or rental — or even at home for that matter, but we were together, and that’s what mattered to me. As far as starting residency, my son was almost one year old by then and still relatively portable. We tried to bring him to any social event so that my fellow residents could get to know him too. When we moved, my husband decided to stay home with him, so we don’t have to worry about childcare (I am super spoiled). And again, I was not shy about pumping when I needed to. As a woman in medicine, no matter when you decide to have a child, there will be hundreds of reasons to wait just a little bit longer. Just do what you think is best for you and your spouse. No time is perfect, but it will all work out. Molly Johnson is an emergency medicine resident. Source
