A Few Lessons from Becoming a Mom in Residency

This is the very first guest post ever on this site, and it comes from none other than my awesome wife. Thanks for sharing your experiences and insight!

I’m the type of girl who likes to be prepared. Give me a test and I will highlight, notate, and study my anxieties away. Years of pre-med, med school, and residency have solidified this routine and have turned me into a preparation machine. So naturally, when I got pregnant in my 3rd year of residency, I hit the Internet to start studying up.

What to expect? How do I let my program know? How will this affect my patients? My career? What will it be like when I return from maternity leave as a newly minted mom?

I was met with endless blog posts detailing how to make the perfect goody bags for my delivery day nursing staff and hundreds of lists about just how many pairs of socks my little one would need. So like the perpetual student that I have become, I spent many restless nights studying these posts, comparing their merits, and trying to fit all of the information together in a way that made sense in my life.

This helped, in that I was so busy reading, comparing, and consolidating this information in between my busy clinics and residency life that I didn’t really have much time to be anxious about the inevitable changes around the corner.

I suppose it’s no big shock that being pregnant and then being a mom during residency still brought quite a few surprises that I had been unable to prepare for. So many moments that made me wonder, “why didn’t anyone tell me about this?” So here it is, a list of things that I wish someone had told me. For preparations’ sake.

Telling your program director

Let’s get this party started. Telling people makes it real, right?

I told my PD that I was pregnant at around 15 weeks. This ended up being good timing because it was early enough that schedule changes and coverage could be arranged but not so early that even speaking to people made me nauseated. Thank you, morning sickness.

Good timing aside, there were still some hurdles involved in divulging my growing secret. Medicine is filled with many types of people, including those that say things like “you’re so lucky that you get to have such a long vacation” when referring to the postpartum weeks.

I found that while these remarks made me furious, they were thankfully relatively rare. I’m not sure how to prepare you for the haters except to say that I think that these comments come from people who simply don’t “get it.” And that’s fine. They don’t have to get it. You’ve got bigger things to worry about (see below).

Luckily, my PD was very supportive and excited for me. In fact, he even encouraged me to run for chief resident despite being pregnant (elections fell in my 39th week), explaining that it might be hard at first but if it was something that I wanted to do, it would be something that would ultimately make my time at work more fulfilling. This advice didn’t exactly ring true immediately, especially when I was making schedules just a couple of weeks postpartum or coming back a week early to run intern orientation. However, despite these initial bumps, his words ultimately served me well. I have found that while it is incredibly hard to leave my baby to go to work, doing meaningful work that I enjoy makes it a bit easier.

While I don’t suggest that every pregnant resident run for chief, I do think it’s worth mentioning this sentiment: Not all hours of work are created equal, and setting things up in a way that is fulfilling to you, may make it (a little bit) easier to go back to work come the end of maternity leave.

I recently picked up Cheryl Sanberg’s Lean In. In her book, she encourages women to “lean in” to their careers and reach out for leadership positions. I’m still trying to figure out exactly how much I actually want to lean in or out as I apply for post-residency jobs, but her perspective was interesting and helped me think about what it actually means to be a working mom and helped me make these decisions. (Ben: she ended up deciding to stay on at our academic institution as faculty)

Note: when I say, “recently picked up” and “book,” I actually mean, I listened to this audiobook on Audible while nursing, pumping, and driving to daycare. (Ben: You can actually get two free audiobooks as part of a free trial membership via that link. Audible seriously changed our lives).

Which brings me to my next topic:

Nursing & Pumping

You would think that a medical degree might have prepared me for this somehow, but it didn’t, which sucked (pun intended).

Did you know that physician moms are more likely to start nursing than the average woman, but also much less likely to make it to 6 months 198% start in a small study with only 12% making it to a year. This is kind of weird because the AAP and the WHO recommend nursing for at least a year (and beyond). So why are we more likely to stop than Jane Doe?

There are probably several reasons, but I will say that pumping is pretty tough. In fact, at first, it felt impossible. I felt embarrassed when telling attendings that I needed to go pump. When I did, I was actually usually met with support, but often some confusion. “Maybe you can use this closet?”

I have pumped in mailrooms, the copy room, closets…etc. Interesting to say the least, if not particularly pleasant. And with a high likelihood of someone walking in.

Also, I went back to work when my son was 2.5 months old and still nursing frequently, so in order to keep up my supply and be comfortable enough to actually work, I needed to pump several times a day.

Luckily, with time and with the advice of many other physician moms, I learned some tricks of the trade and this all got much easier.

• If you want to pump, you have to ask. Or rather tell. Most people don’t know what you need. Even if they want to be supportive, they don’t know the logistics of how much time you need and where you can actually pump. So you need to be pretty proactive here. You aren’t doing this for you; you are doing this so that your baby has something to eat. And that’s important.
• Most hospitals actually have a lactation room for staff, and some even have hospital-grade pumps you can use in these rooms. The OB floor nurses usually know where these rooms are so call ahead and you might get lucky. If you’re mostly working outpatient, you may find that pumping in your office while charting is the way to go.
• Hands-free pumping bras are everything. I mean everything. You can pump AND chart or play on Facebook all at once!
• Pumping can be done in the car (or really most places). I bought a nursing cover and an adapter for my car. This saved lots of time and made me feel super efficient and flexible. Also, several other physician moms have recommended freemies for pumping in the car and even in the OR or during rounds. Apparently they are super discreet, though I haven’t tried them.
• Things can make your life easier. There are a whole bunch of products on the market designed to make pumping and nursing easier. In my case, I felt like if I could spend a couple of bucks and suffer a little less, then I might as well try. So I definitely “tried” a lot of different products. The things that I actually found to be helpful (in addition to those above) were soothies, nursing tanks (which I continue to wear under my clothes every day), boppy, and disposable (and eventually reusable) nursing pads.
• All in all, while nursing may be natural, it’s not easy. It can definitely be worth it though. Just know you aren’t alone in the initial blahness of it all.

Childbirth & Recovery

Speaking of natural things that aren’t easy…childbirth (AKA another thing that my MD was useless for). Between not wanting to head to the hospital because I wasn’t sure if my contractions were psychosomatic or false labor and knowing what every decel could mean, I would say that maybe that my MD was actually a hindrance.

Interestingly though, it was not really the childbirth part that I found to be the hardest, it was the recovery. I vividly (probably too vividly) remembered the vaginal births and c-sections that I “got to” watch and participate in during med school, and I even remembered seeing several women at their 6-week postpartum appointments. What I did not know is what happens in between those two time points. In fact, I have spoken to several obgyns who said that they were shocked at how little they were prepared for their own postpartum recovery.

I will spare you some of the details, but just know that everyone feels like crap during these first few weeks. Whether you are recovering for surgical sites or tears, you’ve got some healing to do (healing down there, discomfort from milk “coming in,” and exhaustion).

Years of residency have taught me to just grin and bear some general discomfort, but in this case, I don’t think that is a good lesson. I think this is a good time to be selfish and ask the people who love you to do some stuff for you and help you out. I didn’t do this and deeply regret it. At this point, we are hardwired to try to do things on our own and to prove how strong we are. But then we just hurt ourselves in this case. Healing is much quicker if you allow yourself a little rest. So buy the creams, soothies, gel packs, ice packs, fiber gummies, and spray bottles and definitely take some pain meds. You’ll feel like a human again soon. And if you happen to come across a med student at your 6-week appointment, maybe do her a favor and tell her what you’ve been up to these past few weeks.

Daycare

Research your daycare options as soon as possible (even before you’re pregnant). Then apply to join as soon as you possibly can. Waitlists can be long and unforgiving. Our original first choice daycare had a 2-3 year wait when we put down our deposit at 13 weeks. Applying before we even had an anatomy scan, we thought we were on the ball—clearly, we weren’t. And yes, every daycare demanded a nonrefundable deposit (150-300 bucks) to hold a spot on the waitlist. We spent $1000 just to have the chance to give someone more money. We thankfully lucked into a fantastic (and expensive!) daycare that we love. We’re still on the waitlist for the others that didn’t depress us. Daycare is cripplingly expensive, but you really want to be the early bird.

Disability & FMLA

At my institution, I was required to file for FMLA through the hospital’s disability insurance company. This was a gigantic hassle. I got multiple emails asking me to let them know the exact date of my delivery in the months leading up to my leave. As I am merely a psychiatrist and not a psychic, this was hard to do beyond providing them with my tentative due date over and over again. Since my due date was on a weekend, this became doubly confusing to the multiple people required to stamp their approval. Even despite this, I still had to spend hours on the phone repeating these same dates to multiple people in order to make sure that my “files” we’re correct. All this chaos and drama was for something that happens literally all the time and really shouldn’t be particularly confusing.

Now as I am applying for my Texas medical license, all of these same forms and dates are resurfacing in order for me to prove that I did indeed have a child and I was not just MIA for two and a half months of residency. (Ben: This process also took months as despite her finest efforts, a bunch of forms were still wrong.)

Lessons learned: Make copies of everything, even if it seems straightforward at first. Be prepared to fill and re-fill out forms and sit on hold.

Depending on your disability insurance, some people can file for temporary disability and get partial pay for their maternity leave. I signed up for the most extensive disability insurance provided by my institution, and I still didn’t qualify (I would have gotten two weeks partial pay for a c-section). You may have better luck if you’ve already purchased on your own separate disability policy. Read the small print in your plan and maybe you’ll get lucky, but if you know you won’t qualify, there’s no point in wasting your time with all the paperwork. I spent countless hours filing disability paperwork after one representative told me I would qualify, only to have the whole thing denied later and a significant part of my postpartum energy expended fruitlessly.

While normal pregnancy recovery would only ever qualify for short-term disability insurance, the time before you get pregnant would also be a really good time to grab some quotes for regular long-term disability insurance and see if you can afford it. You really need it, and you’ll probably never be more insurable than you are now.

Dealing With Self-Doubt

I recently got some good advice on this matter in an unexpected setting: residency didactics. Our lecturer was discussing the importance of creating secure attachments for babies and then stopped and said something like, “The caveat here is that the mom needs to feel like she’s doing the right thing. Babies can sense that.” He went on to ask if any of us had ever had a baby who didn’t sleep “well” or eat “right,” and whether or not we had ever tried consulting the Internet on these matters. Most of my class had not. I, on the other hand, have already accumulated some serious experience turning to the Internet and returning confused and dejected about my parenting choices. He argued that now more than ever it seems that there is no “right” answer for just about everything that has to do with child-rearing and that the constant barrage of “advice” and seeming perfect Instagram pictures of everyone else “doing it right” has left us all feeling insecure and lost.

He went on to say that one of the most important ideas that he has garnered from the field of child psychiatry is that feeling like you are doing the right thing is the best thing that you can do for your child (as long as what you’re doing is within the limits of safe and reasonable child-raising practices). He pointed out that most babies come out OK despite humongous differences in people’s choices regarding discipline, feeding, sleep training, etc, so long as they feel loved and cared for. A key step in eliciting this feeling is just realizing that you are probably good enough and that you are doing the best that you can.

Help

One of the best things that you can have when trying to raise a baby through whatever you are going through is some kind of help (and in my case a partner). Family is great, but an awesome helpful spouse is a huge part of surviving and enjoying those first few really tough months, both for handling things around the house but also for emotional support. If you have money to spare, other people have sworn by their various hired help, from nannies to house-cleaners and laundry services.

Lastly, here’s  a list of some other random things we bought that made our life easier in taking care of a brand new human:

• Halo sleep sacks (we tried every other brand as well, but these are the only ones that he liked sleeping in and didn’t break out of)
• All kinds of wipes (Madela cleaning wipes, paci wipes, sensitive tushy wipes, hand & face wipes)
• Microwave sterilizing bags (though we eventually got a bigger microwaveable sterilizer and use the bags on trips)
• Milk pumping bags (Ben: I like the nuk ones the best)
• Lanolin
• Burpie cloth bibs (these ones are expensive but awesome)
• Keekaroo wipeable changing pad or cheaper equivalent
• Mam Pacis (the only kind he ended up taking)
• Car seat toy (Ben: The little one was insane for this very hungry caterpillar. They were best friends for months.)
• Infant car seat (portable/carryable and the lighter the better, not just a convertible seat; you don’t want to have to wake a baby that fell asleep peacefully in the car.)
• A mechanism to attach car seat to stroller (Ben: This was the most important part; again, you really don’t want to have to wake a baby that fell asleep peacefully in the car. The stroller you buy will work with some brands and/or use an adapter but may not work with all)
• Rocker? Sad to say our little guy wasn’t very interested in his. We wish we had splurged for the Momaroo, which seemed ridiculous at the time but in hindsight may have been worth it for the extra sanity.
• Step and Play and walk-about / pushing walkers (when your little one can hang out in one of these for a few minutes, you can finally get some stuff done!)