Life as a Fellow: Navigating Pregnancy in Training
By: Megan Conroy, MD
May 15, 2020
Like many in medicine, I put off starting a family until after the majority of my medical training was complete. When I interviewed for fellowship, my eventual program director brought up the issue of having children in fellowship without prompting; she elaborated her full support for having a family when it is right for you, noting that the program can adjust as needed. Not everyone is lucky enough to have a boss like this, but even with the world’s most supportive program director, I was surprised to find that navigating pregnancy as a pulmonary and critical care fellow brought some additional layers I hadn’t considered. For you rock star female pulmonologists-in-training who are expanding your families, too, here are some considerations as you approach family planning during training.
Find Allies Who Can Personally and Administratively Support You
For me, this was a program director with a keen ability to keep a secret (and a secret drawer of adhesive notepads with due dates stashed away) and a cofellow who already had two children during training. Having my program director on board helped me ensure that necessary schedule changes could be accommodated well ahead of maternity leave and that my duties as Chief Fellow were accounted for during my absence. Having another female physician and peer as a sounding board for challenges that arose was invaluable.
A Hazard of the Job: Clinical Exposures to Avoid and How to Avoid Them
For some reason, it hadn’t even dawned on me that my job as a pulmonary and critical care fellow could be a risk factor for pregnancy complications. Thankfully, the handy TORCHES mnemonic appeared in the recesses of my brain just before walking into patient rooms with disseminated toxoplasmosis, zoster, active cytomegalovirus (CMV), and one being ruled out for rubella. (These cases actually existed concurrently in the ICU; my cofellow joked: “It’s ‘Pregnancy Bingo’ to get all of the TORCHES.”) Our staffing structure is one fellow in house overnight to cover the ICU and urgent consults; we have no attendings in house. So, when the patient with CMV and a viral load of 1.5 million needed intubation, bedside echocardiography, and evaluation for acute abdomen, I had to get creative—I wouldn’t knowingly expose my baby. This meant asking my colleagues in anesthesia, cardiology, and surgery who possess my same skills to lend a hand. But, it’s not easy to ask for help, especially on a task for which you are competent! Similar needs arose countless times through just 1 month of night float, but someone always had my back. It meant that all of my cofellows who were moonlighting would find out much sooner than I had anticipated telling them, but it also meant keeping my baby safe from potentially fatal infection. Finding polite and unashamed ways to ask for this help as an advocate for my child may have been my first mama bear instinct. It also showed me that, even in the womb, children are just magnets for germs!
Avoiding Hazardous Clinical Exposures May Mean Sharing News Earlier Than You Planned
One day after I had a positive home pregnancy test, I was consulted to see a patient with disseminated zoster. Working with a male attending I didn’t know very well, I simply stated, “I need to exclude myself from examining this patient until such time as they are removed from airborne isolation for zoster.” He asked no questions and proceeded to complete the consult independently. Meanwhile, the nurse who presumed I’d be seeing the patient yelled “Congratulations!” to the whole unit in response to a similarly vague statement. Although many women choose to wait to share their news, probably a hundred of my closest ICU coworkers, nurses, respiratory therapists, personal care assistants, and other physicians in the hospital knew I was expecting almost right away. Miscarriages happen, though. Perhaps being aware that it’s more difficult to keep this secret in our jobs can help you prepare for this added element.
Schedule Changes: There Is Precedent
Many graduate medical education (GME) programs in the United States lighten call load during the first and third trimester, with good evidence that doing so may reduce miscarriage and early labor risk. Find out what your institution offers and consider if this would be helpful or medically necessary for you.
Negotiating Leave Is Complicated but Important
This will vary from institution to institution, but the Accreditation Council for Graduate Medical Education has clear limitations for the amount of time away from training. Thankfully, being part of a 3-year fellowship in pulmonary and critical care medicine allowed me more flexibility than 1-year fellowship programs have. But, the total duration available for parental leave will vary depending on how much time you’ve had away from your program already. Keep in mind that, in the grand scheme of life, extending training by a few weeks or months will have no major impact to your career, and employers are often flexible on start dates out of training. Talk with your local human resources department as well as your program leadership; advocate for yourself and your baby to protect what time you can for maternity leave.
Deadlines Don’t Change Because You’ve Had a Baby
That grant application deadline came 2 weeks postpartum. That national committee I’d been planning to apply for sent the call for nominations 1 week postpartum. This blog post was due 1 month postpartum! Plan ahead to account for the things that won’t go on hold just because you’re out on maternity leave. If you’re able to prepare some of these tasks ahead of time, it can ease anxiety and protect your time to bond with baby. Alternatively, it’s a great time to learn to say “no”!
There’s a Secret Online Network of Super-Woman Physician-Moms
If you’re a first-time mom like me, you might not know about all of the wonderful things our colleagues have created on social media to support each other. Talk to other physician moms and get added to groups like Dr. MILK (breast-feeding support), Physician Moms Group (PMG), local PMGs, and Medical Mommas. Our institution also has a GME parental support program that offers advocacy and support within the institution. Support from these networks can help you navigate other issues that arise for you as you enter motherhood in our profession.
Take care of yourself, mama.
Megan Conroy, MD, is Chief Fellow in pulmonary and critical care medicine at The Ohio State University and a new mom to her son Aiden, who was born in March 2020. She is a candidate for a Master in Medical Education degree. Her clinical interests are critical care medicine and asthma, and her research interests are better understanding the factors influencing entrustment of decision-making among physicians supervising trainees. She is a Fellow-in-Training member of the CHEST Airways Disorders Network Steering Committee, a member of the CHEST Trainee Work Group, and a Fellow-in-Training on the CHEST Physician Editorial Board. Upon completion of her fellowship in July 2020, she will be joining faculty at The Ohio State University Division of Pulmonary, Critical Care, and Sleep Medicine, focusing on severe, difficult-to-treat asthma and medical education.