Mar 4, 2013

Moms and Medicine

I have had the good opportunity this month to have a 3rd year Georgetown medical student who is interested in primary care (score one for the team) and is a mother of a 21 month old. The medical student (who has graciously allowed me to talk about her) completed her first 2 years of medical school, and then took 2 years off as maternity leave. She is 28 years old who is determined not to, in her words, “ be a 40 year old mother of a baby”. She has thought about having her next child at another break point in her training, at graduation from medical school.

With the feminization of medicine (50% of all incoming medical students are women) come some interesting questions. When should women consider starting a family? Is deferring motherhood a wise decision from a career standpoint but an unwise one from a health standpoint? What is the impact of motherhood on colleagues and the health care system overall? And, most importantly, how should we help women cope with the difficulties of motherhood and a medical career?

I do not pretend to have any definitive answers to these questions, but what the heck, I’ll give it a shot. 

Starting a family

I feel that having a child relates more to the relationship one has with their spouse and to emotional maturity and readiness rather than career choices. If you look at it (and, as a father of four, I have), there is never a good time to have a child. One can always have more time, more money, more support. Sometimes you just have to jump (and hopefully have a soft landing).

Deferring motherhood

To me, this is a simple one. It is more healthful to have a child at a younger age. Pregnant women over the age of 35 are considered to have higher risk pregnancies. Fertility goes down with advancing age, and the risk of birth defects increase. Clearly, the biological imperatives trump the career ones. We need to adjust the medical training path to accommodate to this reality.

Impact of motherhood on colleagues, medical system

This is an important issue. There needs to be sensitivity from both sides. Clearly, as medical professionals, we need to have an awareness and understanding of the difficulties inherent in being a medical mom. Moms, however, also need to understand the impact they have on others. Care needs to be taken to have adequate child care arrangements. Some family planning is helpful, too. Being pregnant during ones internship year, for example, can, I think, be universally agreed to as a bad idea (as the Sandra Oh character in “Grey’s Anatomy” felt when she found up she was pregnant. As an aside, I must say that these guys have an unbelievably active social life for interns). There are natural break points in the medical career path, such as the completion of the pre-clinical years in medical school, the end of med school, and the completion of a residency program. These can be used to advantage.

How do we help women cope?

First, we need to talk about the issues involved, and not keep silent about it as an awkward, uncomfortable subject best left in private. While employers are proscribed from asking women about pregnancy, this does not mean that hospitals and practices shouldn’t talk about how they plan to accommodate such a possibility. Remember, medicine is not 9 to 5. It is involves working nights, weekends, and holidays. We therefore need to talk about how our work impacts our families. There are creative ways that women in other fields have managed with their careers- co-ops, shared positions, office childcare. These, and other approaches need to be explored.

One interesting on-line resource that I found was The founder of this web site, Jennifer Neuwalder (Tufts class of 2008) talks of her situation as a medical school mom in her “Survival Guide for Juggling Medical School and Motherhood”. She provides excellent tips on how to cope. The web site also has intriguing discussion boards, asking questions such as whether to be open about one’s pregnancy in a medical school or residency interview (my answer is an emphatic yes. Besides being honest and open, it shows an understanding for how one person in the medical field impacts others).

I know that my student will do quite well in medicine. Her motherhood will likely give her a sense of heightened compassion that will always come in handy. And being a young mom beats being an old one. Society needs to accommodate biology, not the other way around.

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