My Final Answer

I know it may not look like much is going on here in this blog, but I continue to get e-mails from people asking the same question:

As a doctor, when's the best time to have baby? Before or during medical school? How about during residency or as an attending physician? Which specialty should I go into based on my desire to have kids?

I think I have my final answer, really, the end all be all answer. It's beyong cliché. . . but here goes: Accept your callings in life.

If you're a family wo/man, have a family. If you always saw yourself with six kids, think about how much time that would take and subtract it from the latest you'd like to be pregnant and go to it. Something will work out, it alway does. Yes, it will be unbelievably hard, but chances are if you signed up to become a doctor you're a glutton for punishment anyway.

This blog has been brutally honest (as I've been told) about the challenges of becoming a physician while trying to start/raise a family. So long as you go into this process with your eyes wide open, good coping skills, and at least one supportive buddy everything will turn out fine.

Deal with the fact that you'll miss 'firsts.' -You should have known that when you sent in your medical school application. Since none of us remember if mommy and daddy were there when we began walking, just remember that you're more likely to suffer emotional damage than Junior when it comes to absenteeism in the first years.

What children need, says me, are parents who give them their best selves in their formative years (generally accepted as age 3 and beyond). This doesn't necessarily mean, but doesn't exclude, staying at home with them. If you were called to be a homemaker, do it. If you were created to be a doctor, do it. It really doesn't matter what occupation you find yourself in so long as you set a good example of using your talents and giving examples of service. Consider the opposite: A mother who resents her children because they kept her from her career aspirations, or the work-horse who returns home too burnt-out and bitter to enjoy her kids.

The trick here is to choose a specialty (or profession for everyone else) that will build you up to be a better person. -This is where the caveat to my final answer comes. If God blessed you with the skills of a surgeon, but the lifestyle would make you and everyone else miserable, don't do it. Pick the next thing on your list of favorites. Trust me.

Finally, doctoring isn't always the thorn in the side of parenthood. The one perk to being a resident mommy is that when I have to say goodbye to my son, I can always tell him that I must go help others who are less fortunate. I was on-call last night and missing my little guy terribly when I was summoned to see a six-year old boy who was complaining of pain at his gastric-tube site. On the way to his room I saw several children with broken skulls and displaced eyes. You better believe when I came home I held onto his perfect little body longer and with more appreciation than I would have otherwise.

Coming eventually:

• Patriotism and Decluttering - A match made in heaven.
• Living life pre- and post-call
• Are women the cause for the healthcare crisis?
• The "I can't seem to lose this stomach so I'll just have another baby" option.

When's the Best Time to Have a Baby?

Female students, residents, and physicians ponder this ALL the time!

From a pure medical standpoint, before age 30 is when you can reduce a risk factor for breast cancer. 35 and beyond is when the label "advanced maternal age" gets placed on your chart and it's like wearing a scarlet letter.

Professors in medical school know that most women come out of training in their 30s, and yet they still throw that danged chart on the big screen to make all of us cringe in the lecture hall. It's like you can feel your ovaries drying as you contemplate the curve.

So what's a female doctor to do? Most of us ask around, and the usual answer is: "there is no good time to have a baby." That's pretty true if you consider:

• Years 1-2 of med school: All work and no play. Study, study, study. If you goof up your scores in this time period, you'll never get a desirable residency position. -This could mean the difference between matching at a program that is family-friendly versus indentured servitude. Don't forget that you finish this section with an 8-hr exam (try that with a baby sitting on your bladder!).
  
  
• Year 3: A lot like the previous years, but all clinical. Put another way, you're studying AND have physical demands. Good luck having morning sickness and making it to your surgery rotation at 5AM.
  
  
• *Year 4*: Easiest year of medical school. Many women opt to have a baby at this time. . . BUT there are drawbacks. This is interview time, and illegal or not, if you show up with a big bump to a potential residency program that will most likely be a strike against you. -Being honest. Also, no pregnancy is predictable and should anything happen that puts off graduation that will conflict with the start of intern year. Keep in mind that having the baby is one thing, being able to be there for your child when you're about to start one of the most demanding careers in the planet is another.
  
  
• Intern Year: NO!!!! NOOOOOOOOOO!!! It's been done, but not without torture. I don't care what your specialty is, having a baby at this time is insanity. Usually 80+ hours/week, not including commute time is what you're looking at. My friend did this, her water broke during morning rounds and as she was wheeled away her senior resident asked "are you coming back soon?!"
  
  
• *Post-intern Residency*: Feasible if your hours drop from 80/week. If you haven't taken the third board licensing exam, that's TWO days in a row of 8hr exams waiting for you. This is when I had my baby. I was a lot sicker than I had hoped, which really put me behind in my studies. Maternity leave ate up all my vacation and sick days for two years. . . There were times I'd see a patient, excuse myself for a moment to vomit in a nearby sink, and go back to finish my work because I knew that any time I took off for myself would be time taken away from the post-partum period.
  
  Something else to think about are workplace hazards such as radiation and infectious disease exposure.
  
  
• Attending Physician: Now in the work force, you're probably part of a group that expects 'dynamic performance.' It's all about bringing in the money to pay off all those school loans. Can you really afford (figuratively and literally) to have a baby at this time?

Rough stuff, huh? I'm hoping to collect data on other professions and when their 'windows for fertility' occur. If anyone finds the perfect solution, do tell.

It's Not that Simple

Would you like to pick your baby's gender?

One of my readers would, especially since she has two boys already. I am now asked to discuss Shettles' method of conceiving to increase your odds of having one of the sexes over the other.

The theory is that Y-sperm are fast swimmers, but are very fragile, particularly in an acidic setting. Thus if a couple is aiming for a boy (pun intended) they should have sex closest to the time of ovulation and use deep penetration, far away from the vaginal opening where the pH is relatively low. Conversely, those looking to have a girl should get going a few days before the egg is released (assuming the X-sperm endure while the Y- degrade) and deposit the goods along a more shallow domain.

The New England Journal of Medicine has discounted this theory after tracking the outcomes of over six hundred women who allowed their time of ovulation and sexual activity to be recorded and analyzed. You can read the summary here.

I know of people who swear by Shettles, though. "I had four girls in a row, we tried this method and now we have our boy" is one testimonial. Be that as it may, I think we over simplify things when we imagine sperm to carry ONLY the sex chromosomes as depicted above. I know people are guilty of this because time after time they attempt to support Shettles by saying things like, "You see, that X looks symmetric and sturdy whereas the Y has only one leg to stand on." Let's not forget that there are 22 other chromosomes packed in there which would, in my humble opinion, make the contribution of that tiny sex chromosome 'leg' negligible.

This is not to say that there isn't anything 'magical' about sperm. In fact, more and more research is being done on these gametes and the results have been fascinating to say the least. I once met a physician who was so renown in his field that he was given license to write about anything in a medical journal and chose to dedicate an entire article to sperm (totally unrelated to his field of study). The title was 'A Christmas Celebration for a Sexually Transmitted Fatal Condition,' that condition he's referring to is life itself. In this diatribe, he revels in the discovery of sacrificial and warrior sperm. The former type dies on the frontlines to neutralize the vaginal secretions (allowing their brothers to go forth) and the latter exist for the sole purpose of destroying sperm from other men!

Cue Pat Benatar's Love is a Battlefield.