During medical school, I made it a goal to graduate with a degree in one hand and a baby in another. I had a supportive husband, so we started trying to conceive when I was in my third year of medical school. We didn’t get pregnant as quickly as I thought, and we almost gave up on the idea of having a baby at that time. I was already 28 years old, which I didn’t think was too young, and I had already been married five years.

Anyway, we stopped trying to have a baby and my girlfriend and I took a trip to Costa Rica for spring break. It was such a beautiful magical place, with the lush rainforest, green mountainsides, noisy monkeys and all the exotic fruit you can eat. Despite all the wonderful sights and experiences we had, it was hard to fully enjoy myself because I felt nauseated most of the time. And my sense of smell was extremely heightened. I thought perhaps it was the heat or all the exotic fruit I wasn’t accustomed to eating. The last thing on my mind was being pregnant. After returning home, I finally took a pregnancy test and was shocked to learn I was truly pregnant!

My first and second trimester was pretty hard because I was always nauseated or had indigestion. I could literally lean against the kitchen sink while doing dishes and feel like throwing up. The smell of garbage on my way to class as I ran up some back stairs made me feel sick. It was also harder to stay focused on my course work, and I felt distracted by all the changes that were going on in my body while looking forward to my new baby.

My academic performance suffered and I remember struggling to keep up on rotations like pediatrics — of all subjects. During my last trimester of pregnancy I felt well and continued my studies. I remember driving my small sports car in the Charleston heat and the effort it took to get in and out of the low bucket seats. I was always hot and I felt big and swollen with puffy ankles. I also needed to sit down often due to back pain and occasional fatigue. My schedule was set so that I could be off school a week or two before my due date. My mum came to visit us from New York. I woke up, dressed, made pancakes and we went out to my scheduled OB checkup. Shortly after arriving, I was told I would need to be induced because I had very high blood pressure, protein in my urine and pre-eclampsia. I was not expecting this, and after a long labor, our first child was born in the same hospital where I was a medical student.

Adjusting to the demands of motherhood was not easy, and I remember thinking medical school is hard but this is even harder. A newborn teaches you what sleep deprivation is on a whole new level.

I had six weeks off for maternity leave, and I remember the day I had to go back to the hospital like it was yesterday. It was the worst feeling watching my new baby in the car seat as my husband drove off after dropping me in the back of the emergency room. I wanted to start crying as I walked into the ER to start my shift. I was still breastfeeding and working with engorged leaky breasts was not the most comfortable thing. I had tried using a breast pump before work and even tried to bring it to work but there never seemed an appropriate time or place to use it.

I don’t think I could have juggled my responsibilities in the hospital with my duties as a new mother without a supportive partner. My husband would keep the baby overnight after a full days work while I went to the hospital in the evenings.

Fast forward to graduation, and it was all worth it. My medical degree, a bouquet of flowers and my healthy baby boy. But that wasn’t all — hiding beneath my graduation gown was pregnancy number two.

During my second year as a resident, I realized I was pregnant again with my third child. I felt overwhelmed and unhappy with the knowledge that I would now have three babies in the span of three years. I felt immense pressure to keep up with my colleagues most of whom were single and male. I felt like I never had enough time for my family or enough time to study and I worried about what my other residents thought of me. Feeling panicked and embarrassed I went alone to see my OB/GYN doctor to discuss an abortion.

My OB/GYN was a beautiful older Indian woman who sat me down and told me to reconsider my approach. She advised me to avoid making a permanent decision based on a temporary situation. She told me that all these people I was worried about, people who I thought would judge me, I would no longer see once I graduated. Since I already had two sons she asked, “What if you have the little girl you wanted?” She was so right. I carried the pregnancy to term and worked up until the day before my baby was born. I completed residency and then decided to take some time off to spend with all my babies then got a job as an Internist and life went on. Now, I have three beautiful teenage kids — two boys and a girl.

What have I learned?

1. Stop waiting for permission to have a child from your medical school or residency or first job out of residency. You are not going to get it.

2. There isn’t the perfect time to have a baby during your medical training. But with sacrifice and planning, it is possible to have a child and your career.

3. As my OB/GYN said to me, “Don’t make any permanent decisions based on a temporary situation.”

4. Having to sit down occasionally while on long rounds or having back pain while bending down to draw blood is not a sign of weakness — it’s called being pregnant. Your colleagues should understand.

5. Medical school is hard, residency is hard, pregnancy while doing either is even harder. If you are considering having a baby, make sure you have a supportive, committed spouse, partner or very close relative.

Habiba Tunau is an internal medicine physician.

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