I had the fascinating experience of interviewing for residency at 20+ weeks’ pregnant. Although a number of people told me that I was doomed, I found the experience to be quite enlightening. Since I couldn’t hide the fact that life outside medicine was going to be important to me during residency, I felt empowered to ask the “don’t ask” questions during my interviews. What did I have to lose? The perk of interviewing while pregnant was that it was very apparent which programs were going to be supportive of work-life balance and which programs were trying to wish away my protruding belly. This experience helped me to determine where I was going to have the most support, academically and personally.

Some people find the thought of having children during residency unimaginable, but a growing number of us not only contemplate having children while in training, but decide to take actually the plunge into changing diapers. Pregnancy during residency is not a new concept. In 1986, a study reported that 12 percent of women from Harvard-affiliated programs had at least one pregnancy during residency training. Jump forward to 2013–2016, when another study showed that approximately 40 percent of residents had or were planning to have children during residency. Although diapers during residency continues to gain traction, residency programs have a paucity of standard guidelines that outline how to best support residents with children. So, do residents feel like they are blazing a new trail at their program if they decide to have children?

If you decide diapers are going to be in your near future, here is some advice:

1. Be organized! ’Cause mama doesn’t have time not to be

You will be wearing many hats: resident, mommy/daddy, wife/husband/partner — and all of these roles will require your attention. My personal secret was to compartmentalize my life as much as possible. When I was home, it was family time until my kids went to sleep. While I was at work, I focused on work. But compartmentalization doesn’t get you out the door on time in the morning, organization does! Our family has a routine, and we live and die by that routine. When I walk in from work each day, I don’t pass go until bottles and lunches for the next day are prepared. Organization at home will allow you to be efficient, on time, and present at work.

2. Don’t be afraid to ask for help, because the only way to do it all is with a lot of help.

I am blessed that I have a great support system around me. If I know my schedule won’t allow me to pick up my kids from daycare at a reasonable time, I have a list of people who are happy to spend time with my boys. I don’t worry about how this looks to outsiders, or the fact that I probably have the longest list of people on my “approved for pick up list” at daycare. Who cares? What is important is that my boys are well cared for and loved. Having a strong support system means that I rarely have to call off from work because of childcare issues. Because, let’s face it, we still work in an environment when “mommy issues” at work are frowned upon.  Although it was initially hard for my type A personality to let go and ask for help, it is the only way to have it all.

3. Advocate for yourself: understanding the difference between equity and equality is imperative

Traditionally, I think we fall into a trap where we think that everything should be equal. If resident A gets a thing, then so should resident B. But in truth, maybe resident B doesn’t need what resident A needs. We need to move to a system that values equity over equality. This is not intuitive, so when you are resident parent, you must be your own advocate. You are inevitably going to have different concerns than your co-residents who don’t have children and/or significant others. There was one point during my intern year when my husband was traveling for work, and I made it a priority to pick up my son from daycare on time each evening (other than call days). Although my rush to get out of the hospital at the end of the day could have been seen as a negative, I had a co-intern and a senior resident who were extremely supportive, because I communicated with both of them what my needs were that week. Obviously, I always got my work done, but our team dynamics were improved because our open lines of communication were open. Fast forward to my second year, when another co-resident fell ill and needed coverage during an ICU month: I happily volunteered to cover his shifts. When you and your program focus on equity over equality, everyone can get what they need to be successful. It really does all balance out.

At the end of the day, if you are ready to become a parent, don’t let residency stop you. If you are in the special position of choosing a program while expecting a child, ask those “don’t ask” questions during your interview to gauge programs’ receptivity to resident parents. I promise you, they will show their hand.

Some might say I am too positive and naïve, but I think we can do it all (with a lot of help and the “right” supportive program). When you are a doctor, there is never going to be a “best” time to have children. Finding and doing what makes you happy both in and out of the hospital is an important aspect of developing resiliency and experiencing joy during these 3 hard years. Although you will laugh when non-parent residents complain about sleep deprivation, you will also find that babies can teach you a lot about yourself and keep you grounded during this journey. Personally, my boys brought me so much joy during my training years that I truly can’t imagine doing residency without changing diapers. So, as far as my personal belief about changing diapers during residency: do it well and do it often because no one needs a “blow out” right before walking into rounds.

Cassandra Fritz is an internal medicine chief resident who blogs at Insights on Residency Training, a part of NEJM Journal Watch.

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