Dr. Mom and Dr. Dad -- Issues in becoming a parent during residency

Resident Issues

CJEM 2002;4(4):298-301

Introduction | Methods | Results | Discussion | References

Introduction

Most people who have been through a residency program would agree that there are times that one's personal resources are taxed. Those who have a "significant other" undoubtedly experience a mixed blessing. Having a partner to share your life provides great emotional support and good times. However, meeting your commitment to a partner can be challenged by severely limited uncommitted time, chronic sleep deprivation and concurrent responsibility to read, prepare presentations, moonlight, etc. Many marriages fail during the residency-training period¹ due to the inability of couples to resolve these conflicts. So, what happens when you introduce children into this situation? How does pregnancy and the subsequent parenting role affect couples when they are pursuing residency training?

Over a 12-month period at the University of Alberta Emergency Medicine Residency Program, 6 residents (4 men and 2 women, PGY-1 through PGY-5) had children. Some have speculated that the Program Director (in his aging years) neglected to put the progesterone in the bagels during the Academic Half-Day. Others suggest that the Alberta farming environment somehow stimulated fertility amongst our residents. In either case, we have a convenient sample from which to ask questions about the challenges of pregnancy and childbirth during a residency program.

Methods

A nonvalidated survey tool was developed (available upon request) and administered to all eligible residents. Emergency medicine residents who were also parents at the time of the survey were included. Residents were permitted to complete the survey with or without the input of their partners. Confidentiality was promised by the author with the caveat that readers who know the members of the residency program could readily determine who provided answers to most of the qualitative questions. Answers were examined manually using an ethnographic approach to identify common themes amongst the answers to the questions.² Results are organized by theme, with a brief narrative of the theme and supporting quotes provided.

Results

The response rate was 100%.

Pregnancy

Female respondents reported overwhelmingly positive experiences during their pregnancies. Pregnancy offered a "connection" with patients. However, individual examples were identified where fatigue, physical discomforts in later pregnancy, and potential risks to the baby occurred.

Men respondents reported that they were largely unaffected by having a pregnant spouse during their residency. Some expressed desires to be more supportive at home. Two respondents who had other children already indicated that they had to take on an increased role in child care during some phases of their spouse's pregnancy.

Challenges

Residents were asked to identify the biggest challenges of having a baby during residency. A major theme identified was the lack of time to invest in the couple's relationship. Respondents also indicated that balancing commitments was difficult. Guilt came up as a common theme, along with the unequal share of the work that fell to spouses.

Adam Lund

Dr. Rebeccah Rosenblum in her PGY-1 year (2000)

Benefits

All respondents had positive comments, despite the challenges that were also mentioned.

Adam Lund

Dr. Shona Maclachlan, PGY-2 year (2001), with daughter Athena, at the ED desk, Royal Alexandra Hospital, Edmonton, Alta.

Access to extended family

Respondents clearly identified the value of having family nearby to help out, and those who did not have such access commented on its absence.

Schedule flexibility and program director support

Female residents indicated a need to schedule less call-intensive rotations later in pregnancy, as well as to arrange time off for maternity leave. Both female residents reported that they had no difficulty arranging this and commented on the positive and supportive role that the program director took in facilitating flexible scheduling.

Male residents required flexible scheduling around their partner's due date, as well as time off immediately after delivery to help in the early days with a new baby at home. Residents indicated that their requests were accommodated without any problems in the emergency medicine residency. One resident had previously experienced the birth of another child while in a surgical residency program and indicated that he was not accommodated at that time. The two experiences were totally different for him, with the supportive, flexible program director making everything easy, and with the other program director causing much stress and tension for his family.

Professional association

Generally, the professional association was deemed to be unhelpful. During surgical training, there was no recourse for being denied time off. Another resident felt that the time off for the male partner was inadequate. However, given the flexibility of the program director (see above), the professional association did not have to be called upon to defend rights of the residents in our program.

Suggestions for other residents considering kids

The group was asked if they had advice for residents considering having children during their residency training.

Discussion

As an informal, qualitative study, the methodology and results cannot be assessed using the same strategies that are used for quantitative, randomized, placebo controlled trials that we are used to seeing in medical journals. The results are, at worst, merely hypothesis generating, but at best provide a human insight into these issues in a way that a quantitative study never could.

Several themes came out of the responses to the survey. Both female and male residents in our program made minor adjustments during pregnancy to increase personal comfort or support for a pregnant spouse. Issues such as amount of call, availability of meal breaks and concern for physical safety during pregnancy would seem to be areas for further investigation. Program directors might also be conscious of the extra demands on residents who have other children at home in addition to a pregnant spouse.

There are clearly numerous challenges for couples having a baby while one partner is pursuing residency training. The lack of time to invest in the couple's relationship, the challenges of balancing parenting as a new major role in addition to the many other roles attached to residency, and the guilt associated with not performing at a high level in all roles represent the major challenges. However, the respondents to this survey universally emphasized the happiness, fulfillment and new perspectives gained through becoming a parent, despite the abovementioned obstacles. The presence of extended family as a supporting factor was also clearly emphasized.

Flexibility in scheduling and overall support from the program director were identified as important factors in becoming parents during a residency. Female residents are well supported when their late pregnancy is less call intensive, and flexibility for unexpected changes in the timeline is accommodated. Male residents benefit from having flexibility in the weeks surrounding the expected due date and appreciate having time in the first weeks to a month following the birth of their child to participate maximally in their family. The program director for this group was remarkably accommodating to this group.

References

1. Myers MF. Doctors' marriages: a look at their problems and solutions. 2nd ed. New York (NY): Plenum Medical Book Company; 1994.
2. Bogdan RC, Biklen SK. Qualitative research for education: an introduction to theory and methods. 3rd ed. Needham Heights (MA): Allyn and Bacon, a Viacom Company; 1998.