Postponing the Childbearing Years

“Do you want kids?” The person will ask, a seemingly harmless questions that in no way offends me, but still makes me flustered. I’m caught off guard because for so many years I wasn’t completely sure of the answer, and certainly not on the timing. I can see why this question can be offensive and painful for some— for those suffering from infertility who would want nothing more than to be raising a child, this hits a nerve. For others who don’t have a similar “open book” approach as me, this question is invasive, irrespective of the complexity of their answer. I know this, yet I still find myself asking other people in my work environment this same question—mainly because I’m so curious if others are so carefully balancing the pros and cons of such a life altering decision. And when I do know a woman is pregnant, or if someone has children, I basically invade their personal space with curiosity, as I search for every individual’s perspective as it may apply to my own choices.

Yes, I want kids!

Deep down, I always imagined myself as a mother one day and I look forward to that time. But for me, it wasn’t any time during my twenties. And at my current age of 31, it’s still not any time soon. But please, do not feel alone if you have grappled with that decision on and off for years, and if you go back and forth deciding what is best for you, your partner, and your future family. I imagine this is the nature of most people (women especially) in a highly competitive and demanding career.

In regards to medicine specifically, the barriers to low-stress and healthy childbearing are PLENTIFUL. The inherent issue with becoming a doctor is the rigidity in our academic calendars. Our entire lives revolve around July 1st, even before we’re residents. If we choose to have a child during medical school, depending on where we attend, the standard 6 weeks of maternity leave (which is an atrocious amount of time by any standard) may set us back from graduating on time. No big deal for some degrees, but for medical students this means having to delay entering the MATCH by an entire year! A whole year just to get a few weeks of maternity leave. And with hundreds of thousands of debt dollars collected, the truth is, a year is a really long time. The same issue arises in residency, as fellowships are becoming a more frequent part of our post-graduate training. We’re glued to that July 1st deadline to avoid a year delay. This puts women of childbearing age in a major predicament— either take minimal maternity leave ( I know some who have taken as little as 2 weeks of actual leave), or accept a significant gap in their training that can put a great financial strain to their life.

The additional barrier is obviously the physical, mental, and emotional hardships faced during residency especially, that make pregnancy and raising a newborn seem like an impossible task to do it all simultaneously. There’s no doubt that there are AMAZING parents who do it (and gracefully) but it is not without significant struggle and sacrifice. I am truly blown away every time I see one of my coworkers move through the stages of pregnancy, to being a brand new mom, to finding her rhythm in balancing her new life. It is absolutely beautiful and astonishing, and each of them make me so thrilled to one day join them (and… also a little terrified.)

I can honestly say that unlike many young women moving about through their training years, I have always felt supported to raise a family if that were my choice. My medicine program director specifically told us that he hopes we never have guilt about our family planning decisions, and that we should feel completely supported for our decision to become pregnant. This same feeling follows me through fellowship, as I watch my co-fellows raise families and gracefully balance call schedules with kid schedules and ob/gyn appointments. The male fellows equally rearrange their schedules to allow for maximal time for maternity leave. This is how it should be! But this is not the reality for so many programs, as residents feel the pressure of someone missing for weeks. Program directors and chiefs imagine the “nightmare” this might create, and an unstated but understood discouragement for childbearing creeps in. This is absolutely heartbreaking, and one of the reasons I’m writing this blog is so that we can continue talking about reproductive decisions as a WONDERFUL life change, rather than a major inconvenience to others. We improve as a community when we foster the birth and raising of children who are loved and encouraged. As a medical community at large, we can do better.

The truth is, I’ve enjoyed the luxury of being selfish all these years. My free time, is mine. And while I’ve soaked in the wisdom of moms in how they’ve incorporated their child into all the things they loved to do (pre-birth), they are well aware that everything is different. I’m waiting until I’m ok with that feeling- the feeling that everything will be different. And that day is not today.

The image that sometimes keeps me up at night :-P Linda Heffner et al., NEJM

The image that sometimes keeps me up at night :-P Linda Heffner et al., NEJM

I am, on the other hand, hyper-aware that aging and fertility do not go hand in hand. I also realize the great privilege of having a loving partner for whom we can together make a decision on this. And it would be naive for me to believe that I can wait until I’m 38 years old and have zero concerns or issues. This physiologic truth is often times what causes me to zone out as I drive home from work, or stare off thinking about when I see a very young pregnant woman. I go back and forth with the thought, “omg omg what am I waiting for, it’s going to be much harder years from now” but also thinking, “yeah but there’s so many things I still wish to do, before bringing a child into this world. Also you’re already stressed so please chill.”

I have asked dozens of attendings if it gets easier. If having a child after finishing training will somehow make it easy-breezy, and the unanimous answer is “Absolutely not.”  Demands of this career do not just magically dissipate once you’re the boss; in fact, many agree that the first few years out are the hardest part of this path, simply because you’re growing your confidence as you make the ultimate decisions.

I am not waiting for this either. Just waiting because right now, that feels like the right thing to do. Waiting for a time when having a baby sounds more magical than a trip to Costa Rica. For the time when we are free of financial worries even if my husband becomes a stay-at-home dad (and yes, this is our plan!) Waiting for that time when I wake up and think, “Wow, I believe it’s time to be a mother.”

There is no right answer to my original question. Choosing whether or not to have kids should have no bearing on our opinion of someone. No one is “better” because they are able to raise children while also having a career. On the flip side, a woman choosing to raise a family does NOT mean she isn’t serious about her career. The decisions that surround families and careers are so individualized, and the best thing we can do is rejoice in each other’s happiness. And isn’t that the point?

All my love,

Shanny DO