Five pediatric residents navigate becoming Dr. Mom

For some, the thought of being pregnant during a demanding clinical rotation may be more nauseating than the first trimester.

Judith Chrystal and Tamara Vineberg with files from Nicole Anderson, Megan Fowler, Alex Jackman, Linda Mahgoub and Daniela Migliarese Isaac - 07 January 2019

Pediatric residency can be a challenge, a joy and a life changing experience. Becoming a parent can also be all of these. Doing both at the same time? Are you crazy? Five pediatric trainees experienced motherhood for the first time just as they were launching their medical careers. The residency moms recently got together online, after the kids were in bed, to reflect on and share their remarkable journeys and to encourage others who may be considering starting a family during their medical training.**

When is the perfect time to start a family?
Not only were these women experiencing the daily joys of pediatric medicine, this time period aligned with some of life's sentinel moments: engagements, weddings and babies.

Neonatologist Linda Mahgoub had just applied for specialty training when she considered starting a family and considered how she might balance her new life. "After I applied for my specialty training, I started getting anxious about my so-called 'ticking biological clock', as I was in my late 20s. I started my training while in my second trimester of pregnancy. Naturally, I had doubts about whether I made the right decision and if I should have waited longer. But I soon realized there may never be the perfect time and actually, it was easier than what I contemplated," says Mahgoub.

Developmental pediatrics fellow Alex Jackman has had two children during the course of two residencies in the Department of Pediatrics. "Overall, my experience has been extremely positive and I've been well supported," says Jackman. "There are challenges in pregnancy and return to work in all jobs, with a pediatrics residency being no different, but it's certainly doable and fun too."

Residency and nausea
For some, the thought of being pregnant during a demanding clinical rotation is more nauseating than the first trimester. Daniela Migliarese Isaac, a fellow in the Division of Pediatric Gastroenterology & Nutrition, appreciated the support from staff and nurses who brought her juice and ginger candies. "Morning sickness can be a bit obstructive, especially during the early morning endoscopy as a fellow. I found that once this subsided, I felt good overall the rest of the way through and was fortunate to be able to work until my due date," says Migliarese Issac.

"I remember the first few months being really hard, especially when most people didn't know you were pregnant and you felt so horrible. But overall, I really appreciated all the support and understanding I had from my residency program, fellow residents and staff," adds Megan Fowler, now a clinical lecturer in the Division of Pediatric Emergency Medicine.

The women felt they received tremendous support. Rotations were optimized and the call schedule was changed to meet their needs, and the postgraduate medical education office helped them navigate the logistics of their maternity leaves . Also helpful was support from the Professional Association of Resident Physicians of Alberta (PARA) and the Office of Advocacy & Wellbeing in the Faculty of Medicine & Dentistry.

When their babies arrived, the women began to have new-mom anxiety.

Becoming Dr. Mom
"I remember taking Brooks home from the hospital after his birth, fairly confident that as a pediatrician-in-training I would quickly figure him out. After the first night, I was rapidly reading sleep books and texting my fellow resident moms about the newborn sleep-wake cycle. Every abnormal eye movement was a seizure, every day of jaundice was one step closer to a liver transplant and every crying episode was testicular torsion. What I soon realized was my bias to see 'sick' in all children. And how very blessed I was to have a healthy baby," says Nicole Anderson, a neonatal-perinatal medicine fellow.

"Talking about fears or concerns for your new child is important but trying to channel the role of being a parent and not the child's physician was very helpful. We relied on our wonderful pediatrician to answer any questions we had, as I found it's hard to be moderate when it comes to your own children," adds Migliarese Isaac.

How long should I (maternity) leave?
The length of maternity leaves varied for the physicians, depending on where they were in the course of their studies or career. Migliarese Isaac was inspired to return to work in time to complete her Royal College exam with her cohort. "I was able to take approximately six months of maternity leave and remain eligible for the exam, which worked out well," she says. "If you are considering this, it is doable, as I wrote the written exam when my daughter was 2.5 months old and completed the OSCE when she was about 3.5 months."

A support system is important to help with the transition and new challenges of being both a physician and a parent. "I still find it hard to juggle family and work life, especially with working weekends, call shifts and shift work. One of the biggest things I learned was that it was okay to ask for help. I tried to do everything on my own and was getting burnt out. I realized I needed help," says Fowler. "I had a good support system of friends, family and my 'work family' to help me out."

Anderson faced the challenge of maintaining breastfeeding when she returned to seeing patients. "My first call shift back at work I found myself in the pediatric emergency department reviewing an admission with a medical student, connected to my breast pump and crying because we were admitting a baby just days older than the baby I left at home. Suffice to say I don't think that student is going to have kids anytime soon," she laughs.

Jackman summarizes challenges to anticipate as finding breastfeeding and pumping support and locations on-site, balancing group call schedule needs and anticipating that you will need a lot of support for childcare during Royal College exam year. Migliarese Isaac reflects that, "Some of us experienced feelings of guilt and sadness to be away from our little ones, and others were happy to go back to work earlier than originally planned. Often there is a combination of these thoughts. Having a support system is the most helpful part, both from the work side of things and the social side."

How becoming a parent can help you become a better pediatrician
Jackman says that one thing all the women loved about going back to work was the new ability to look into another parent's eyes and relate to the anxiety, fatigue and pure joy that motherhood brings. "Being a parent will make you a better pediatrician. You will learn so much about normal baby behaviour, physiology, sleep and poops! You will also have a better understanding of parents you see, which has made me a better listener and better engaged in empathizing," she remarks. "The shared experience of parenting can bond people, and this can help establish a relationship with families."

They also agree that trainees should consider parenthood if it is the right fit for them. "I believe being a mom during my residency and fellowship has positively shaped me into who I am today and helped me become a better clinician, mother and wife. Therefore, if I went back in time, I would do the same," says Mahgoub.

**The experiences are those of moms who were pregnant during residency. Parenting partners also experience great life changes and challenges when a child joins the family. Parental leave, lost sleep, and new responsibilities are common threads. Send a note to to add another perspective to this story.