It’s 1:30 p.m. on a Tuesday, and I’m sitting comfortably, propped up by four pillows with my feet on a medicine ball in front of the sofa. I laugh with complete delight as I stare at my belly and see the spunky kicks of my daughter, dancing inside my womb to the beat of her own music. The joy I feel is indescribable. But then, I look around. A UWorld 40-question block is pulled up next to me, with a Step-Up to Medicine book behind it. Even six months before, I had never pictured my life like this, “indulgently” sitting on the sofa while life moved forward. Like most of us in medicine, I was used to high productivity and little downtime. Before medical school, I had completed a PhD program, not to mention countless other activities we all do to ensure admission to medical school. But that was OK; it’s what I knew I needed to do. Pursuing a medical career is all-consuming, a fact to which I had resigned myself long ago.
That all changed when my husband and I discovered we were expecting our first child. We were, of course, ecstatic. Nearing thirty years old, I was aware that with each year that passed, it might be more and more difficult to become pregnant, and I did not want to compromise my dream of becoming a mother. Over the years of school, I had become aware of the other hard truths of medicine: one in four female physicians experience infertility, nearly double the rate of the general population. Shockingly, a recent survey of female surgeons published in JAMA Surgery reported that, of the 692 women who responded to a survey, 42 percent suffered a miscarriage, and nearly half reported significant pregnancy complications.
Women in medicine are painfully aware of our colleagues’ and friends’ difficulties as they struggle to conceive, usually discussed behind closed doors or over hurried breaks while on clinical duties. It’s not difficult to guess why the rate of infertility, miscarriage, and complications is significantly higher among female physicians: stressful training environments, poor sleep and diet, lack of physical activity, the feeling that “this isn’t the right time,” lack of accommodations or support in school and training. The list goes on. Many female doctors who want families delay trying to conceive until the biological odds are against them, leading to heartbreak and reliance on expensive technologies like IVF. These challenges and potential roadblocks must be discussed more often and openly with students when considering medical school. It is drilled into us early on that medicine is a “sacrifice,” but I’m not sure if we truly understand the sacrifices until it is too late.
As with everything in my life, I immediately sprang into planning mode. I set up the “perfect” fourth-year medical student schedule; if everything when according to plan, I would have eight weeks off with the baby, take two board exams, apply to and interview at residency programs, and still graduate on time. But then, week six of pregnancy hit. I went from highly functioning on five or six hours of sleep to barely functioning on twelve. Constant nausea and dizziness wracked my body. I lost weight and existed in a state of perpetual fogginess. Even still, as we like to do in medicine, I pushed forward, trying to maintain my “perfect” schedule. I wasn’t going to be “that pregnant student.” But if I was being honest, I was an overwhelmed mess, both physically and mentally. And I knew if I wasn’t healthy, there was no way my child would be healthy.
I started reading and talking with other pregnant moms in medical school. Learning their stories was heartbreaking. My own OB described taking Step Two while ten days postpartum with breast milk leaking through her shirt for nine hours. Another story online shared the account of a mother who unexpectedly failed her board exam and ended up going into early labor due to the stress. Googling “motherhood in medical school” returned stories of women so stressed they had to get C-sections. I was appalled and discouraged. Finding national resources, information, or positive support for students like me is difficult. At the minimum, it would have been helpful to find an organized cohort of successful (but frank) “pregnant in medical school” stories with small suggestions or practical advice for things like testing accommodations during board exams. I recognize that I am not proposing major solutions to this problem, but that beginning with small steps is crucial for moving forward. The importance of support and positivity during one of the most stressful times in a woman’s life (both physically and mentally) cannot be overstated. As the average age of medical-school matriculation increases and the clear crisis of infertility in medicine grows, my situation will become more common.
Society cannot expect women in medical training to delay having children any longer than it already does. Medical institutions should have clear, well-documented, and easily accessible policies and adequate support and mentorship to help young women balance life as students and expectant moms. We must do better. And some are working toward this: I found that the American Medical Women’s Association has created an Infertility Task Force to raise awareness among students early in their medical school education. But much more can (and should) be done.
As time progressed, I realized that the perfect schedule I had meticulously planned would not work. The pressure cooker in my head felt ready to explode. But then, a close friend (also in medical school) suggested I take a leave of absence. A leave of absence? Taking a step back? The thought had never seriously crossed my mind. How would that affect my residency application? My future career and its trajectory? My kneejerk reaction was that I had to push through, as I had done so many times before. Pregnancy is tough, but I was tougher. But then, week 18 came, and I felt our little girl kick for the first time, reminding me of the absolute blessing I had been given. Tears filled my eyes as I knew what I should do. I realized that this timeline was not for her but for me. My own ego didn’t matter anymore.
So here I am, about to begin my year-long leave of absence. To be honest, I have never been happier. I experience the many joys of pregnancy while prioritizing and maintaining my health, something I have never done before because of my “push through” mentality. But now, it’s much easier for me because it’s not just for myself but for my daughter. I recognize that I’m extremely fortunate to have this opportunity. I also acknowledge that I cannot know how this move will affect my future career. But for now, I will continue to sit on my sofa on Tuesday afternoons and laugh as I’ve never laughed before as I feel her kick. Despite its many challenges and tradeoffs, motherhood has already changed me for the better.
Natalie Eichner-Seitz is a medical student.