Four female physicians share their life & death experiences. Miscarriages from overwork. Sexual harassment. Threats of termination. No legal protection. Medical training in America. Listen in:
Stacey Maddox, M.D.
I failed my first ED [emergency department] rotation in third year because I had a miscarriage. I had to take two weeks off and the attending agreed to pass me for a two-week rotation, but then didn’t. All I ever wanted to be was an ER doc. The subsequent glowing recommendations I received from other ED rotations didn’t help. All residencies saw was that failure. And my school let it stand. Apparently, you’re supposed to still be on rotation and seeing patients with your baby falling out of your uterus.
Tameika Lewis, M.D.
Like all female residents in my program, I was not supported during my pregnancy. I had my first child during my chief year and the dept chair threatened not to let me graduate on time if I took one day more than 6 weeks with my newborn. Imagine that… an OB/GYN residency refusing to support the rights of their residents to have families…. So I prematurely ripped myself from my tiny newborn at exactly 6 weeks so I could graduate, even though I wanted at least 8 weeks, seeing as I had a cesarean. I deal with the “mommy guilt” of that decision to this day. Its such a shame because I worked like a Hebrew slave for those people (I even worked the day I went into labor…I finished my rounds completely out of breath, and then had my baby by c/section 2 hours later)….I wasn’t alone though…the director actually insinuated to another resident that if she had another child they would fire her. I always thought that was illegal, but unfortunately we don’t get any legal protection in residency, and everyone was too afraid to challenge authority (we just wanted to hurry up and graduate). The same guy even sexually harassed another resident, but again, she was too afraid to come forward.
Eilis Clark, M.D.
I was senior resident, with severe spinal headache, lying on lounge sofa, supervising junior residents, afraid to use anymore leave. I was told to get up. I had cerclage for preterm labor, and doctor recommended bedrest but told me he knew I probably couldn’t do it as a resident. Residency director told me if I took leave, it would extend my graduation date, and that meant I probably couldn’t get a job. I believed him, and worked. My water broke in clinic. I gave birth to 21 week infant who died 2 hours after his birth. I hate my decision.
Ann Weiss, M.D.
I became pregnant in my 3rd year of EM training. I did not feel very supported. My sense was that everyone (other residents and attendings) was fearful that I wouldn’t be able to do my work, in turn, causing more work for them. I think I managed pretty well overall. I remember difficult shifts with sciatica and feeling hypovolemic in trauma lead during procedures. But I always showed up every SINGLE day. Only once in 9 months I was told by an attending to go sit down and eat lunch while he covered things. I was so shocked at the offer that I can’t even remember if I took the break. Somehow I made it to month 9 without preterm labor and had arranged to do an easy rotation (radiology) out of the ED until my delivery. I was SO happy to put my stethoscope away. I remember putting it in my drawer and crying that I made it through 8 rigorous, nauseous, and uncomfortable months. But the very next day, I was ripped out of radiology to work an extra ED shift to cover a resident who outright quit. It was the most disheartening thing to happen. I went into labor after that excruciating extra shift, about 3 weeks early. Thankfully my daughter was healthy and I had 8 weeks home with her.
Going back to finish residency was the hardest thing I have ever done. I wanted to breastfeed and made it a priority to pump at least once during a shift but had very little support to make it happen. No resident had done this in recent memory according to the nurses. I eventually found the “grieving room” as a place to pump because it was in the ED and not a bathroom or closet corner. I was walked in on a few times. Everyone was shocked that I dare take 15 min away to pump. No one helped me do my work. I answered calls and ate a snack while pumping. It felt like a passive aggressive protest against a nursing mother, not pitching in. I had to miss some traumas, and attendings covered me during those times, but none of them made it very easy. I’m not sure where the inner strength came from to be able to do something so daring. Somehow, I stuck it out until I graduated residency. I’m sure everyone around me thought they were very “tolerant” of my condition but I felt surrounded by critical and resentful eyes that didn’t make any conscious effort to make things more do-able for me. Everyone seemed out for themselves- and any threat to their schedule or workload was frowned upon. I don’t remember complaining. I didn’t miss a single day in the ED. And I made up a few weeks after graduation to meet the program requirements. If ever asked by a student/resident if they should consider pregnancy while in training, I would highly discourage it!! I wonder how other women have dealt with this?
Have you practiced medicine while pregnant? Share your story below.
Pamela Wible, M.D., was conceived during her mother’s psychiatric residency and reports on human rights violations in medicine. Need help? Contact Dr. Wible.
That is so sad. Attitudes are very different in Canada, I think. Residents regularly have two children by the time they finish residency, and the standard is generally to take one year mat leave for each pregnancy. I remember one senior resident who was pregnant and due at the end of PGY4. She was so fed up of residency that she tried to take a one month mat leave in order to graduate on time and the PD asked her to reconsider and take a longer mat leave “for the sake of the baby”. She ended up taking two months and people were extremely shocked, but it worked for her.
AWESOME! Let’s model the humane medical education programs around the world.
Additional public comments via social media:
“Joni Scott, MD was pregnant during her senior year as the Chief Resident in Surgery (1990). She would catheterize herself with a leg bag to make it through the days cases.” ~ Rick Anthony Perez-Ricketson
“My husband had 24 hours off residency when I gave birth. So despite the fact I had hemorrhage I was discharged at 24 hours so he could take us home. The weeks that followed were hell for me. And, he had taken no vacation days the prior year because he was saving them all for after the birth, but was then not allowed to use them. So a full year of working more than the legally allowed residency hours and not a single day vacation, and 24 hours paternity. As he was in 11th month of residency he did not meet qualifications to take FMLA either.” ~ Kelley Waite
“When my mom was an anesthesia resident in NYC, she was so overwhelmed with taking care of her kids that my older brother (a baby at the time) had to live with my grandmother in South Korea for a year. The struggle is real with balancing motherhood and residency.” ~ Alicia Cho
“When I was pregnant with my first, I was hospitalized on bedrest for 3 weeks for pre-eclampsia. He was born at 36 weeks and did fine, but my transitional internship was extended 3 months which was actually not that big of a deal. My husband and I were in the Navy and were going to flight surgery school after internship, so it just meant we went to a later flight surgery class. When I was pregnant with my second, I was a peds intern. I was having issues with my blood pressure and was feeling really crappy. I talked to the OB I was seeing about putting me on bedrest given my issues with my prior pregnancy. He refused, citing the Navy instruction on hours limitations for pregnant servicemembers but then told me that he recognized that I had no way to force my program to follow those rules. He basically recognized that I was screwed but refused to help me. I delivered her at 35 weeks after being induced for low fluid. Someone had to cover call for me the night I delivered. So messed up.” ~Erika Beard-Irvine
I became pregnant as a 4th year surgical resident (in 1993) and I delivered 4 months into my chief year. I never missed a case and I used to wear double lead for fluoro cases. I didn’t want any special treatment. Ironically, the only person to be blatantly unfair during my pregnancy to me was an older, female pediatric surgery attending. During a case, I had to sit down for a few minutes because I became lightheaded. I was able to finish the case without incident. The attending berated me for allowing myself to become pregnant while taking care of children. I was the first resident in my program to become pregnant in many years. When I delivered, my program director called it a medical leave and allowed me to take 6 weeks off. When I showed up for my next scheduled rotation, I was told that I was being sent to a less desirable hospital because the attendings assumed I would not be able to handle the workload. I didn’t even think to question it. I was hoping that things were better for residents today, but maybe not.
May be better in some places. Depends on who you run into and how bitter they are about their OWN lives. They are just taking out their grief and frustration on you. Some programs still very malignant.
I had my first child during third year of medical school in the late 80s. Many people were surprisingly supportive, the women were worse than the men, one accused me of being a “dilletante”. I was on a vascular surgery service and had to leave every time they rolled in the fluoro so I tried to compensate by doing the floor rounds and all the debriding and scut work. The nurses saved me and were encouraging and protective. I was able to take off enough time and pumped during noon conference. Some attendings complained that I missed conference but I was clear that I had to pump.
I had my second child during the beginning of third year of my Family Medicine residency, it was harder. I delivered at the hospital where I was working, it was awkward. These were the days of 36 hr shifts and I was in a fog of exhaustion, being pregnant only added to that. I have a distinct memory of doing chest compressions on a stool during a code, with my belly in the way but that a pregnant belly made a great shelf to deliver a baby onto. There was definitely a special connection to pregnant patients. I went into labor at work and I was dictating charts in the recovery room. There was a continuity requirement for residents so I did nursing home rounds for all my fellow residents while on maternity leave, taking my baby to the nursing home. It was actually quite lovely to share my baby with some of the lonely patients there.
I was still breastfeeding as an ER attending and distinctly remember getting a let down when I would examine a crying baby. I was fortunate because I have a supportive husband and we had family in the area who helped a lot. My mother would fend off my children when I was post-call and let me sleep. I finished medical school and residency late. When I applied for my medical license I had to explain gaps in time during training and had to produce birth certificates for my kids to prove I was not incarcerated or in rehab.
“When I applied for my medical license I had to explain gaps in time during training and had to produce birth certificates for my kids to prove I was not incarcerated or in rehab.” That says it all. The medical boards must protect the public from dangerous doctors who may be taking time off to nurse their babies. Wow.
I’m currently writing a fiction novel where my main character becomes pregnant during her second year of her ob-gyn residency. I am not a doctor, but want part of her struggle to paint a realistic picture of what pregnant women face in their residencies. She struggles with exhaustion, morning sickness and stress from being overworked. She doesn’t have support from her family or partner (who is also in his residency) so I want her to get support from the hospital administration (it’s obviously a work of fiction). My question is, would it be possible for the CEO of a private hospital to be so involved in the hospital (started by his father and uncle) that he prioritizes the staff’s health and allows my character 8 weeks off in her second year and another 8 weeks off in her third year without delaying graduation?I want to write it in a way that someone who reads it who has been in a similar situation can find it believable. She does complete more then 110 hours a week until she delivers the baby at 31 weeks. I would really appreciate any comments.
In one residency program I am acquainted with, post-partum parents were put on a rotation called “Developmental Pediatrics”. Guess what? They became better pediatricians!
Dr. Wible,
I loved and hated your recent blog post about maternity care in residency. Loved that you are elevating the issue; hated that it is so pervasive. I wanted to share my own experience and tellingly, because I am still in residency I did not want my name attached or my experience recognized, so here I am sending it directly to you (and publishing anonymously here)
I had my third child during my intern year in my Ob/gyn residency. I had two in medical school, and of those, having a baby in residency was probably the most difficult. My rotations were arranged to make things ‘easy’ for me with little regard to my input. I spent my last 5 weeks of my pregnancy on nightfloat and consults – the constant walking gave me contractions and irritated my sciatica, for which I rarely could make it to PT as recommended because of my demanding schedule. I was assigned call at 39wks, 40wks, 40wks+5 and 41wks+5, even though I had informed the chiefs of my due date. I was informed I would be responsible for those shifts and finding someone to swap shifts with me if I did not think I could make it. I swapped all but my shift at 39wks, which I did rounding on 40 patients on our inpatient unit, including one who had shingles (that detail was left out of the signout and I discovered it when the tech came running down the hallway as I walked in the room). Even though I had talked early on with my CNM about avoiding induction, at my 39wk+5 appt, exhausted and uncomfortable I asked to be induced that weekend at 40wks to avoid returning to work Monday and to maximize my maternity leave. While I was allowed to take FMLA, as the sole provider for our family we could not afford for me to take more than the four weeks of vacation and sick leave I had left (I had to use my other 40hrs of sick leave for OB/GYN and PT appointments). On return I had a relatively easy rotation as the only provider (ie no in-house attending) covering consults in 12hr shifts on the weekend, plus 1 day a week with the consult team. I had no one to cover me while I pumped and often worked extra hours to complete the work I couldn’t do while pumping. I was questioned why I was taking so much time, and advised to be attentive to work hour restrictions for interns, but still get everything done. We supplemented that first month while I tried to get my supply stable. For the four months between returning from maternity leave and the end of intern year I had one weekend off – to make up for the call I ‘should have had’ while on leave. Call tallies at the end of the year showed I worked more weekend call shifts than any other intern. What kills me is call shifts and rotations were assigned by the chief resident. When brought to the program director, however, she stood behind the chief resident’s assignment of responsibilities.
Thankfully my pregnancy was easy and without significant complication. The delivery, while I didn’t really want an induction, went smoothly. I can’t imagine how I would have been treated if my pregnancy had been more complicated.
The trouble about being a resident is that our entire professional career hinges on completing our program in good standing with the PD and attendings. Criticizing those who hold your certificate of completion – your key to return on investment – is paramount to career suicide. Thus, we keep quiet and the status quo marches on. I appreciate you giving a platform for these stories, to remind us that we can’t just take our certificate and go. These aren’t just resident issues, these are physician issues, human issues, and we all need to advocate for change in our residency education to create a culture of medicine where we practice what we preach.
I know their stories all to well. Residency was difficult. Miscarriage during ER shift (had to see patient in the gyne room before I could be seen). Preterm labour at 22 weeks for next two pregnancies. Contributing to advice on ER case while they were finishing my C-section for a miissed breech….and then their was returning to residency with an infant at home.
My experience was thankfully marked by universal support in my Family Medicine program. I was pregnant my last year of residency. The 6 other residency classmates in my year all agreed to switch shifts so I could have a lighter load during my last months of pregnancy. I made sure even with my growing girth, carpal tunnel, and sciatica to run to as many codes with the team, deliver newborns, and stay up for the night float months, overnight calls as I didn’t want to experience any resentment from the call team or classmates. I delivered a week early, but did not have to make up any extra work. After I returned after maternity leave, my program director (female, with 2 kids of her own) made sure I always had access to an attending’s private office to pump during lunchtime. My other classmates also voted to allow me to take home call (I only lived 5 minutes from the medical center) after delivery for the last 1/2 year so I could continue to breastfeed my son on demand overnight. I am grateful always for the kindness shown to me, especially after reading the horror stories above.
I was never pregnant, but as a single physician, adopted a newborn from Latin America. I was an attending MD for the family medicine-run obstetrics unit. I was given exactly one week of leave to travel/return with my baby. I returned to work under duress after that one week.
It was devastating for me emotionally. After having taken OB call every other night for five years, performed thousands of vaginal and c-section deliveries, I was given literally no time to bond with my new baby.
I tendered my resignation soon thereafter. My “mentor” (the chief of OB) told me I was short sighted to “damage” my career by leaving their institution. In addition he told me he was “deeply disappointed in” me and that he had lost respect for me for choosing my newborn over the prestige of working at that institution.
I moved closer to my family and began a new position about two months later. I was blessed to have adopted a second baby and raised both children as a single mother. Looking back I am astounded that I worked sixty or more hours a week and raised my children alone. My folks were a God send…
The state of medicine is fractured; we physicians, especially those of us in primary care, give and give and give — until it hurts physically and emotionally (and earn little in comparison; my salary is the same as in 1995!).
Today at age 56 I am exhausted. Later this month I will take a two week vacation
— the longest consecutive vacation time since I started Residency training in 1990. And I wonder if I will be alive and healthy enough to someday enjoy retirement.
Amy, first I commend you for standing up for yourself and your children!! You MUST say no and draw boundaries so that you have a personal life! Read this: (I think you may already be ahead of some docs in this area) How to say NO for people pleasers. I’d love to talk to you. Sending you an email now.
I had to support myself from age 16. I had a good job full time job as a nurses aid during my undergraduate years and got a full scholarship to NYU in New York for my undergraduate studies. I chose to move to Texas for medical school because the out of state tuition at that time was only $900.00 a year. When I was in my second year of medical school, I got pregnant with my third pregnancy and lost it (I have had 9 pregnancies and only 2 live births). I got pregnant again right away and had a relatively uneventful pregnancy. I delivered my daughter at 38 weeks. Labour started during my pharmacology final. I left the test room half way through my exam because the contractions were too hard and I was puffing and panting. I went on to labour for 36 hours and push for two hours then have a forceps trial and then the c section. I had been married for 6 years when I got pregnant with this child. I had focused so much on having a successful pregnancy that I had not noticed that I had severe martial problems. My husband at that time thought I should stay home and quit medical school once I had a baby but he had never told me that. My husband got physically abusive and it was unsafe for me and my daughter to stay with him. So I left him and took my daughter. I was dirt poor and I had no family anywhere to go live with. I decided to finish medical school as a single parent. My husband disappeared and I got no child support. The Medical School tried to convince me to give my daughter up for adoption. A dear friend in my medical school class (Andrea Lynn Richardson, M.D., Ph.D.) moved in with her future husband and let me live in her condo rent free. I worked for a year and found a great babysitter. So I moved into a rent house 2 doors down from the babysitter. It was in a bad part of Dallas. There was the sound of guns going off every night. I went back to do my third and fourth year of medical school. If not for my babysitter Myrtle Washington I would never of made it. She watched my daughter all the time I was at school ding rotations including the on call nights. I would go my rotations and then go home and pick my daughter up and take her back to my house. On call my daughter would stay with Myrtle. I endured and graduated in the middle 50% of my class (The first two years I had been in the top 20%) Some of the professors made my life deliberately miserable. They thought I should not be a mother and in medical school. And some were wonderfully supportive. My residency was a disaster. I choose psychiatry. My first attending went out of the way to make my life miserable. He thought women should not be physicians and especially mother’s should not be physicians. He was the most pathologically mentally ill physician I have ever had the opportunity to work with. He made my life hell by trying to get me kicked out of the residency program. After 10 months of his hell I got ill with a depression myself and could no longer work. I switched to a family practice program in Houston. They were wonderful to work with. Such a different attitude. I have been practicing since I graduated in 1989. I am now doing exclusively hospice. It allows me to care for patients and families who are in dire need. Oh and I have been happily married to my second husband for 25 years. My daughter is a 31 year old high school math teacher and varsity volleyball coach. (She went to college on a volleyball scholarship she is 5’10.5″ and graduate school on a math scholarship)
Oh you have been through SO much. You now deserve to be happily married and enjoy your career. I’m glad you found your “happy place” in medicine. We do need to keep sharing our stories. Thanks for your courage and willingness to share your pain with the world.
Being pregnant while residency myself, I am very much touched by these stories. I want to disagree though on the very last part of the article. To discourage pregnancy during residency is not the solution! With the very long training, 8 years average(ms+ residency), probably more (fellowship) for a lot of people, it is simply impossible to push it off to after training. Especially with the increasing infertility rate, moms with advanced age face more challenges. It is also well known that advanced age increases the risk of Down syndrome – one we know about, probably more we don’t know about. This is not a universal problem though. The US is one of the few countries among 118 countries in the world to not have mandated maternal leave. Residency is one of the very few fields that remained like this while corporate policies are getting so much better. We hear an increasing number of companies are granting paternal leave in addition to their long standing maternal leave. But throughout all these years, what have the medical world done as a change?
Note to my past self: Residency and practice as a parent is tough. You will be a better, more understanding doctor as a parent, because children make you understand vulnerability. In your work, you will meet some terrible people and some of the most wonderful people (doctors, nurses, allied health, and patients as well) whom you will always remember with gratitude. You will wonder why the terrible people are in positions of responsibility and you may doubt your worth. If you can’t find someone wonderful to talk over your problems with – get out and find the wonderful people, because they are out there somewhere. As physicians we think we have to fix things, but sometimes we need to save ourselves by transferring to another residency or another job.
Further back: when you interview for residency, ask the residents how their program director helped them through a challenge. Ask who they can call if they’ve had a bad day.
For breastfeeding moms: it’s not a failure if you didn’t get through a whole year breastfeeding, or even 6 months, or less, or not at all. What matters is quality time, even short term, with your child. Thank the people who make it possible.
Also, jackets/white coats are handy for covering letdown, and remember to firmly cross your arms over your bosom when you hear a baby crying, that may stop the letdown.
Remember to find friends who can give you other survival tips; guys, you too!
PS. You will outlast the terrible people, they tend to weed themselves out. If they don’t, go find greener pastures, it’s not quitting, it’s called living.