One of the questions that I get emailed most is, “when should I have children?” This comes from pediatricians in varying stages of training, and even those in college thinking about a future career in pediatrics. It’s a great question with no answer! The answers to this depend on so many personalized factors and there are pros and cons to each. To oversimplify, there are few suggestions I can offer that may help you in your decision, but they are unapologetically biased by my personal experiences.
During medical school, I saw two women choose to have their first child between the second and third years, taking one year off. This allowed them to take a break between the didactic and clinical years of medical school. At the time, I thought this seemed like an unnecessary delay in training. Later on though, I thought this idea seemed brilliant. The pros include: a long maternity leave and younger age at childbearing. Their children were then three years old when they entered residency, which could certainly have its own pros and cons. For one, they were done breastfeeding and waking overnight. Their children were more independent and in preschool. However, they are also old enough to know when you are missing for 80 hours/week and remember it. Also, unless you are then willing to have a second child during residency, there will be a large age gap between children.
I saw many co-residents have children during residency. This is much harder to generalize as the experiences are very variable. In general, it’s hard to be pregnant during the first two years of residency, which include many more inpatient months and overnight calls. Maternity leaves tend to be shorter too, depending on your delivery and residency program, you typically only have 6-8 weeks off. Due to the long hours of residency, you will likely need a very flexible partner and/or nanny or au pair to have enough childcare coverage. Raising a child and affording high-quality childcare can be expensive on a resident salary as well.
Many colleagues chose to have their first child during fellowship, which similarly to residency is often more challenging in the first year. Later on in fellowship though, there are more research months, which gives you more flexibility and more time for sleep! Depending on your fellowship program, you may be able to extend your maternity leave.
For those not doing fellowship, having a baby as a junior attending is the sweet spot. Longer maternity leave, better hours, higher salary. The only real con is older maternal age.
For me, I had my first child during 3rd year of residency and if you have read this blog before, you know that he came at 34-weeks gestation. Nothing about it was easy. We had an eleven day NICU stay and 6 week maternity leave. My second was born during my second year as an attending and things were much smoother. My pregnancy was easier, my maternity leave was 12 weeks, my hours were shorter, and my salary was higher.
The real answer though is that you have to have your children when YOU are ready. You have to make the choice that feels right for your growing family. Consider your own health, time, family support, financial situation, housing, etc. and then follow your heart. In some ways, there is never a perfect time to start your family. Even if there were, you never know how your pregnancy will go, how healthy you and your baby will be, or what effect having a baby will have on you. I have friends who have a post-partum stroke, miscarriages, and infertility. Every day I take care of families who have children with complex congenital conditions and life-changing diagnoses. Having children is hard in so many ways.
And yet it is also the greatest. Of course having had a preemie I have regrets and wonder what if, but in holding my sweet six-year-old, I can’t imagine changing a thing. I love being a working mom and know that although my career has made me miss a lot of time with my children, my work is worth it. I know that being a pediatrician makes me a better mother and in many ways, being a mother makes me a better pediatrician.
I would love to hear reader thoughts on this! Share your stories in the comments.