Emergency Medicine Residency and Pregnancy?

[vengaaqui]

Hi all. I'm a second yr resident in a three yr program and just found out I'm newly pregnant, likely due in the early fall of third year. I'm excited and terrified as it happened much faster than expected.

Any tips for getting through shifts, telling your PD, or anything else? The third yr schedule isn't out yet so there's time for that, but just kind of shocked and wondering what this means residency-wise (although my particularly residency has had pregnant residents in the past so at least there's a track record).

Thanks!

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[EM4life]

First of all, congratulations!! As someone who did scheduling in residency and had multiple pregnant co-residents, please tell your PD as soon as you are comfortable because if they are making rotation schedules, they can still make sure you have easier rotations post partum/immediately prepartum so that it's less of a problem if you go early or have a lengthy recovery. Check with your GME or PD on how much time you are allowed to have off post partum. My coresidents squeezed in easy rotations off of the mandatory 6 weeks off and ended up having plenty of time off. Depending on your program, you may qualify for short term disability as well. You will do fine! You may hear or feel some grumbling from other residents, whatever, just brush it off your shoulders, life happens. Keep in mind that you will likely have to tack on a few months of residency in the end to make up for your hours.

Do what you normally do for shifts, nothing changed for me, I found it a nice distraction from the little annoyances of being pregnant actually and in general patients were super nice to a woman with a big belly! Bring lots of snacks. I found sometimes it was hard to intubate with a big belly (haha things they don't tell you!) butting up against the patient bed. Post partum, if you are planning on breastfeeding, make sure you start pumping early, like a month post partum, so that your body gets used to the pump and you have a routine to make it fast and easy because it will be hard to pump quickly during a shift otherwise. PM me if you have any questions! Again, congrats!

 

[Birdstrike]

Hi all. I'm a second yr resident in a three yr program and just found out I'm newly pregnant, likely due in the early fall of third year. I'm excited and terrified as it happened much faster than expected.

Any tips for getting through shifts, telling your PD, or anything else? The third yr schedule isn't out yet so there's time for that, but just kind of shocked and wondering what this means residency-wise (although my particularly residency has had pregnant residents in the past so at least there's a track record).

Thanks!

Congratulations! Your first?

 

[The White Coat Investor]

It's tough, but I prefer covering for a pregnant/post-partum resident than having a 2 month pregnant attending join the group without mentioning she's pregnant! I don't know why but it seems like every female doc/mid-level we hire has a baby within a year of being hired! People have just put it off for their educations and now they're out, so it's that time of life, but it can be frustrating. It's like the nurse we hired who then told us he was being deployed with the National Guard just before he could start, so we had to hire again....It's legal, but it's still annoying.

 

[vengaaqui]

Birdstrike, thanks. Yes, first. And, thanks for the great advice EM4life. I don't think there's ever a "good" time as a female in medical training or newly out, especially one who took time off between college and medical school and is thus bumping up near "advanced maternal age."

 

[Pinner Doc]

Congrats. I had my son about 15 months after leaving residency, so I can't speak to balancing pregnancy/motherhood and being a resident. I'd be happy to chime in with experiences juggling motherhood and EM work in general. I'm also quite well versed in pumping at work. Let me know if any questions!

 

[Pinner Doc]

It's tough, but I prefer covering for a pregnant/post-partum resident than having a 2 month pregnant attending join the group without mentioning she's pregnant! I don't know why but it seems like every female doc/mid-level we hire has a baby within a year of being hired! People have just put it off for their educations and now they're out, so it's that time of life, but it can be frustrating. It's like the nurse we hired who then told us he was being deployed with the National Guard just before he could start, so we had to hire again....It's legal, but it's still annoying.

Well, at least from the examples you gave, it's equally annoying behavior among both men and women.

At the shop I was at when I took maternity leave, we're all ICs. All time off is unpaid. I took two months. Luckily, we have a big cadre of part-timers who fill in as necessary. I was also the scheduler for the group, so I had a stake in getting that schedule filled.

 

[bartleby]

Completely agree with telling your PD ASAP. One consideration is that if you save up your vacation time in your third year of residency and use this to "extend" the amount of time you would have off from using your sick days, in many cases it will only cause a minimal increase in the length of your residency.

Congratulations! Aside from being a physician, being a parent is the most rewarding experience I've had in my life.

 

[Fiddlergirl]

Congratulations! I'm a resident with two girls, both born during residency. It's not as bad as you're probably imagining right now. As everyone else has said, tell your pd as soon as possible. Be prepared that it may not stay a secret as long as you would like! I was about 8 weeks pregnant and thought I was keeping it a secret until a nurse walked up to me with Zofran and said "We all saw you duck into the break room and throw up. When are you due?" You'll be fine. I've breasted them both, and most places are very accommodating. I don't pump on shift, but apparently I'm some sort of breast milk camel that can go for 12 hours without pumping, and plenty of em residents find time to pump on their shifts. Feel free to pm me if you have any questions!

 

[Belleza156]

Hi all. I'm a second yr resident in a three yr program and just found out I'm newly pregnant, likely due in the early fall of third year. I'm excited and terrified as it happened much faster than expected.

Any tips for getting through shifts, telling your PD, or anything else? The third yr schedule isn't out yet so there's time for that, but just kind of shocked and wondering what this means residency-wise (although my particularly residency has had pregnant residents in the past so at least there's a track record).

Thanks!

Hi, your post is two years old, but I now find myself in a similar position. I just started 3rd year and I am around 8 weeks. My obgyn said to wait until I'm over 12 weeks before I tell anyone other than close family. I am terrified about breastfeeding/pumping. I dont know how I will be able to carry 15-30 patients at a time and be able to take a 30 min break to pump. Finding time for one break in a 12 hour shift seems undoable, let alone more. I have gone through several shifts without eating, drinking water, and even peeing. Not healthy but time is never on my side in my ED. There is always a never ending stream of patients and the hospital wants patients seen within 30 min.

I was wondering how the pregnancy worked out for you?

 

[Angry Birds]

Hi, your post is two years old, but I now find myself in a similar position. I just started 3rd year and I am around 8 weeks. My obgyn said to wait until I'm over 12 weeks before I tell anyone other than close family. I am terrified about breastfeeding/pumping. I dont know how I will be able to carry 15-30 patients at a time and be able to take a 30 min break to pump. Finding time for one break in a 12 hour shift seems undoable, let alone more. I have gone through several shifts without eating, drinking water, and even peeing. Not healthy but time is never on my side in my ED. There is always a never ending stream of patients and the hospital wants patients seen within 30 min.

I was wondering how the pregnancy worked out for you?

If you are in your third year, and you are currently only 2 months pregnant, that means you won't deliver until well into the second half of your third year. You could ask to switch your elective and non-ER blocks to the end of the year. It's easier to get out of non-ER blocks in my opinion, since an off-service resident is rarely crucial. Plus, you'll punt staffing issues to non-ER departments, i.e. not your own home department.

In any case, good luck! You really shouldn't feel bad. It's your right to have a baby and there is no right time for someone in medicine. Anyways, congrats!

EDIT: Of course, I'm assuming you are in a three-year residency.

 

[deleted109597]

15-30 pts at a time? I'm going to go with "no", pregnant or not.

 

[Daiphon]

Hi, your post is two years old, but I now find myself in a similar position. I just started 3rd year and I am around 8 weeks. My obgyn said to wait until I'm over 12 weeks before I tell anyone other than close family. I am terrified about breastfeeding/pumping. I dont know how I will be able to carry 15-30 patients at a time and be able to take a 30 min break to pump. Finding time for one break in a 12 hour shift seems undoable, let alone more. I have gone through several shifts without eating, drinking water, and even peeing. Not healthy but time is never on my side in my ED. There is always a never ending stream of patients and the hospital wants patients seen within 30 min.

I was wondering how the pregnancy worked out for you?

You'll find time to pump because they have to give it to you as part & parcel of the ACA (https://www.dol.gov/whd/nursingmothers/ ); and you need to not feel bad about taking it.

Lots of residents here have done it, as has my wife. From what I understand, the handsfree bra is crucial, and most loaded clinically while on the unit & documented during pumping.

It's the ED, we all flex as needed, and we've got each other's back. Does the department come to a screeching halt when you get sucked into a code for 30 min or more? Sure, it'll possibly slow down; but the bus keeps on moving.

Seek out any female attendings, residents, or nurses who have pumped during shifts & ask their strategies. But remember family comes first, so if this is the route you choose to take then commit to it & don't let anyone tell you otherwise.

Congrats!!!
-d

Semper Brunneis Pallium

 

[Belleza156]

15-30 pts at a time? I'm going to go with "no", pregnant or not.

I wish I was exaggerating. Easily 15 patients since I'm responsible for my patients and the first year resident and the medical students patients. Some attendings may help by picking up their own patients but I can't bank on that. During that 3pm surge it easily goes up to 20+ when I have all the active ED patients and patients going to ED observation that I am responsible for as long as they are in my area. Let's not forget the admitted ones that the nurse continues to ask me to do stuff for even though I tell them over and over the patient is admitted and to call the inpatient team. But our administration says as long as they are physically in the ED, they are still my patient.

I look forward to the day one year from now when I leave NYC and that many patients is not the norm.

 

[exsanguination]

I wish I was exaggerating. Easily 15 patients since I'm responsible for my patients and the first year resident and the medical students patients. Some attendings may help by picking up their own patients but I can't bank on that. During that 3pm surge it easily goes up to 20+ when I have all the active ED patients and patients going to ED observation that I am responsible for as long as they are in my area. Let's not forget the admitted ones that the nurse continues to ask me to do stuff for even though I tell them over and over the patient is admitted and to call the inpatient team. But our administration says as long as they are physically in the ED, they are still my patient.

I look forward to the day one year from now when I leave NYC and that many patients is not the norm.

Maybe I am a weak PGY3 but actively managing that many patients at the beginning your third year sounds dangerous!! I am not there yet

 

[Belleza156]

I didn't say it was safe for patient care. In fact it's the opposite. I rush to try to clear them but I honestly can't safely handle more than 12 active patients. I just focus on making them stable enough to walk away from for over an hour or two. Then when I'm getting down to 8 patients the dinguses in triage dump another 6-10 patients in one hour so they can clear the waiting room. I can't figure out why an attending would ever want to work in NYC. The pay is **** and the volume of patients is a set up for early career burn out.

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[Angry Birds]

Maybe I am a weak PGY3 but actively managing that many patients at the beginning your third year sounds dangerous!! I am not there yet

Yeah, I thought it was a typo and was 15-30 patients during one's whole shift. 15-30 patients at the same time? Sorry, my bull sh** detector just went off.

 

[shoal]

ummm. there have been a few studys looking at this... more then 4 active patients even for an attending -- things start to become extremely inefficient. i often had 10+ pt with my name on them during residency. however 3 were waiting for beds upstairs.. 2 were psych. 2 were extremity pain.. which only leaves you with a few.

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[Belleza156]

ummm. there have been a few studys looking at this... more then 4 active patients even for an attending -- things start to become extremely inefficient. i often had 10+ pt with my name on them during residency. however 3 were waiting for beds upstairs.. 2 were psych. 2 were extremity pain.. which only leaves you with a few.

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That's true some are pretty much wrapped up, maybe pending UA or something before admission or handoff. If 15 have my name maybe 8 are active, 3 are in "observation" waiting to go to out obs unit and another 4 are pending hand off and I forget all about them as soon as the hand is there.

But 3-5 patients at a time is what triage starts to dump once they want to clear the waiting room. After 3pm every hour you can get an additional 4 patients which are levels 1-3. None are leaving quickly except for less than a handful that were worked up at triage and dont have a real complaint in the first place, at least not one for me to address. So my attending has no choice in the matter. Even if I can't handle the bolus of patients the attending is still responsible for them as soon as they are assigned to our team.

They can ask triage to slow down but it never does anything. They still keep coming. Admin doesn't want the waiting room full and wants ppl seen in under 30 min. I'm not sure efficiency is what they are aiming for.

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[Belleza156]

Hence getting back to the original purpose of the post..... I never attempt to eat after 3pm because it's not feasible. I try to get away for 10 min around 1 pm which there is still a steady pace. That would probably be the time in which I will pump. But it seems like pumping is a 25+ min endeavor. I'll have to make it work but as soon as I'm ready to announce my pregnancy I'll ask admin to create a breastfeeding room nearby. There isn't an area that people wouldn't just walk into constantly anywhere near my ED. But my understanding is that there is supposed to be. I could go up to the NICU or L&D to the breastfeeding room but that's a 5 min trek.

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