Doctor Mom

For a growing number of women training for a career in medicine, pregnancy is a complication

Chloe Zera returned to work seven weeks after giving birth to her daughter and soon grew exhausted. Not only was she up during the night with her baby, but Zera was training to be an obstetrician and regularly worked 24-hour shifts.

She felt so tired, she found it hard to absorb information. She pumped breast milk on the fly during her six-week surgery rotation, usually while a junior resident briefed her on patients.

"I was just getting by," said Zera, who finished her residency at Massachusetts General and Brigham and Women's hospitals in June.

For the growing number of women entering medicine, becoming a doctor increasingly includes a complication: pregnancy. Women now make up 40 percent of the 105,000 residents in the United States and 48 percent of medical school students. There is little data on the number of female residents having babies, but program directors in many specialties believe childbirth is becoming more common, both because of the increase in female residents and because residents of both genders are demanding more balanced lives.

In the last 10 years, most teaching hospitals have adopted maternity leave policies for residents. Even so, new moms face a range of difficulties beyond exhaustion, from time limits placed on maternity leaves by boards that certify physicians in their specialties to resentment from fellow residents who must shoulder extra work while they're gone. Academic medical centers also feel the pressure when a resident gets pregnant, because they depend on these physicians-in-training to provide most of the round-the-clock care to patients, especially in Massachusetts with its large number of teaching hospitals.

"As far as we've come, there still are significant barriers to parenting during residency," said Dr. Debra Weinstein, vice president for graduate medical education for Partners HealthCare System, the parent organization of Mass. General and the Brigham. She co-authored an article on the topic in the New England Journal of Medicine last year.

Researchers are increasingly studying the impact of childbirth during residency on mother and child. Doctors at the University of Maryland are surveying hundreds of female surgeons about the attitudes of their colleagues and other aspects of their experience. Researchers at Columbia University Medical Center are studying whether the grueling physical nature of the job, which is largely spent on one's feet, leads to higher rates of pre-term labor, premature birth, hypertension, and other complications. Smaller studies have suggested pregnant residents do face more health problems.

After giving birth, residents usually return to work earlier than most professional women - and face more exhausting schedules.

National certification agencies limit the amount of time residents can take off, usually to six or eight weeks. Dr. Jo Buyske, associate executive director of the American Board of Surgery, said that surgical residency directors last year began pushing for a more generous leave policy, and the board is debating whether to extend the current six-week maximum.

One significant problem, she said, is that other residents have to pick up on-call shifts for colleagues on leave, shifts that require at least 24 hours straight of work.

The Association of Women Surgeons, in its "pocket mentor" manual for residents, warns that "the pregnant resident may be the recipient of unwelcome comments and possibly open hostility. Both faculty and resident peers can resent the additional burden . . . " The manual goes on to give tips that "can lessen the resentment," such as working a full schedule right up until going into labor.

Several residents at Massachusetts teaching hospitals said they thought carefully about the timing of their pregnancies, trying to plan them during research rotations, which don't require overnight shifts. They said women's experiences vary widely depending on whether their residency director is supportive or not.

Dara Arons, 34, is a third-year resident in family medicine at Boston Medical Center - a program she chose partly because it has a reputation as family-friendly. To help her with breast-feeding her 4-month-old daughter, for example, the residency program directors block out 15-minute slots four times a day when she is freed from seeing patients so she can pump breast milk.

Dr. Danielle Walsh, 37, who finished her general surgery residency at Mass. General in 2002, thought about quitting after her daughter, Kamryn, was born in 1999. Kamryn developed a digestive disorder, and had trouble keeping down food and gaining weight. She required frequent hospital visits.

Walsh's residency director scheduled her on rotations with lighter workloads. "He even had his wife baby-sit my child a couple times," she said. "He didn't let me quit. He made it work for me."

Some female residents, she was surprised to find, were not as supportive. "There was a perception that I wasn't as dedicated," said Walsh, who co-authored the women surgeons group's manual for residents. "They just seemed to have trouble with the fact that I needed to put my child first. In their life, residency came first."

Zera, the obstetrician, considered postponing motherhood until after her training. But the 30-year-old and her husband want three children, and she was worried that she could lose her window if she didn't get started. Her daughter, Ivy, was born on March 6, 2007, while Zera was a third-year resident. She tried to do most of her on-call shifts before her leave and to plan her pregnancy so she would give birth during her five-week research block, the only time during third year when a resident is not on-call.

"The chiefs in charge of scheduling knew I was pregnant before my parents did," said Zera, who is doing further training at the Brigham.

But the unexpected happened. Zera's blood pressure climbed and she went on bed rest three weeks before her delivery. This meant other residents had to take her on-call shifts during that period - favors she paid back when she returned to work and her daughter was a few months old.

Not all residents find their programs supportive, and some end up quitting. In a job interview at one hospital, Zera said, a senior resident made it "very clear that it wasn't appreciated that people got pregnant during residency."

Dr. Christine Rohde, a plastic surgeon at Columbia who has sent surveys to 4,000 female surgeons of all ages for her study of pregnancy during residency, said some bosses have told pregnant residents to drop out, while others have suggested terminating pregnancies. "One thing that's coming up repeatedly in the survey responses are the interesting and horrifying stories about what they've had to deal with," she said.

Liz Kowalczyk can be reached at kowalczyk@globe.com.