Having a baby as a Junior Doctor
Experiencing the pitter patter of tiny feet is a life changing, challenging and wonderful experience but how do you manage it if you are also a junior doctor? JuniorDr’s Fareeha Amber Sadiq, recently a new mother herself, invites you to consider some ideas and strategies for planning a family whilst coping with the practicalities of working as a junior doctor.
A recent General Medical Council (GMC) report described the number of female doctors as rising and likely to overtake the number male doctors on the General Medical Register in coming years. As medical training is a long process and fertility reduces with age, many are understandably interested in starting families whilst they are in the earlier stages of their careers.
Creating a supportive workplace environment and more flexible working patterns is therefore fundamental to supporting this growing number of female doctors. However, as the GMC report describes, some specialties are more flexible than others and female doctors are underrepresented in certain specialities such as cardiology, gastroenterology, anaesthetics and surgery1.
More recently there have been increased efforts to retain female doctors in paid employment - examples include the GP retainer scheme2 and Less than Full Time Training (LFTT)3. Many argue that there is a strong need to change the culture in many areas of the NHS and to remove the barriers which are discouraging women from entering senior leadership positions4.
Many female and male doctors will continue to face the constant juggle of parenthood with their medical careers. Combining both of these can be rewarding, however it is important to be aware of ones resources and limitations.
Keeping and open mind
Planning when to have a baby will be based on your individual circumstances and how manageable you believe combining medicine with parenthood can be. Parenthood will always throw its own challenges but you can learn to cope with these.
With pregnancy it is vital that you keep an open mind. There are many uncertainties and although it can be incredibly rewarding, having children is definitely one aspect of your life that you have very little control over. Doctors are a group of adaptable and resourceful people and therefore this strength can counterbalance the uncertainty that comes with pregnancy.
As it can be stressful to look after a young child and work as a junior doctor it is advisable, as much as possible, to mobilise resources and people around you to help. It can be difficult to ask for help when you have been working independently, however having a strong supportive network of connections and caring people can enable you to feel less overwhelmed and for your anxieties to be better contained. This may be family, friends or paid help.
It is also worthwhile looking into childcare options prior to having your baby as there are often waiting lists and the more popular childcare places can be oversubscribed. When considering childcare,
it is also important to speak to other parents and consider the wide range available depending on your preference and budget.
Looking after yourself
For any prospective parent it is important to look after your emotional and physical wellbeing as these can be stretched both during and after pregnancy. This may also be the first time you come into contact with hospitals as a service user. Being on the receiving end of care can be challenging and is a different position to manage because of expectations and beliefs that you may have around providing effective care to others.
By looking after yourself well you are also preparing for looking after your child. Both of you will benefit from the extra care you take to ensure you remain in good health.
One of the key things to ensure is that you attend all your antenatal scans and review appointments. Getting adequate rest and eating a healthy balanced diet is important. These are not surprising messages, however with hectic and pressured working patterns sometimes these vital needs can be neglected.
In later stages of pregnancy you may find yourself experiencing tiredness or other health issues which may necessitate coming off your on-call rota. This decision will depend on you and your baby’s health, and the nature of work that you are involved with. It is a personal decision and should be made after discussion with your GP and/or midwife.
“By looking after yourself well you are also preparing for looking after your child.”
Attending local antenatal classes can offer helpful support, particularly for non-medical partners, and can also help you meet other parents who live nearby and who could become great sources of support through the coming months and years. Depending on your health, gentle exercise such as swimming, prenatal yoga and massage can aid relaxation and reduce stress levels.
Dr Rebecca Viney, Associate Dean of Professional Development, Coaching and Mentoring Lead at the London Deanery suggests: “Step back from the situation, imagine yourself in ten years time from now, what would you be saying to yourself looking back? It might be: get more sleep, more help, stop worrying, have fun and live in the moment.”
To receive maternity pay you must have had 12 months continual service for the NHS and be still employed at 11 weeks before the baby is due to ensure that you are paid maternity pay.
Maternity leave can be up to 12 months and during this time you accrue annual leave and pension benefits as usual. You will receive eight weeks full pay, 18 weeks half pay and then 13 weeks statutory maternity pay. You are not obliged to inform your employer until after week 16. Maternity pay is calculated on the average of your weekly earnings between about 16 and 24 weeks of your pregnancy.
“You are the expert when it comes to your family needs and values, and the balance will change over time.”
What you must do when you find out you are pregnant:
- Let your HR department and line manager (eg. TPD, consultant) know about your situation in writing, at least 15 weeks before the baby is due. When you provide this information, your employer will also request a MATB1 certificate. This will allow for an adequate risk assessment and also to enable maternity benefits to be put in place.
- The risk assessment should be followed by your employer making changes to your work environment as necessary.
- Inform your department regarding planned antenatal appointments in advance.
- Discuss your on-calls and how to modify these if possible and/or come off completely in the later stages of your pregnancy.
- Decide when you would like to take your maternity leave and communicate this with your organisation. Consider whether you will remain a full-time trainee or you will return as a Less Than Full Time Trainee (LTFT) and apply to work flexibly if this is your decision.
- Paternity pay is two paid weeks
- Additional Paternity Leave and Pay (APL&P) allows eligible fathers to take up to 26 weeks additional paternity leave. This should provide more choice and a more equitable sharing of leave.
Maintaining a work/ life balance
Life does change dramatically during pregnancy and after the baby is born. As a doctor who is a parent, it can be helpful to remember to keep life in balance and that Winnicott’s idea of “good enough” parenting is key.
Rather than aiming for unrealistic ideals, the focus should be more on celebrating parenting’s complexity and enjoying the journey that parenthood takes you on without any guilt or excessive pressure.
Dr Rebecca Viney’s advice to those experiencing parenthood and a career in medicine is: “Remember to be present and live in the moment. You are the expert when it comes to your family needs and values, and the balance will change over time. So it is worth creating time to set goals that you value, to work out your unique family priorities and to balance these with your career.”
“Coaching and mentoring can help you to achieve this work-life balance. Make sure that you keep your career safe, and find a role model who has reached their potential even with children, just to remind yourself that it is possible to do anything - it just may be that you have a slightly more interesting and different career path.”
Fareeha Amber Sadiq is a ST6 in Child and Adolescent Psychiatry, London.
Coping with pregnancy as a Junior Doctor – A personal view
For my husband and I, making that all-important decision of when we should start our family was something of a balancing act. On the one hand, now that we were both in our thirties, concerns regarding potential fertility issues were increasingly prevalent. On the other, completing my training as an anaesthetics registrar was a major goal, with enormous implications for both my professional development and for our family life. In the end, we decided to let nature take its course and were lucky enough to fall pregnant during my ST5 year.
While delighted to be pregnant, this was undoubtedly a time of emotional as well as physical turmoil. My booking scan was unfortunately not entirely the joyful experience that we had hoped for. The amazement of seeing our little bean’s heartbeat was soon tempered with the devastating news that there was a high risk that our little one may have serious congenital or structural defects. It felt as though our world had come to an end. The ensuing weeks awaiting the results of genetic testing and a detailed scan were traumatic, to say the least.
All this was compounded by the fact that I was undertaking a Fellowship in Obstetric Anaesthesia at the time. There is no doubt that it was difficult to concentrate on work when all I could really think about was what was happening with my own pregnancy. At the same time, my experience of being a
‘high-risk’ patient certainly gave me a whole new insight into what the hospital experience must be like for many patients.
I was under the care of a superb obstetrician who kindly and sympathetically prepared me for what to expect at each stage. At the very least, I have learned a valuable lesson in the importance of good communication with patients.
Luckily, everything worked out well for us; the chromosome assay was normal as was the 20 week detailed scan. This news certainly alleviated the stress, although the emotional scars remained.
“The amazement of seeing our little Bean's heartbeat was soon tempered with the devastating news that there was a high risk that our little one may have serious congenital or structural defects.”
Informing my department of my pregnancy was a task I did not look forward to, but in the end, happened surreptitiously. On one occasion in my first trimester, the consultant I was working with noticed that I was keen to avoid exposure to X-ray while in theatre and guessed that I was pregnant. I planned to formally inform my line manager after the twelve week booking scan. However, following the news of my high-risk status, I found it difficult to broach the subject. In the end, I found myself confiding in a sympathetic consultant colleague who kindly offered to inform the rest of the department on my behalf. This allowed me to then speak to my Lead Clinician in my own time.
Informing my lead clinician of my pregnancy was important for a number of reasons. Firstly, it was essential to complete the necessary paperwork to ensure my entitlement to maternity leave and pay, along with arranging a start date for my leave. I initially (somewhat optimistically!) planned to work until 38 weeks gestation. It eventually became apparent that this would not be possible as I was just too big and tired in my third trimester to continue to work effectively in the theatre environment.
Following ongoing discussion, it was agreed that I would take two weeks of annual leave after 34 weeks and then commence my maternity leave at 36 weeks. Secondly, I had to have regular scans throughout my pregnancy and required significant time away from my clinical duties to attend these as well as antenatal appointments.
Thirdly, it allowed a risk assessment to be undertaken which could identify any potential workplace risks to me or the baby, which could then be modified. Such risks included exposure to ionising radiation, dizziness if I had to stand for too long, the need for regular bathroom breaks (unless I wanted to self-catheterise, of course!), difficulties transferring anaesthetised patients and particular problems covering ICU duties, such as having to run to cardiac arrests carrying a heavy bag.
A number of small modifications were then made to my clinical duties. Where possible, I could avoid theatre lists involving x-ray exposure, a stool would be provided and (most importantly), I was taken off the ICU rota. This is certainly not possible for all pregnant trainees - I was lucky that my department was able to make it work in my particular circumstances.
A helpful tip that I picked up from a colleague regarded maternity pay. I was concerned that there would be no maternity pay for the last three months as I was taking a year off. I was informed that it was possible to request that human resources will annualise maternity pay, meaning that there will continue to be some income all the way through until returning to work. This took a bit of negotiation, but was certainly possible within my health board.
“I was just too big and tired in my third trimester to continue to work effectively in the theatre environment.”
Finally, I had to consider my options with regard to returning to work. The decision as to whether to return on a full-time or flexible basis is very individual and can be difficult. I had to balance the desire to finish my training expeditiously with the desire to spend as much time as possible with my baby. It is also important to consider financial aspects of part time training and childcare, along with the impact flexible training may have on the ability to stay engaged with departmental activities. After much deliberation, I made the decision to go back to work on a full-time basis.
The best advice I can offer to pregnant junior doctors is to think through your options, talk to people who have been through a similar experience and to keep your line manager and all other necessary parties up to date.
Angela Jenkins, ST6 Anaesthetics, Glasgow
LONDON DEANERY (for London trainees and doctors) offers a mentoring programme for doctors undergoing transitions and requiring extra support. Contact for more information: http://mentoring.londondeanery.ac.uk/
BRITISH MEDICAL ASSOCIATION
WOMEN’S MEDICAL FEDERATION
1. General Medical Council. The state of medical education and practice in the UK: 2011. www.gmc-uk.org/publications/10692.asp
3. Topley R, Ashwell G, Webb J, Brightwell A, Roden R, Corrado O.J. Trainees’ tales of less than full time training” BMJ Careers. 22 Aug 2012. http://careers.bmj.com/careers/advice/view-article.html?id=20008522
4. Khan M. Medicine - a woman’s world? BMJ Careers. 5 Jan 2012. http://careers.bmj.com/careers/advice/view-article.html?id=20006082
This article is brought to you in Association with JuniorDr