I cried when I found out I was pregnant with my second child. While I was happy to expand my family, I knew the task of growing a human was not easy. In addition to anticipating the grueling physical demand of pregnancy, multiple people in my family were dealing with medical issues and the Covid-19 pandemic had just turned the world completely upside down. I was overwhelmed, but it was my fear for my career that brought me to tears.
As a senior resident, I had committed to an additional year of training in reproductive psychiatry and women’s mental health. My pregnancy, I feared, had put this subspecialty training in jeopardy. My fellowship accepted only one doctor each year, and I worried that my training directors would be disappointed in me. “They’re going to think I did this on purpose,” I thought to myself, afraid of being perceived as a saboteur.
I worried for several weeks about how to share my news, even seeking counsel from my residency program director, who helped me craft a carefully worded email to my new employers. My news, however, was greeted with congratulations and my program director helped me organize a flexible arrangement to accommodate my needs. Given how it all turned out, I feel silly now thinking about the weight of the worry I carried. But my fear was not entirely unfounded.
During residency I was passionate about the field of forensic psychiatry and wanted to spend my career working at the intersection of mental health and the law. To that end, I joined the professional society for forensic psychiatry and attended the organization’s conferences. I learned that the field was saturated with conservative white males. With a few side sessions on “diversity” topics, mostly attended by the underrepresented women and minorities, at these conferences, only peripheral and perfunctory consideration was given to my professional development as a Black doctor, and no consideration for my development as a pregnant woman.
Doctors-in-training are taught early that striving, no matter the cost, is integral to our success.
Over the course of my residency, I worked hard to cultivate relationships with phenomenal forensic psychiatrists, most of whom were minorities and parents themselves. They showed me how to navigate the political whitescape and that it was possible to find belonging. I was ready to do that work. That is, until I gave birth to my first baby and began learning about maternal and infant mental health.
Intrigued, I attended a perinatal mental health conference to learn more about the field. I was blown away to discover that this specialty was not only concerned with the reproductive health and well-being of patients, but also the reproductive health and well-being of its clinicians as well. I was amazed, for example, to find nursing and lactation rooms were provided and prominently noted throughout the conference. I had never seen a professional society be so intentional about the fact that mothers are clinicians too. Disillusioned by the vibe of forensic psychiatry, I decided to pivot to a career in women’s mental health where I felt I could be myself — a Black mother — without the taxing emotional labor of striving to belong.
The essence of my belonging in the field of reproductive psychiatry is the exception, not the rule.
Doctors-in-training are taught early that striving, no matter the cost, is integral to our success. We are praised, for example, when we suppress our humanity and forgo our most basic needs like sleep. I have known female physicians across the spectrum of specialties who have suffered in their own striving in medicine. Barely healed from childbirth, some have been traumatized by short parental leaves; others have mourned the loss of milk supply, due to lack of support around lactation and pumping at work. For those desiring children, this natural drive must be weighed against the intense and lengthy demands of training that overlap with prime reproductive years and the palpable stigma of physician parenthood.
In May, a study published in the Journal of the American Medical Association found that, on average, non-physicians have their first babies at age 27 and female physicians desiring children delay childbearing till age 32. The study also noted that physicians have dramatically increased rates of childbirth after age 37 compared to our non-physician peers, which increases the risk of maternal and fetal complications associated with pregnancy in an advanced maternal age. The study did not collect any data on race, so I don’t know if Black doctors, for example, had a greater delay than white doctors. Given the increased pressures minorities in medicine face to be perfect, I suspect this would be the case.
As a group we tend to catch up to our non-physician peers by having children later in life, but on an individual basis this decision to delay increases the risk of infertility. Overall specialists, both surgical and non-surgical, who spend up to seven years training after medical school had a lower incidence of childbirth relative to family medicine physicians, who train for three additional post-graduate years.
As I tearfully stared at my positive pregnancy test, a few months shy of starting my sub-specialist training, I worried about how my new colleagues would react to my news. As the JAMA study pointed out, unsupportive supervisors were a barrier to physician-motherhood. While my instinct turned out to be far from the truth, I realized how deeply perverse the indoctrination was that sparked this distress.
I feel lucky that as a physician pursuing sub-specialist training, motherhood has not been a barrier to my career. I worry that I was supported because my specialty takes all aspects of health and wellness into account. Doctors in other specialties may not have that privilege.
The warmth with which both of my pregnancies have been embraced has shown me that it is possible for a career in medicine to center the reproductive rights of physicians. We too deserve the freedom to choose how and when to build a family.
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