This is a (really long) spinoff from another post (about whether waterbaby27 should have a baby in med school). People are always trying to figure out if they should have a baby at X point in their medical career, and people always respond with their stories, pro and con (including residentmom, who has had a baby in every point in her medical career!). That is great, since people need to know what kinds of situations can come up. But I was thinking about something more objective, like some kind of scored quiz where people could answer questions about their own situation and get an answer, like "this will probably work out well," or "this will be a total disaster," or "this has a 50% chance of working out." People who have already taken the plunge and had a child could see if the results reflect the reality of how difficult or easy it is.

So I have been thinking about making such a quiz, but I have no time, so I can't do it. But what I have done is to list some things that seem like good predictors of how things will work out. By "work out" I mean that you will be able to continue your medical career and feel okay about the balance of family and work. Maybe this will be helpful. Maybe other people will add to the list, too.

Husband

It seems like the people with stay-at-home-dad husbands are usually very happy with that arrangement. Other good factors would be a husband who is willing to share child rearing and housework, a husband with a very flexible job, a husband who will not require you to move for him, a husband who would be willing to move for you, and a husband who values your medical career. Negative factors would be a husband in the military, a husband who is a surgeon, a husband who expects you to support his high-powered career, a husband who is not a good father or husband, and an absent husband (or no husband at all).

Family caregivers

It seems like the people whose parents or in-laws can provide a lot of free childcare are extremely grateful for that support. The number of family caregivers, their proximity, and their availability seem to be positive factors. Negative factors are family members who require your care, such as sick or elderly parents, or family members who would not do a good job for whatever reason.

Paid childcare

It is a big challenge to find childcare that is excellent, affordable, available at odd hours, and available for sick children. I don't know much about this part, but people have reported all kinds of good combinations of daycare, in-home caregivers, and caregivers on call. It seems like the wider your net of potential caregivers, the better.

Money

The more money you have, the more options you will have. It is expensive to raise a child, and it is also expensive to become a doctor. Husbands with money are also good, unless they are completely unavailable because of their high-powered work. Being willing to live frugally is a big plus.

Your attitude toward parenting and homemaking

A positive factor seems to be a willingness to delegate a lot of the parenting and homemaking. Negative factors seem to be the belief that mothers should stay home with young children or a lot of family pressure to do so (not that this is a negative or incorrect attitude, just that it makes it harder to balance motherhood and work because of the guilt).

Your attitude toward your medical career

Positive factors are a love for medicine, and a belief that you are/will be a good doctor despite not spending 100% of your time on medicine. A negative factor would be that your medical career is so important to you that you do not want anything to interfere with it (because having a child will definitely interfere), or conversely that your career is not as important as your husband's career (because then you are more likely to sacrifice your career). Feeling beaten down and disillusioned by the reality of medicine is another negative factor.

Your stage in education/training/practice

There are endless permutations on this one. So much depends on your local situation, such as a medical school with course material available in a variety of formats, or a culture of family-friendliness in your particular hospital. Then you have to think ahead to how old your child will be when you are an intern, etc. The only thing that seems clear to me is that internship is the worst time to have a baby.

Family-friendly field

To me, this means 2 things. First, how competitive is the field you want to enter? If you want to go into something super competitive, you will need to work very hard and do very well in medical school, and having a baby then could definitely hurt your chances. Second, once you get in, how flexible and supportive will your bosses and colleagues be? The availability of true part-time work, hours that correspond with daycare/school hours, and the ability to take time off (short- or long-term) are also positive factors. And just in case anybody did not know, surgery is not a family-friendly field.

Other commitments

Anything else that takes up your time will make it difficult to balance medicine and motherhood. Caring for an elderly or sick parent, other children to take care of, a long commute, a time-consuming hobby, or even a well-rounded life could be seen as negative factors if you are really pressed for time. On the other hand, already having other children can be a good thing if you already have a system of support that works well.

Unknown factors

You can't predict some things, such as infertility (although your age is an important predictor), complications of pregnancy and childbirth, a sick or special-needs child, an illness in you or your caregivers, or the collapse of medicine as we know it, but these things can definitely upset the balance of your life. And as they say, you can never really know what it is like to be a parent until you are one.

Your own influence on the above factors

You can influence a lot of these factors yourself, such as convincing your husband not to be a surgeon. You can plan ahead so that things are more likely to work out, such as picking a city for residency that is close to family members who can provide childcare.

So do these factors make sense to those who are parents? Did I leave out any major categories? Does anyone have anything to add? Does anyone want to create a scoring system for fun (SAHD husband = 10 points, surgeon husband = -10 points, etc.)? Sorry for the long post, but I just felt like putting it all out there in one place.

Very, very well put. I'd give the highest point value to husband, childcare, and family-friendly field. Good point about one's attitude towards medicine; that probably has so much more to do with it than we think.

Wow- this is really good! Kind of helps me organize my own self too.
I think we mommders would eat up a quiz like this.
Good point on the impact that your own attitude on career/parenting has on the level of difficulty you experience.

sahmd, I think this is right on. Husband-factors are far and away the most important in my opinion, and #2 is the "attitude toward parenting" one. Or maybe that's just the one I'm struggling with presently. I love my son's daycare center, but when he spends more than 30ish hours there in a single week, I start to twitch. Needless to say, my twitchy weeks are pretty frequent. I can certainly see that the strain I'm feeling right now would be diminished if my attitude about how much daycare/week is acceptable was relaxed somewhat.

The only other category I can think of is something like "personal vigor" ... someone who really needs eight or nine hours of sleep/night to function will struggle more than someone who needs six. In a somewhat similar vein, if you read/learn/memorize very quickly, that's also a big plus. I suspect that the women who manage both medical training and motherhood and come up smiling have deep reserves both of energy and intellect.

Yes! I can certainly see exactly where I am on all of the topics you mentioned!

"Your attitude toward your medical career" is particularly interesting to me because this is something we have not discussed much yet in these threads. Yet it is key. This factor is influenced so much by all of the others. For example, women physicians who bear most of the "bread winning" responsibility in their families seem to give their careers more importance. In my case, my husband makes more than I do so I tend to defer to his career. For example, I am the one to cancel my patients when an emergency such as a sick child or snow day comes up. This is ok with me because we take a bigger hit financially if he stays home instead. The other thing is, I have to absorb some stress from him and support him emotionally - he is basically the managing partner in his practice and needs me to support him in this role. However, "supporting his career" both in terms of scheduling issues and emotional availability to him does definitely affect my commitment to my own career. It takes a "back seat" to his. I do not resent this really because his income allows for a good lifestyle for our family. Just the way it is. But we are not truly equals. I suspect this is the way it generally is for most dual career families.

Those are good additional categories, Emily2651. The time you need for sleep (or other self-care) and the time you need to spend studying would definitely affect the time available for anything else. And you definitely need energy to keep up with kids and to be productive as a doctor or doctor-in-training. Being younger would probably be a plus there.

And kpzr/9145, there are social expectations as well about the man's career being more important. I made more money than my husband when we were both working full time, so financially it would have made more sense to sacrifice his career. But, being male and being older than me, he had such an entrenched image of himself as "breadwinner" and "hard worker" that it was really impossible to get him to change that.

I also should point out that a lot of the issues I listed came from the book, "Opting Out." For those who haven't read it, it is an analysis of interviews with professional women who ended up staying home with their kids.

What a really thorough summary.... we should sticky this thread.

I had not thought about that "attitude toward career" aspect, but it's easy to see how that contributes. Another thing that affects me a lot is flexibility-- I have a lot more time off and a lot more say in when it happens than my husband who is a fellow-- so a lot of times I deal with unexpected issues just because it's easier. It was key for me to find a job with a lot of time off and a lot of flexibility for just this reason. When my husband finally becomes an employed person I am planning to work part time if I can- again I chose a field where that would be more likely. Flexibility. I am also not gunning to be a high-powered academic attending with multiple publications and speaking gigs-- I am just working my private practice job with no glory, but that is how I like it. If you want to be that person, motherhood may not be a good fit for you- unless you have that coveted stay at home dad available.

It is a combo of having an awesome husband/partner and your attitudes... my kids love daycare, so the fact that they are there from 7 am - 5pm M-F doesn't bother me. My social butterfly (4 y.o) actually wakes up super early Sat/Sun to get ready for school. (She does go back to bed after the disappointment of no school...lol)

Support network while in school is another I have found to be important- friends who understand your struggles, or can just be that "am I being totally unreasonable?" sounding board. One of my friends was in the ER yesterday, and two of us went and reviewed bone and muscle lectures with her. Lightened the mood and got some studying in.

I am not sure where I will end up- I have had people tell me I have 'surgeon' written on my forehead. I am not sure, because of the kids/DH. I need immediate results, and I must do well. I will accept a slightly lower grade to bake cookies with the kids, but I am competitive.

Learning to let things go (like the four foot pile of laundry that just got done Saturday) has been the hardest. I am getting there, but I am also just starting this journey.

I do wonder what role previously having a full-time professional career plays in 'success' in medicine? I think I am more comfortable with the daycare piece b/c I was a manager working 60-70 hour weeks in social work (i.e. I made less than an intern). My children were actually at daycare more hours per week, and it forced me to start that long journey towards accepting that you cannot be superwoman in all facets of your life at all times.

Great list sahmd! Maybe someone can develop a quiz or a survey- it would surely get some use!

Great thread---I also wanted to add that while listing all the pros and cons and comparing them (on a sheet of paper, say) could be a very helpful strategy...BUT for those of us who are a little more emotional, this is only part of the picture.

Just as SAHM noted, you can never truly know what it's like to be a parent until you become one. Sure, you can plan to have a baby at "x" time or around x time, barring for it possibly taking longer than you expected/miscarriages, etc... However, no woman can truly know what it's like to have a child, the emotional and hormonal impact, and the impact of that slap in the face "OMG this is the hardest thing I've ever done!"

Also, as I've learned the hard way, residency and fellowship/training pre-child has NO comparison to residency/fellowship post-child. I basically turned into someone I would never expect-a less high-achieving, less competitive ball of emotions who was content to spend more time with her baby at the expense of her dream to be a specialist. The essay "From Doctor to Stay at Home Mom" by Tara Bishop, M.D. was a perfect example and helped me realize I'm not alone.

Even had I filled out a quiz pre-baby, I never would have predicted the choices I made post-baby.

Back to the quiz, in my opinion, the factors most important (just my view, might not be true for others): having family nearby (I didn't), personality (I really thought I could become other mom's who seemed to thrive on working as hard as they worked pre-baby-I could only be me!), SCUT at the program of your choice (in general, NYC/NJ/Baltimore and maybe Boston programs have a ton), sleep needs, and ability to multitask (didn't realize that as you climb up the ladder, you face less time in the hospital, however you face more out-of-work responsibility for self-teaching/reading journals/preparing presentations).

Also good idea is to talk to mothers in your potential chosen field/specialty to see how family friendly that field can be.

I hope I don't get flamed for this, but I wonder if part of the difficulty of predicting our emotional response to parenthood is due to the hormones of pregnancy and/or breastfeeding. I weaned my daughter fairly abruptly because I caught pneumonia and my milk dried up. It seemed that my emotions also changed fairly abruptly right at that time. I was not as content to sit around and go with the child-centered flow. I was more my old self, but of course with new responsibilities. I don't know if it was the hormones or something else about breastfeeding or just a coincidence, but it did make me wonder if hormones had influenced my decision to stay home.