My husband and I are expecting our first baby during the first few months of intern year. Both of us will be interns. While we are so happy about our new baby on the way, we are also scared about the uncertainties that may await, particularly the exhaustion and need for quality child care for ~80 hours a week. We are trying to set up our rank list and are wondering simultaneously if we should both try to match this year. For women that have gone through this...what are the most important things to do if going through the match (i.e. pick cities with low costs of living, etc), or would you recommend one of us sit out on the match this year. Additionally, what kinds of childcare worked for you to cover 80 hours/week? How many weeks of maternity leave were you able to request? How much should be budgeted from one's salary for childcare? Any strong feelings about au pairs vs nannies?
Thank you so much for your advice.

Yikes! Two interns having a baby must be the most difficult arrangement in medicine. My guess is that the best way to handle it would be to do the couples match and then you defer for a year while he does internship. Take a look at this other thread about all the factors that go into making it work (or not):

http://www.mommd.com/forum/ubbthreads.php/topics/72256/Predictors_for_balancing_medic#Post72256

You have to couples match, so sitting out is not a good option. What fields are you going into? Do you have family available somewhere to help? Realistically you are not actually going to need childcare 80 hours a week... you may each be working that much, but generally not simultaneously. I started intern year with an 18 month old and a 12 week old and a husband in internship as well. We found a great daycare and also used a college girl to pick up the rest of the time and do overnights if our call matched up. Go ahead and budget a lot of money for childcare. Au pairs are limited to 45 hours a week, and nannies have to be paid overtime in most states, so you will probably not find this a good economic option (especially for only one child). You also need to look into maternity leave options in your specialty, as this can vary. for example, in FP I was able to do electives at home and not extend my residency. In some fields you have to extend for time away (like anesthesia, surgery, etc) so you can think about maxing out the available time (keeping in mind its not paid a lot of times...) and also think about which programs seemed "family friendly" when you visited. There is a lot to consider, but it's not the end of the world. This will probably be the most stressful year of your life, but with good planning and tolerance for sleeplessness, you'll come through it and so will your baby. The biggest stress will probably be on your marriage, so make sure you are communicating well and no-one is taking the lion's share of the work or building up resentment. Good luck!

Wait, maybe I am wrong. If you do the couples match, can you then defer after you get a position? Or do you have to defer the match if you want a year off before residency?

I'm pretty sure you can't defer if you enter the match. The match is a one-year contract. I still think you should couples-match though to avoid chances of being apart, unless you are going into a non-competitive specialty, you are an outstanding candidate, and there are multiple residency programs in the cities he ranks first.

Hmmm...if that is the case, then would it be possible to do the couples match a year late? Both of you could take a year off after med school and parent or do something -- anything -- less stressful and time-consuming than internship. I am just trying to think of ways you can avoid what will be a difficult situation. But if you can't avoid it, listen to residentmom! She has made all kinds of difficult situations work.

I would agree-one of you should defer if possible. If you can't avoid couples matching then both of you will have to defer-I believe when you enter the match you are signing a one year contract, but I have also known people to match and then defer, so not sure there. Maybe they go outside the match? That is another option as well, depending upon what you are going into, sometimes things open up mid year...you could always start mid year...also trying to do intern year over two years is a possibility in some programs, that might be an option to check into...

Yikes! Congrats. I agree- we were an intern and 2nd year resident when #2 was born. Double internship would have been really hard.

family family family, or loans loans loans. With 2 interns, I'd really think about getting a live-in! You're both going to be on overnight call at some time together. Aupairs look great to me if you have space, you just need to meet her and get settled BEFORE you plan to go off to work.

Could you call ACGME anonymously and find the formal rules on match / couples match, before calling and idenitfying to your potential programs?

And, as above, maybe he can match first and you can tag along and look great in the new city as a researcher / volunteer / shadower and then you'd be applying to programs who knew you face to face. This improves your chances of any special requests, too.

I would second what ohiomom says about you tagging along and meeting people face to face. I know our residency often lets people in under special circumstances...it is outside of the match...good luck!

Re: sitting out this year and making face contact with your program. That is true but I would attempt it only for relatively non-competitive fields. What are you going into?

Re: maternity leave, I think most places would let you take the mininum 6 weeks although they are not technically required to, since you have to be an employee for over a year to qualify for FMLA. Lots of programs have their resident handbook online so you could look for more detail. Also try to get in contact with moms at the programs and get a feel for family-friendliness and program history regarding mat leave.

Re: childcare, you could do:
1) daycare + babysitter: probably cheapest, but it could be challenging to find someone willing to work early morning or overnight. It will also be stressful at times if the sitter is not available and you have to get a back-up. If you find the right person, it would work well.
2) daycare + au-pair: you'll need daycare since au-pairs have limited work hours. Not sure if that'll be cheaper than a nanny though.
3) full-time, live-in nanny: probably the least stressful option but costly... remember though that this will be only for one year. You should be able to do option 1 after intern year, assuming you're both going into a specialty/program with less call in subsequent years.
4) THE SOLUTION: any chance you do residency near a grandmother???

Good luck!