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!

I'm in intern year, and I had a baby 2 months into residency. My husband in studying for a PhD and is also very busy. This year has been really difficult for us. I also have a 2.5 yo. We use daycare and then a college student for evenings when I'm oncall and my husband has class. My mother lives out of state but she has been able to come and help out for extended periods of time when we needed extra help (my husband's final period, difficult rotations for me). The hardest part for us is that we hardly have any "us" time. As far as being tired in pg, it was worse with my first - I didn't have time to be tired this last time. I don't reccommend having a baby in intern year, but it can be done. I does matter a lot what speciality though, I'm in family medicine in a program that is really supportive of families and breastfeeding.

All, (from the original poster)
thank you for your perspectives. Unfortunately this has been a difficult time as my husband is becoming more convinced one of us should take a year off, whereas I think we should at least go through the match and be affiliated with a program, and do our best to get through, and if we can't make it then we ask our programs to take time off. Additionally he is matching in Pathology and I am matching in IM, so I don't think the combination is that challenging to manage time-wise.
And his reason for one of us taking the time off is because he believes that the first year is so crucial for "bonding" and "brain development" that the attention one of us might be able to provide far supersedes anything we could have with daycare or a nanny. And I think he is afraid of having a maladjusted child and that fear is driving all of his thinking.
It is an extremely frustrating situation, as there is no evidence for this from what I have been reading in the forums. And additionally, its not as if you stop raising your child after 1 year, they grow and the same goal of being as nurturing as possible is there... It seems more legitimate to take that time off if we were unable to find daycare, or manage financially, but I feel that taking a year off could just as well be the end of being in medicine for one of us....and wouldn't that also mean that if we ever wanted to grow our family we would have to take a year off again?
I just feel that these decisions are very hard and unfortunately he is a pessimist about what we will be able to handle and I am an optimist. And the decision about whether to match is looming.

Here is what I think as a recent new mother: your husband is right on about this. (Like you my husband is also a med student, and similar to you, I objected to the idea of taking time off, but the logistics of plugging ahead with the clinical years just didn't work for us.)

I don't know you personally, but what you have written in this last post sounds very similar to what I would have said before my son was born. For me, things changed so much when he came into my life. It's like I became a totally different person, and "getting through" the year was just no longer acceptable. My husband and I decided to each take a year off so that we will now have two full years of full-time parenting, and even still, I cringe at the idea of eventually putting him in daycare and having a stranger essentially raising my child once we hit intern year. The thought of it hurts so much that I am prepared abandoned all my previous ideas/goals for residency location and specialty so that I can ensure that my son will be in the most loving family environment possible (hopefully close to grandparents).

Why do you think taking time off would be the end of medicine for you? I guess I just feel like it would be a safer option. Starting a program and then leaving it, or perhaps not leaving it but regretting your decision to forgo the first year of parent-child attachment and bonding, seems like the worse option in my mind. It's one thing to be an optimist, but that can only take you so far.

Obviously I don't know you so I'm sorry if I'm being intrusive here. I guess what I'm trying to say is that your feelings may change drastically once you actually have your child, and you should be prepared for that. Especially since your husband is already having reservations about going ahead, it just seems like you would be setting yourself up for huge regrets down the line. And now that I'm 1/2 way through my year off of school, I can tell you that taking time to bond with your child is not such a bad thing! And yes, maybe you will do that for each and every child you have, or maybe not. But if you did, and you had a good attitude about it, it would be a truly wonderful thing for both you and your children.

So...by "one of us" does he mean himself? Or you?

sahmd, I was thinking the *exact* same thing.

That is also what I was thinking.

I have 4 children, and they all attended daycare starting at 8-9 weeks, and they are all (well, except the 4th, we're not sure yet!) high achieving, motivated, loving children. I personally went to daycare and you'll note I did OK in life.

I feel like the benefit my children get from my personal satisfaction and achievement is also an issue. Honestly I would poke my eyes out if I had to stay home for a year, and my children would watch cartoons and eat donuts all day. Seriously. I don't think this makes me a bad mom, and I don't feel guilty about it. Now, I do hope to work part time in the near future, but I would NEVER have considered delaying my training. I'm more of a "get it over with" kind of girl, I'd rather take the pain and move on than to drag it out. My older 2 children were around when my husband and I did our intern year together, and he worked routine 100 hour weeks (AFTER the 80 hour rule, mind you) and yes, it was very very hard. But neither one of them can even remember it. And we went ahead and got pregnant with our 3rd that year, too. On purpose. :P

It's late and I'm rambling, but that is just my 2cents. Everyone has to do what is right for them, but it sounds to me like you don't WANT to take a year off, and he isn't volunteering to do so, and that is worrisome. Good luck and let us know what you decide.

I think the hardest thing about this situation is exactly what odoole alluded to ... it's near impossible to predict how you will react to motherhood. There are so many variables: how your kid will sleep, how easy a time you'll have with breastfeeding, how you're able to arrange childcare, how well your husband is willing/able to step up, on and on. Could be that you'll handle this just like residentmom, resilient and collected, indefatigable. Or you could be like the rest of us schlubs.

I'll be totally frank with you: I don't think I would have made it through the year you're proposing. I think I would have quit. Being away from my infant son 80+ hours/week (HELL), trying to pump, no sleep for months. I really think I would have walked away. So if you're trying to preserve your career, I'm not sure which option is safer.

By comparison to your situation, my intern year has been a walk in the park: kid was 15 months when I started, husband works a completely flexible 40 hour/week job w no call/nights/weekends. It's still kicking my butt. I still think about quiting.

BTW, I completely agree w RM's assessment of daycare. I love daycare. Love it. We couldn't afford a nanny when our kiddo was born, but we could now ... and he's staying in daycare. And we'll put any future kids in daycare. Daycare has just been so great for him.

Emily, I definitely don't deserve all that credit. I had a rough intern year, probably the worst year of my life, but the important thing (to me) is that my kids did not notice and do not remember. And then it was over and life moved on. As far as I know pathology internship is relatively easy in terms of hours in house (someone let me know if I'm wrong here, but I'm pretty sure at my med school they averaged 45 hour weeks). IM can be hit or miss depending on whether you are at an academic powerhouse or more of a community program, and vary by months (my husband did a medicine internship, and actually did something crazy like 5 months of ICU, and it still wasn't that bad).

I agree that everyone has a different response to babies-- some are ready to go back to work in 10-12 weeks, and some decide they want to spend every minute with their baby from there on out. I think if you are self-aware you can predict which one you will be in advance. I knew I was never going to be a stay at home mom. My sister is pregnant right now and wants nothing more than to stay home. It sounds to me like the OP is not of the stay at home type, and is struggling because her husband wants her to be. That worries me.

Advice-I agree with the others in that you can't know how you will react to being away from your baby until after it is born. Rest assured, though, that plenty of kids go to daycare and do just fine.

I worked full time until I was eight months along with my second. My older two have been in daycare situations since they were 12 weeks old. It is VERY dependent on what kind of care situation you have-I think a good daycare can be a wonderful thing. My third has been at someone's home with other children, and this worried me at first but she is also doing great, however, we are starting her in daycare 2 days per week next month just to get her to be around other kids her age and get her used to routines with other kids around.

My children are all independent and well adjusted. I get many comments on how they play well with other children and are not afraid of trying new foods, new situations, etc. They also have nice manners(most of the time). So I wouldn't worry about daycare and brain development in terms of making your decision-kids are remarkably resiliant and tend to do well regardless. The decision making is more going to depend on how you will react to things. I always knew I wanted to work part time, but not be a full time SAHM either. Everyone is different. If you can arrange things such that you have an out, that would be the best. If you are happy with taking a year off, then do it. It shouldn't ruin your medical career-plenty of people do this. We have many super 4th years at the med school I teach at. It can be very enriching and doesn't reflect badly at all in terms of match. But don't let your hubby pressure you into taking a year off, either.

As far as looking for evidence for brain development and such, just go with your gut! You guys being happy is the most important variable in terms of having well adjusted children!

Hi,
I'm due in September of my second year or residency. I also had a miscarriage and would have been due during intern year; so, I had talked with my program director.
As a compromise between the short maternity leave vs. taking a whole year off, I would recommend taking an extended maternity leave and come back early if you find you don't need the whole time off. If you take, say, 4 months off, you will need to make up some extra time at the end of residency; but that seems to be a much better option than waiting a whole year.
I think delaying residency is probably not a good plan; it will always be waiting there hanging over your head. What about a sibling? And...you are planning on being a working mom, right? Obviously, not at 80 hours per week; but nonetheless. Good luck working this out with your husband.
Again, I would recommend just taking an extended leave!