Hi- I am 34 years old, completed my IM residency, working as an Internist and starting my Nephrology fellowship in July. We have a 3 yr old son, have been TTC for 8 mths, had 2 miscarriages in Nov and Dec. Never thought that pregnancy during fellowship would be an issue as my first pregnancy was a breeze, I have no med issues, I could not wait till I completed my fellowship as I will be 36 and my husband will be 40.

I conceived the last cycle and found out yesterday that I am having twins. The due date will be at the end of September. I have great family support, my parents will be there with me for the first year after delivery. I do not see any post natal issues.

However, the big concern is starting a busy fellowship in my last trimester. With the possibility of being put on bed rest towards the end and then needing at least 6 wks as I will need a c section, how will the fellowship handle it. Is this doable or should I consider reduction to a singleton pregnancy. Personally, it will kill me to do that, as I love to have both babies but I cannot forego the fellowship at any cost. Please advise!!
Thanks!!

Hi! I'm just a medical student, so I can't speak to fellowship. But I guess my question, is why is it that you can't forgo the fellowship at any cost? I'm not saying you should, I guess I'm confused about that statement, though. Let's say the unthinkable happened, and you had to delay fellowship by a year or two. Couldn't you reapply again and still do nephrology? You're already a board-certified internist, which is just fantastic (I'm envious, as I'm 30 and nowhere close). I guess I don't understand why you couldn't put off fellowship if it became necessary. Also, there are other women who have had children towards the beginning of fellowship. You might have to take a leave of absence and extend the fellowship to make up the time if you have unexpected complications. But to me it seems like a tough decision to reduce to a singleton pregnancy just to lower the risk of those -- you could still have complications even with just one baby. I personally don't think I could reduce the pregnancy if I were expecting twins. I'm sure there are a variety of views on this, but it's just my perspective. My child(ren) is/are more precious to me than my specialty. I wish you the best of luck! Please keep us updated on how you do!

I would never reduce a pregnancy for any part of my career. That's my opinion. I only have one child, but being a doctor is very very secondary to being his mother. In no way shape or form is any part of my career more important than my family. Guess I don't have anything different to add compared to newmommdphd.

Can you delay entering fellowship by a year? You'll need to talk to the PD about this either way, why not see if that is a possibility? They may prefer figuring out a way to fill your spot now than figuring out how to cover your extensive absences later.

I'm also in the anti-reduction camp. I ended up completely out of rotation when I had pregnancy complications and delivery of my son last November, and it worked out in the end. No amount of money or curriculum could ever come before my child.

We are all moms here and you are gonna' get a similar answer. Kids come first!

I vote for starting fellowship, then delaying the finish. With twins everything is so unpredictable, and pregnancies for WIM are not always the easiest, even when a first pregnancy has been easy. I say plan for the worst, hope for the best.

At the end of the day, 30 years from now, you will NOT care if you finished your fellowship one year later.

I'm also a mother of twins, though mine came during my 3rd year of psychiatry residency. Challenging, but I'm not going to even pretend it's as tough as renal fellowship.
Still, I can identify with the worries about career sacrifice. I'd never even heard of reducing twins to singletons when I was a mother of twins, but I was so scared at the time I can see how someone would contemplate it.
For me, the thought that got me through it all was reminding myself that my life had gone so easily, so planned for me up until then -- parenting twins was the toughest, most unplanned, unexpected thing in my life. And in order to grow, to see what I'm really made of, it took the challenge of what is deeply unpredictable.
It was such a struggle at first, and I'll admit I didn't always handle the rough spots with grace, but I love my kids so much. They are healthy and fun, and now that they are over 2 they play together. I've had to compromise on my career aspirations. But some other unexpected incident, or simply tiring of the rat race may have led to the same outcome.
Just remind yourself that every pregnancy is loaded with the unexpected. It seems you really wanted this pregnancy. Give yourself a few days or weeks for the shock to wear off before making a decision. Your fellowship will make do.

Can you speak frankly to anyone at your fellowship about what the options will be if there is a complication?

I agree with good enough, it's not to hard to imagine how/why you'd consider reducing your pregnancy and ultimately, you have to do what's best for your FAMILY.

I'd also like to say that it's very hypocrital for someone to judge your thoughts about this considering the fact that women in medicine (premed thru Doc) have the highest rates of pregnancy termination among ALL professional women.

That is an interesting statistic, Path. Do you happen to know if that is only for recent years, or if it reflects past decades as well? I imagine that the termination rates have gone down as medicine has become a little more family friendly, but I really don't know because no one discusses these things, either IRL or on MomMD.

I don't think anyone has outrightly judged her, but more shared our own opinions about our thoughts on reduction of a twin pregnancy. OP is free to do what is best for her whether or not we would or not. But that is a fair statement - she asked for advice not our opinions.

The idea that reducing a pregnancy is akin to picking your career over your children is what makes some of the comments judgemental IMHO. Having children is not in "end all, be all" in life, simply ONE aspect of it, among so many others.

SAHMD, I imagine that stat is over a period of decades and you're right, the number probably is lower over the past ~ 10 years. And I forgot to mention that this number also includes predoctoral/PhD's as well.

If you are already matched into your fellowship, then I would contact them and find out what your options are. Don't make a decision without all the information. I assume there is some middle ground between pregnancy and fellowship, somewhere. If you are not matched yet, I would wait and discuss it when you are already under contract. A fellowship, just like any other job, can not fire you for pregnancy. You may take more than a year to finish, but it sounds like you have great family support and that can not be underestimated.

Yes. Ignore my first comment and just read residentmom's twice, instead =).

I don't think twin pregnancy necessarily means you can't do this fellowship. I don't know about reduction, but does not sound all that safe even for the other baby. You've had trouble conceiving. Why take that chance? And when you see this beautiful baby, don't you think you would be wondering about the other one? I totally understand your concern regarding this fellowship, but I agree with other ladies here that you should find an alternative to reduction. BTW I am a 1000% pro choice and a feminist.

I'm slightly hesitant to bring this up because it isn't really the heart of the matter, but is it actually feasible to do a reduction? There was an article in the NYT magazine a few months ago about reduction in multiple pregnancies and it seems not many practitioners will agree to reduce twins to a singleton, because the relative risks are not as great as with higher-order multiples.

Anyway OP I think the heart of the matter is in your first post, where you say you would really love to have both babies and it would kill you to do the reduction. If the only thing standing in your way is the timing of your fellowship, well, I think that is something that can be overcome. Try talking to your PD before you make any irrevocable decisions.

Also, this may be *way* TMI, but I had a very easy twin pregnancy. I worked up until 37 weeks, taking public transportation to and from work every day (including making due when the city's public transit system went on strike!). A few days after I stopped work, I had an easy, scheduled c-section. I managed fine post CS living in a rowhouse with only one bathroom on the 2nd floor that necessitated climbing stairs.
Twins are not going to inherently harm your work in fellowship, so long as you have help in place. So in addition to your mom and husband, look into doulas and nannies!

I don't think so either. Telling someone what I would do (in general) is not judgmental. Plus, we are human. Our advice comes from our experiences and beliefs. I'm pro-life, so my advice will involve pro-life avenues. I don't understand why this is an issue at all. No one has stepped over any boundaries in the least here.

Thank you all for your responses. I apologize if I unintentionally intitiated a pro life/pro choice argument. That was not the intention.

Just to answer some of the questions that were raised here-
Fellowship is always optional, I just don't want the option of not doing it. Being a foreign grad from a community hospital, it was extremely difficult for me to secure a spot, this was my 3rd and last time trying. My program director from residency will not give me any further letters if I leave this spot, so, I have never considered leaving the fellowship. I guess, I could talk to the program director, I am worried that he will ask me to hold off and reapply. I am okay with waiting a year or six months or starting on time and finishing late. I just do not want to lose this opportunity for good.

Reduction to singleton pregnancies is safe and is actually shown to have better outcomes than twin pregnancies. I don't think I was considering it, I guess I was looking for reassurance saying that it is okay, but I know no one can do that, I will try to talk to the program, stay well and hope for the best.

Once again, thank you all for the support.

Do you have a contract? If so, then you are free to be pregnant and be happy. If not, don't mention it until you do, and press to get one signed as soon as possible. Good luck.

You didn't spark debate on my side. I was merely giving you an opinion from my point of view. Perhaps there are some who don't like that, but those that post here are not of the same background, and it's important for you to hear differing views, whether you agree with them or not.

Ultimately, it's your decision, I just know what I would do in this case, and that's the best I can discuss. It's important for you to talk about your concerns, though, and I'm glad you did. Good luck in your decision.

As a mother of one, I would like to say that in all you do, the area of your children is the last place you want to have regrets. IMO, I would rather find other possibilities first like talking to the PD or trying to work something out before thinking of reductions.