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.