Am I crazy to consider doing this?! Starting first year as doctor (FY1) @ 34 weeks pregnant

[pregmedic]

Hey everyone, name change for this to maintain anonymity. Any input much appreciated, especially from people from similar backgrounds or those with similar experiences.

I am a mature student who is reaching the end of medical school studies. We were recently delighted to discover we were pregnant again, after a previous loss. I am currently 10 weeks, all is looking good and all going well I will finish up with medical school in a few months. I am due to start my first job in the August intake but I will be 34 weeks pregnant at this point.

I obviously can't predict how I will be feeling at this stage but I'm hoping to be able to start with everyone else and then work as close to my due date as possible. I can't take off anymore than a couple of weeks without the need to extend my programme for ANY reason and I won't know how I feel about returning to work quickly once baby is here but I'd like to take as little as possible. I'm not against taking between 3-6 months if needed and would consider longer obviously too. A large reason for my desire to return quickly is that it makes much more financial sense for me to be at work than my partner. My partner is very willing to take time out of work to care for the baby and we have discussed all this at length.

I would also aim to breastfeed and express and/or go home in breaks to breastfeed baby once I return to work.

Do I sound completely crazy by even considering doing this? Am I missing something and not being practical?

@snoopy18 You're right, I might have absolutely no chance of starting at 34 weeks..the best laid plans!

You do realise that on those 45 minute breaks no one will cover your work? It'll be waiting for you so you'd need to factor in staying an hour and a half later to get it done. I'd move to formula with maybe obe or two breastfeeds a day if you're going back that early. Good luck with your deliberations.

Speaking as someone who went back to work in a pressurised full-time job (not medicine, no night shifts) when my baby (who is now a medic) was 8 weeks old, I can say it is probably the biggest regret of my life that I missed that time just being a mum to my child. At the time, we chose to do it that way for financial reasons, I was the bread winner, I thought I could do it all and have it all. But I couldn't. I nearly cracked under the strain and I lost that time that I could never have again as a new mum to my beautiful baby. Fuck paying the mortgage and financial security. I so wish we'd just gone in to debt and I'd had that time.

Don't do this to yourself and your baby. Finish your course then defer for a year and go back to your F1 year refreshed and ready to hand your baby (now bonded, breastfed and weaned) to other care givers.

@pregmedic also you may regret missing out on the early days / time of having a baby - career is of course important without a doubt but you’ll never get that time back with baby (something I’m trying to remind myself of too!)

Even if you ever plan to have more kids in the future, weigh up If it’s worth missing out on the early days of babyhood because of work. Time is more precious and memories than work. You’ll never get it back. (again reminding myself of this 😂)

@snoopy18 All very true. It's not even my career I'm most concerned about though, it's primarily from a financial point of view that I'm considering going back so soon. You can't get the time back with baby as you say x

Oh hell no. Seriously, it's too much.

Defer. Defer. Defer. I understand the finance aspect, but it's a LOT of stress, particularly at a time when you should be enjoying your time with your baby.

I guess it depends on your temperament and how confident/organised you are, plus how your pregnancy goes.

I was an anxious F1 who found practical procedures hard, so if I had been pregnant I would have taken at least a few months off. Pregnancies are unpredictable so 2 weeks early is considered normal. In both my pregnancies I stopped at 36 weeks and i’m glad for that as my belly felt so tight and it would have been hard to get in an appropriate position to do difficult cannulas etc. Getting a needle stick or splash injury when pregnant can cause lots of anxiety.
Don’t forget all the out of work stuff you have to do like ePortfolio, mandatory teaching etc. Which can eat up your day.

Would strongly advise starting at the 2nd or 3rd rotation if possible - talk to your training program director and/or the dean of your medical school. I think as it is F1, I would recommend full time or 80% LTFT so that you can get used to rhythms in the hospital.

Don’t worry about starting at the same time as your year group. I heard that 50% of F2s choose to do an F3 year so it will even out within 2 years. PM me if you want further info. Good luck with finals and all!

I say this in the nicest possible way, but absolutely do not do this. f1 is beyond hard. Late pregnancy is beyond hard.

Defer.

And I really don't mean to sound patronising but you're being a bit naive if you think all those policies will be actually possible in real life. When the wards are already 3 short on doctors, your alone looking after 20 odd patients... You won't be able to just leave to breastfeed. Sorry but that is the reality.

I completely appreciate the money side and the complicated issues with mat pay and managing bills, I was in the same boat. So because it's super stressful. And congratulations on your pregnancy.

• you are... sorry 😱

I'm just not sure that you're thinking of the reality of being a doctor when you think of your post-baby plans. I was at work this week, watching a FY1 almost tear his hair out with frustration because he'd ordered a particular test and the department had cancelled it because they thought he should be able to determine the patient's problem from another test that had already been done. He was frustrated because he'd ordered the test for another reason, but he was going to have to reorder the test, then contact the department to ask that they wouldn't cancel it, on top of his remaining workload. Meanwhile, he was carrying 3 bleeps because, well, it's Friday, so it's the weekend, isn't it.

I'm another one concerned that this may not be realistic. Will you be able to do CPR at 34 weeks? Run to a crash call? Most doctors I know who were pregnant as junior doctors were trying to go on mat leave by then. I'll never forget the paeds reg who ran to a crash call at 28 weeks, then came in that night contracting. Luckily she didn't progress, but they were worried enough to be giving steroids.

It's a pretty good day if everyone on the team manages one break to wee, drink and eat. I've known a couple of regs manage to express in an acute speciality, but not anyone first on. Might be different in a non acute speciality.

What if you drag yourself back at the last possible instant to not fail ARCP, then you or your baby catch a bug, and you have to take a few days off? Plan destroyed. Worried that this is very might just barely maybe if everything goes perfectly type plan...the NHS laughs at those.

I had my baby 12 weeks ago, I could probably go back to work now (although I do an office based desk job with few repercussions if I balls up due to tiredness) but I wouldn't want to in a million years. The newborn days are important, you can't get them back either.

Can you defer for a year?

@pregmedic
Thanks for the responses so far. I am entitled to up to 2 x 45 minute additional breaks per shift as part of the breastfeeding policy for the NHS which, depending on where I am working, should be enough time to travel home and bf if necessary

Can I ask if the 2x45 minute breaks are specific to your Trust or NHS employees in general?

I will be returning to work soon as a front line paramedic and the nature of my job dictates that expressing at work is going to be a logistical nightmare.

I’m not sure I had a single break throughout FY1, (even to eat or drink or pee) also probably never left anywhere near 5pm. I think it would be very difficult to manage this, and might need a lot of extra support from your colleagues to cover all the time that you’d be away, which wouldn’t make you very popular.. I suppose it would depend what rotation you were doing though, some jobs it might be more possible. Good luck anyway, hope you can work it all out.

I don't want to not give bf a proper try, I am open to formula feeding if needed but doing it because it's convenient for me to go back to work makes me feel sad and selfish.

It's not sad or selfish. A fed baby is a fed baby. We mixed fed and after a few weeks the baby would only take a bottle. I think you need to decide what you really want to do. I went back to work after 5 months and it worked for me because (a) I do a lot of work from home so saw my baby a lot even though I also work very long hours and (b) my partner was able to take SPL and as the baby would take a bottle could feed whether I was there or not.

The thing that is quite hard to get your head around before you have a baby is that the baby doesn't give a shit about your timetable when it comes to feeding. The baby will not necessarily only want to feed every 3 hours. The current thinking is that newborns at least should be fed on demand. Formula fed babies are slightly more likely to feed on a regular schedule than breastfed babies but not necessarily. Your baby will have to be able to take a bottle for this to work, because otherwise your partner is going to be jiggling an increasingly demented, starving baby until you can get away to come home to breastfeed, or getting said demented starving baby ready for a drive or walk to the hospital to sit in some horrible room (forgive my assumptions) to breastfeed. It's hard to convey just how nightmarish the logistics of getting a baby out of the house can be. What if you take your break and are waiting to breastfeed and then your partner phones to tell you the baby's crapped all over itself and through all its clothes and needs a bath and a full change of clothes and nappy before they can leave? What if the baby is messing about on the boob or can't latch for some reason and isn't finished by the time your break is up? What if you start to take your break and your partner is there and someone walks into the room and tells you that one of your patients is in serious danger? What if your baby has D&V or chicken pox or foot and mouth or some other infancy nasty that your hospital patients won't want, and can't come to the hospital and you can't get away?

Basically, if you're going to do this you need to plan it on the basis that your partner has to be able to feed your baby without your breast or breast milk, and I think that the only way to be absolutely sure of that is to formula feed from the outset.

Think you're going to struggle. I'm around 34 weeks and a senior registrar and struggling on the wards. I'm working until 37 weeks and wishing that I had decided to go off earlier - and I have been doing this job for years. Not sure I would cope if I were an F1 who is totally new to the wards. As an F1 you spend the whole day running around- I lost about a stone in my F1 year through extent of sheer physical activity. Sorry but being heavily pregnant just won't be practical.

And your expectations of the wards are entirely unrealistic. We may be supposed to get breaks but the reality is we don't. As someone said above - if you've managed to pee, eat and drink on a shift, you've had a good day. There is no such thing as being able to 'pop home' or have set breaks - whatever the written policy may be. I would take as much time off as you can after baby's birth.

Sorry - medicine is a really hard job. It sucks that we work ourselves to the bone and it shouldn't be this way - but it is, especially in a climate of chronic understaffing. Best of luck.

I'd defer if i were you. Maternity leave is there for a very good reason.

I can't comment on the medic specific angle but I think it might be worth looking at how this works in other countries. For example in the US the lack of proper maternity leave legislation means lots of women go back to work between 6 and 12 weeks post birth. While I'm sure this is tough lots of them manage brilliantly - even with expressing and bf. There is also less of a sense of 'missing out' on time with your baby as it isn't the norm or possible for lots of women.

I think it's great that maternity leave is much more generous for us in the UK but I hate the times it can feel more like a obligation than an opportunity. My DH and I plan to split the leave as close to 50/50 as possible but I've already had several people tell me I/my baby will miss out! It's crazy! She will be cared for by a loving parent for a full 12 months after the birth and what about DH's time to bond with her?

Financial and work situations do weigh into our decisions and not everyone will have a totally free choice to do anything but please don't feel guilt of missing out if this is possible for you and feels the best option for you and your partner!

I don't think it's a great plan. You are going to miss out on your babies first months, and have a stressful time instead of a nice one. And you are going to miss out on getting a good learning experience in your formative year as a doctor. So it's a lose lose as I see it.

You wont see those 45 minute breaks until at least registrar level! Even when not pregnant I've caught majority of my FY1s in the loo or storage cupboards crying on a bad day! It's HARD! Any nhs job just now is hard I left work at 28w due to the sheer stress, hip pain and lack of compassion! Who can really work 12 hour shifts on thier feet with 5 minute breaks to pee and eat!

I would defer too. You will be doing the baby, yourself and your patients no favours at all with your plan. You may want the extra money, but unless you absolutely need it to live then I wouldn't be giving the plan any headspace at all.
It would be bad enough for everyone (and I'm including you here) without you wanting to breastfeed, but with this thrown into the mix, no matter how generous your employer's conditions of service are I cant imagine any way that it would work when you are on duty, or for that matter when you are home, as presumably you will have to find time to pump as well as feed so that your baby can be fed at all the times you cant be there.
No matter how well organised you might be (and your employer's certainly wont thank you for trying to be superwoman) I predict that you will find yourself being pulled in all directions and someone, be it yourself, your baby , your husband, or your patients will be short-changed. The first 4 weeks of a FY1 job are hard going for all new doctors, but you will be heavily pregnant at that time too. Can you really imagine yourself rushing from ward to ward, bending over beds etc etc. in the knowledge that in not so many weeks time you will be back to it all again with a tiny baby added into the mix at home that needs you to feed him/her, and that you want to be with.

The timing of this pregnancy is ideal really in that you should be able to defer for a year. In my mums day maternity leave had to start 11 weeks before the baby was due, so whilst 34 weeks may be just a bit sooner than you would like, it's not that early in the greater scheme of things.
If you can afford to, I'm with everyone else who says you should defer. Money is nice, but it's not the be all and end all. You will have many years to come when you can hopefully reap the rewards of all your hard work.

I’m a hospital staff grade and managed to work until 36 weeks but it was tough going and I’d been in my current post for four years so knew the job well. I can’t imagine starting as a new F1 in late pregnancy.

As far as going back to work goes, it really depends what rotation you are going into. A supranumerary or GP post would probably be just about manageable. Yes, you will get extra breaks for expressing but you can’t guarantee when you will get breaks as it’s often not possible to leave the ward at set times if you have a poorly patient, need to organise an urgent scan etc. As a PP mentions I would also ask if anyone is covering your ward/workload during these breaks as otherwise the jobs will pile up and you will struggle to get home at a sensible time.

I was planning to go back full time and express when my son was six months old. I have now deferred my return for another three months and I’m planning to go part time and probably stop breastfeeding so I don’t have the hassle of expressing at work. I could probably manage full time if my partner was at home with the baby but out of hours childcare is too expensive for both of us to work full time.

Honestly I would defer if you can. I do sympathise about the finances though - I did medicine as a mature student and I didn’t have a family to support but still struggled to manage paying the mortgage, tuition fees etc.

Also should add that my son is 12 weeks now and still takes a good hour over his daytime feeds so going home to feed would certainly not be an option for me at this stage!

@Clevs the policy for breastfeeding is healthboard specific (I'm hoping to get into Scotland) but I found a leaflet online that suggests that employers that all NHS employers should provide provision for breastfeeding to returning employers who wish to continue.

Thanks for all the helpful responses and reality checks Still not really sure what to do, if I absolutely need to return when the baby is very young I think I will need to just add in some formula feeds to take some of the stress off me!

Mostly crazy I think, yes! But I can see why your thought processes are as they are.

Things that might be worth finding out:

1. What is your first post? There are still some supranumery F1 posts e.g psych, ITU/anaesthetics. If you had one of these then you might be able to come in for a couple of weeks, get a feel for it, know you should be extra to the requirements. You would then get paid for your shadowing week, those 2 weeks and have some flexibility about coming back. You won’t get NHS maternity but could come back when you wanted.

1. Have a chat to occupational health - could they recommend that you don’t do on-calls/long days/nights for those first couple of weeks when you’re heavily pregnant before you go off? It might be manageable for you to do the post take ward round, jobs and some discharge summaries. This might also give you a bit of a feel for what you want to do about returning. Sadly that policy sounds very good but your workload/bleep won’t be covered and I just don’t think it’s realistic on the ground in real life. I regularly worked hours late, no breaks for eating/peeing, lost a load of weight in F1 and I wasn’t pregnant.

1. Who is your foundation programme director? Are they reasonable and nice? What’s their experience of this situation?

1. If you did start would they have cover for your post? This isn’t your responsibility or for you to worry about but if that cover is starting when you do then you’ll have an extra doctor to play with at the beginning which might make doing 2 weeks work more contemplatable. However I wouldn’t be surprised if they just don’t have the numbers and your post is just unfilled for the 4 months. Not your fault and don’t feel bad about this.

1. Is it worth you starting LTFT? Makes you more likely to be supranumery, might be more manageable for those couple of weeks and still gives you the flexibility for when you return. You could potentially do this and return at 0.6, 0.8 or full time later.

1. If you do start could you do some KIT days later in your Mat leave for actually keeping in touch but also for some cash? They might be open to you coming in and ploughing through that outstanding discharge summary pile or something on a couple of days. One of my old trusts used to pay locums to do this.

I think bottom line - the best laid plans don’t always work out, you don’t know how you’ll feel at 34 weeks and it might not be possible anyway but there are some things for you to explore.

It’s even harder to plan for the returning part, you really really don’t know how you’re going to feel but this can be figured out.

Congratultions and good luck!