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Things I wish I’d learnt before Emergency Medicine and Parenthood

Author: Louisa Mitchell / Reviewer: Charlotte Davies / Codes: ObP3, SLO2, SLO7, SLO9 / Published: 16/03/2016 / Reviewed: 29/04/2025

 

Pregnancy, Parenthood and Emergency Medicine

Family is a big part of EM – whether it is the work family, or the home family. Here we discuss some aspects of EM and offspring. We look forward to hearing your suggestions and tips too. 

Family Planning 

There is no right time to decide you want to be a parent. It’s hard having young children as a foundation trainee, and as a resident doctor, and as a Consultant. The older you get, possibly the financial security helps, working patterns may improve, but physical health and other demands may make it harder again. It is however, important that you think about you and your partner’s fertility and family expectations early – if you become a Consultant at 48 and then try to start a family, it will be difficult. Talk early about all the options – some people do solo IVF or egg freezing to add being able to have a family and a career. 

  • There is never a good time to have a baby- there will always be money, work, or time issues, and another exam or hurdle to pass. There is always a way to make it work.
  • Don’t leave it so long that it’s too late.
  • It’s perfectly possible to go through EM training and exams with children, and even as a single parent. That’s not to say it’s easy, but nothing worth having is given away easily.  Keep your goals in mind when it gets difficult.
  • While you’re a trainee, base your family in one location and accept the commute to your training hospitals.  Don’t keep moving house – the commutes are worth it in the long run.  If the hospital is an hour’s drive away or more, finding somewhere local to stay after late finishes and between night shifts is imperative.
  • The BMA website offers really useful information for all doctors considering starting a family.
  • Most agree that, for Dads, 2 weeks paternity leave isn’t enough. Try and take at least a week of annual leave on top of it. This is particularly important if you are adding to your family i.e. already have at least one child to look after.
  • The parent not on parental leave (usually Dad) will be TIRED at work in the early days. It is expected that you will go back to work and function as normal. Lack of sleep as well as the huge change to your life is exhausting. Be kind to yourself and do what you can to make work temporarily easier.

 

Some of you will want to be expecting, but it hasn’t happened yet. Some of you have been expecting, but have had tribulations on the way. There’s some podcasts and tips in February 2020 anaesthetic newsletter, but also here.

Assisted conception can be difficult to schedule around a rota, but this can also be in your favour – make friends with the rota coordinator early so last minute alterations can be facilitated! 

 

Early Pregnancy

If your partner is expecting congratulations! Look after them – they’re likely to be tired. If you haven’t already, have conversations with them now about parental leave, shared parental leave, child sickness arrangements, and childcare arrangements. You don’t want a night of work, followed by a day of childcare, followed by another night at work – it won’t make you a safe doctor or a good parent! 

If you’re pregnant…
First of all congratulations – you’re expecting!

When I found out I was pregnant, the aspect I was most surprised about was how tired I was. At six weeks growing something the size of a blackcurrant inside of me I would come home from every shift exhausted and I’d fall asleep as soon as I sat on the couch. At work I did not want to tell anyone I was pregnant until I had had an ultrasound scan at 12 weeks. This meant that I had to sneak away between patients to be sick.

Some people like to keep pregnancy private for as long as possible whilst others shout it from the rooftop as soon as they see that second blue line on the stick. Looking back I wish I had confided in one of the consultants earlier as I perhaps would have benefitted from speaking to someone at work at the time so I’d definitely recommend considering this.

I rotated to a new post when I was about 14 weeks pregnant and immediately told my supervisor and rota coordinator. One of the consultants carried out a risk assessment for me and gave me lots of useful advice. These should be carried out every few weeks and rota considerations can be discussed then. I was taken off nights at around 28 weeks as I was struggling with the shift patterns by then but this is totally dependent on individuals. Some people are taken off nights and lates around 20 weeks and others continue throughout their pregnancy. Don’t be a hero, do what’s right for you at the time. Pregnancy is a protected characteristic, so your pay should be protected – but nights can be swapped to days rather than being “off” days! 

The Royal College of Physicians released a useful document in 2013 which addresses risk of adverse outcomes in pregnancy for those that work prolonged hours; shift work; perform heavy lifting; stand for prolonged time or have a heavy physical workload. Shifts in the ED can encompass all of these so the document and attached leaflets are well worth a read prior to educational meetings or risk assessments when pregnant.

You need to tell your employer officially before you are 25 weeks pregnant. This means tell human resources (often via an official form) and send in your MATB1 form. Don’t forget to make sure your educational supervisor, training program director and deanery are all also told. I managed to forget this as assumed that they all communicate with each other, it doesn’t always work out this way!

Leave and pay

You are entitled to have your antenatal appointments off work and should not have any pay deductions. I have heard of some people having to prove their appointments so be prepared to take appointment records into HR.

You can choose to take your maternity leave at any point from your 29th week of pregnancy. Personally, I waited until my 38th week but I took annual leave the week before so did my last shift at 37+1. That was right for me as I was doing ok until then and felt like I was still able to work well.  It is difficult to plan during your first pregnancy as you cannot tell how you are going to be feeling at the latter stages of pregnancy. I had to state when I wanted to start my maternity leave when I sent in my MATB1 form at 25 weeks. You can change the start date but have to give 28 days notice. I also had to give my return-to-work date at that point. This can be changed too but with 8 weeks notice.

Deciding how long to take for maternity leave is a very personal decision. Although I would have loved a full year my finances were a little bare with moving house shortly after my baby was born and I was also keen to return and crack on with what was left of my training. I took 8 months but with accrued annual leave this turned out to be over 9 months. I was so anxious and sad about the prospect of going back to work. I had a meeting with my educational supervisor prior to starting and this really helped. I also was taken off nights for the first 4 weeks to ease me back in which was great. I actually really enjoyed going back to work and think that 9 months was the right amount of time for me. Another way to ease going back to work is to take keeping in touch (KIT) days. I took some of these during regional teaching and a couple at the hospital I had worked in prior to maternity leave. You can take up to 10 and get paid for them but the amount of pay depends on when during your maternity leave you take them so discuss this with your payroll department.

Pay

To get NHS maternity pay you have to have 1 year of continuous employment without a break of more than 3 months by the time you are in your 29th week of pregnancy. This does not have to be with the same trust so moving between jobs or roles is ok. You can have 8 weeks of full pay, 18 weeks of half pay, 13 weeks of statutory maternity pay or maternity allowance followed by 13 weeks of unpaid leave if you take a full year of maternity leave. How much your pay is depends on your average weekly pay for 8 weeks leading up to your 25th week of pregnancy. I was able to spread my maternity pay out equally over the 8 months I had off. This meant that I did not suddenly drop in pay between full pay, half pay or statutory maternity pay. Speak to your payroll about this as an option as it makes budgeting much easier and means that you do not find yourself suddenly penny-less!

Those adopting a child are entitled to the same leave and pay as detailed above and the BMA have useful information for those considering adoption.

Patients to avoid in pregnancy

Infections which pose a special risk to a pregnant healthcare workers include: CMV, influenza, measles, mumps, parvovirus B19, pertussis, rubella and varicella-zoster virus (chickenpox and shingles).

The problem in the ED is that most patients come with an undifferentiated rash and being pregnant means you should avoid contact with any patient with an undiagnosed rash compatible with a systemic viral illness because of this. You may find that this will wipe out most of your paediatric practice.

I know some pregnant colleagues who have avoided the children’s side of the department and others who have just carried on as normal. Personally, I felt that it was impossible to avoid all feverish children so carried on as normal but if I saw that the patient had any rash resembling measles or rubella I would have asked a colleague to see them.

I also attempted to avoid potentially violent patients – this is difficult to predict! 

Parenthood 

An emergency medicine (ED) consultant, a senior surgical trainee, and a salaried GP sat in a bar. Old friends on a rare night out, they were collectively parents to six young children. Conversation turned to the challenges of combining parenthood and a medical career. As the EM consultant, I found it striking that the challenges were similar for all three of us despite our very different career pathways. The stereotypically ‘family friendly’ career choice one of us had made, general practice, wasn’t easier, practically or emotionally than the surgical career traditionally reserved for the career-absorbed.

Following this discussion, I decided to survey selected regional colleagues for the key tips they wish they’d known when they had embarked on combined parenthood and emergency medicine. I hope the distillation of the emergent themes from these responses below, prove valuable to those planning, or in the throes of, the combined ‘careers’ of emergency medicine and being a parent.

Emergency Medicine and families

  • EM is a surprisingly  family friendly speciality – the shift and on call patterns give time off during the day to see your children, and there’s more flexibility around shift work than more regular working days.
  • EM also works well as the nature of our workload, and the lack of ongoing responsibility for named patients means you can fairly rigidly compartmentalise life and work – many surveyed agreed “when you’re at work, be 100% about work, when home, be 100% there for your family”.
  • EM also works well as a part time career choice, for the same reasons.

 

Logistics and nativities

  • A set rota is makes childcare planning much easier if both parents are working. They are becoming rarer – as out of hours consultant shop floor presence becomes the norm, rotas get more complex.   A predictable, if not set, rota is achievable, however, and it really helps those with young families (also all those with other outside interests!)
  • Think about how you’d like to get to and from work in your permanent post. This affects where you should live.  Being able to commute by bike or even on foot is great for some. Others don’t mind quite a long commute, and use this as their decompression time so they arrive home leaving work behind in every sense. If you’ve got some flexibility around your hours, avoid 9am starts and 5pm finishes – we’re the specialty that never sleeps, why would you want to commute with everyone else?
  • Consider where you and your partner’s wider family live, too. There are pros and cons of living near grandparents, but they can potentially help cover unexpected late finishes or times when both parents must be at work.
  • Have bomb-proof childcare set up when you’re clinically committed or on call. This must include being called by nursery or school if there’s a problem.
  • One consultant advised “Move heaven and high water to attend nativity plays, school concerts etc. They are precious, unrepeatable memories – you will need to be super organised and willing to swap / time shift but it is so worth it.”
  • But another stated “Missing the occasional nativity etc when they are young because of shift patterns isn’t the end of the world. As they grow up there are so many opportunities to attend sports/music/arts things with them.”

 

Colleagues and children

  • Your colleagues will be surprisingly understanding and flexible so long as you show willingness to be flexible too. This is one of the joys of emergency medicine – you’re part of a mutually supportive team.  If things are difficult, talk to your trainers and your colleagues – we have all had hard times, and all will try to help.  Remember you are not alone. And take the help that is offered!
  • Be flexible within your inflexibility. Yes, you may only work 3 days a week (if part time or fixed rota) but within this, try and help your colleagues out wherever possible. If you can make the odd extra shift work within your child-care arrangements if the department is under pressure then do so. What goes around comes around.

 

Time management and priorities

  • Everyone surveyed stated that family must come first. Careers are great but you can’t plan everything else in your life around them.
  • Learning to say ‘no’ – to some of both work’s and your children’s demands – is empowering.
  • Kids grow up quickly and those early years never come again. Our careers go on almost for ever.  Remember there is no rush to ‘be successful’ in your career.
  • Learn effective email and time management. Think hard about putting work email on your phone, for example. Develop strategies or ‘rules’ that keep work from encroaching into your home life.  For some, rigid compartmentalising is key. For others, a bit of flexibility helps keep on top of things.
  • There are always going to be more worthy causes at work than people to champion them. Learn to say “I think this is really important but I cannot meet that need at the moment.” Someone else may step in, or they may not, but the needs consistently outweigh the resource to meet them. You can’t do everything.

 

Looking after yourself

  • Any feelings of guilt to family or work are probably only in your head – you can’t be everything for everyone all the time (see above). Be realistic.
  • Imposter syndrome appears to be particularly prevalent amongst women returning to emergency medicine after maternity leave – it will pass, and you aren’t alone.
  • All EM senior doctors work hard.  Sometimes it helps to remind yourself that this means you are being a great role model to your children. For the same reason, you shouldn’t moan about work too much when at home!
  • Stay active, healthy, and don’t drop your own hobbies. When your kids leave home they (and your partner) are all that stands between you and burnout.

 

The other parent and career in the equation

  • Don’t fool yourself for one minute that your career is more important than your partner’s career, job or parenting role. Similarly, never let anyone tell you your work priorities are of greater import than your partner’s – that’s a (constantly evolving) discussion between the two of you.
  • Look after your relationship.

 

Returning to Work

Returning to work can be difficult. You might still be breastfeeding, in which case you’ll need a breastfeeding risk assessment and any appropriate modifications should be made. The breastfeeding for doctors peer support group on Facebook if you haven’t already joined, will be invaluable for this – more details here. I’d recommend ensuring you trial your childcare arrangements (whether it’s nursery or grandparents) before you actually start work so you don’t spend shift one panicking about whether they’re taking a bottle not from you.

If you’re in training, find out who your SuppoRTT champion is, and get a supported return plan.

Final thoughts

  • A consultant I once worked for said he missed his kids’ childhoods and when he stopped working, they didn’t know him.  He died a year after retirement.  Now is the time to live life as a parent, not later.
  • No-one will ever put ‘They gave their life and soul to the NHS’ on your gravestone.  But if you’re lucky, they might just put ‘They were a really good Mum [or Dad]’.
  •  

 

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References

  1. Oxtoby K. Women in medicine. BMJ 2009; 339 :b5144
  2. McCarthy A. What I wish I had of known starting my fourth year. BMA, 2020.
  3. Supported Return to Training. Workforce, training and education. NHS England.
 

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