I have attended hundreds of births. As a paediatrics non-consultant hospital doctor (NCHD), I have witnessed that unique and magical moment when a parent meets their newborn baby more times than I can count.
For me, the experience represents both great privilege and great responsibility. Mostly, I am able to maintain a certain emotional distance from the event. I busy myself checking the equipment, making sure that I am prepared for all eventualities.
I listen to the urban sounds of inner-city life, stifling a giggle when some particularly colourful language wafts up from the street below.
If it has been an especially gruelling day, I might try to remember the last time I ate or drank, making a silent promise to take a break soon, all the while knowing that in a maternity hospital the babies set the schedule.
On occasion, the swell of emotion that builds in the room is so great, I find myself swept away in the wave, blinking furiously to fight back a tear from escaping. And sometimes, just sometimes, my mind drifts to my own future — wondering if, and when, I will ever find myself in that woman’s shoes.
A few weeks ago, I found myself sitting in quiet terror at my kitchen table, reading an article on a popular medical blog. It was written by a paediatrics trainee working in Australia.
She told a story of becoming breathless at work and trying to push through, until later that day learning she had significant fluid build-up on her lungs, as part of a serious complication of IVF. A chest X-ray showed she was struggling to keep going with “less than a quarter of aerated lung”.
Some of you may scoff at this and say she should have stopped sooner. Those of you who understand how difficult those words can be to say in the current healthcare climate know better.
The article referenced sobering statistics from a recent survey that looked at Australian and New Zealand medical parents’ experiences of infertility, pregnancy and parenthood.
Over one-third of female doctors reported suffering a pregnancy loss, more than double the baseline population risk. Almost 30% underwent in-vitro fertilisation (IVF) to conceive — the average population rate of IVF being just 4%.
While there is a distinct lack of data looking at fertility amongst NCHDs working in Ireland, similar results have been replicated worldwide.
As a woman who has just entered my 30s, the tick of my own biological clock is loudening. Due to my training, I am acutely aware that the risks to both mother and baby increase with age.
This is particularly apparent after 35 years' old, where there is a significantly higher risk of infertility, pregnancy loss, fertility interventions and adverse neonatal outcome.
When I try to picture the next five years and where starting a family might fit into that, I feel overwhelmed.
I take cold comfort in knowing I’m not alone in this sentiment. Research conducted by the Irish Medical Organisation (IMO) has revealed that 48% of NCHDs in training (54% of female, 29% of male) postponed having a family for fear of the impact on training opportunities, highlighting that this is not a female-specific issue.
In saying that, by virtue of biology the weight of reproductive responsibilities lands heavily on female shoulders.
In Ireland, medical training involves frequent displacement, moving hospitals (and often counties) multiple times a year.
On completion of training in Ireland, many doctors will undertake further specialist training in the form of an international fellowship for another one-two years.
It can be a logistical nightmare and it’s hard to see where caring for a child fits into this.
The dissonance between family life and work responsibilities as an NCHD in Ireland is echoed in data collected by the IMO showing 69% of NCHDs in training with children (76% of female, 37% of male) have considered changing their career speciality as their current working conditions did not seem conducive to caring for a child.
So what’s the solution? I believe it starts with a cultural shift. Our current medical training structure is centred around the prime reproductive years.
Thus, a concerted effort between national training bodies and the Government is required to develop and implement policies, strategies and infrastructure to facilitate trainees’ right to have and care for a family, if they so choose.
Acceptance of breaks in training, increased flexi-time opportunities, on-site hospital childminding facilities and increased availability of fellowship posts in Ireland are examples of potential strategies.
At this very moment, we are sitting at a critical juncture where current decisions will determine the future of our health service. This is a prime opportunity to change the landscape of NCHD training in Ireland with negotiations to avoid industrial action ongoing.
Supporting doctors’ choices around pregnancy and family planning are key issues affecting NCHD welfare and must be addressed.
There is no ideal international blueprint to follow, no one specific country getting it perfectly right.
But therein lies the opportunity — the chance for the Irish Government to be innovative, take progressive action and put our healthcare service on the world map for a positive reason. What a wonderful change in narrative that would be.
But for now, I can’t help but contemplate the bitter irony that in choosing a career dedicated to looking after other people’s families, am I endangering the chances of having my own?