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Fam Pract Manag. 2007;14(6):60

Dr. Schrager is an associate professor in the Department of Family Medicine at the University of Wisconsin in Madison. Author disclosure: nothing to disclose.

I was feeling rather smug about the balance in my life a couple of weeks ago. I work part time in an academic setting. My husband, also a family physician, works full time. We have two boys who are both in school (kindergarten and first grade). We have set up our schedules so that one of us is with the children after school every day. And it seemed to be working fine … until Oct. 19.

That was the day one of my obstetric patients needed to be induced. The induction did not go well, necessitating my presence at the hospital for more than 18 hours and a C-section at midnight. I had a meeting after work the next evening, and I was on call the following day – when I didn't return from the hospital until 4:30 a.m. After three days away from home with little sleep, I feared that my precariously balanced life was in disarray and I began to question my choices, particularly my decision to deliver babies.

The care of pregnant women is one of the most joyful parts of my job. However, as we all know, the birthing process can take a long time and does not always follow a schedule. Furthermore, having a pager on 24 hours a day can be distracting. It's hard to enjoy a nice dinner out when you're thinking, “Should I have another glass of wine?” When my pager finally goes off telling me that a woman is in labor, my first thought is relief that I no longer have to worry about the timing of her labor. But my next thought is “What do I have to do for the next 24 hours or so?” or “Who will pick up the kids?” These sorts of questions continue popping up in my mind until the baby is actually out.

So, after 10 years in practice, I have come up with some guidelines to merge my love of obstetrics with my desire for a balanced life and time with my family.

1. Be open with your patients. At the initial visit, I am up front with all of my pregnant patients about my limitations in availability. I explain that I will try my best to be at the birth, but there may be times when I am unavailable (e.g., because I am with my children and do not have child care). No patient of mine has objected to this.

2. Be specific with your partners about your needs. I try to be very clear with my colleagues and let them know when I am unavailable and when I want to be involved. My partners are wonderful about covering for me, as well as for one another, but they need to know what I need.

3. Co-manage pregnant patients. I partner with either a resident or another faculty member at our clinic to care for pregnant patients. This increases the likelihood that someone the patient knows will be available at the birth.

4. Remain involved. Even if I miss a delivery, I try to stay involved in my patient's experience. I usually round on mom and baby the next morning or sometimes later that evening. I find out details about the labor from the delivering physician and help my patient process the experience. None of my patients has stopped coming to see me because I missed the birth of her child.

5. Do not change your life. I try to live my life without worrying about who is due when. If I am going to be unreachable, I will sign out to the on-call physician. Or, if I am in town, I try to enjoy whatever I am doing without worrying about when my patient will go into labor.

6. Do not feel guilty. Feeling guilty for not being present at every birth will ruin your enjoyment of obstetrics. I do feel regret when I am not present at a birth, but I don't let those feelings turn into guilt.

The majority of family physicians no longer practice obstetrics, in part because of lifestyle issues. If we acknowledge these concerns and get creative, we can develop new models of care that make maternity care more palatable to our colleagues and to new graduates. My model is admittedly a work in progress, but it allows me to continue my practice without sacrificing my family time.


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