By: Graci Gorman, MD
When I returned to my job as an ER physician after maternity leave, I planned for the smoothest transition possible. I worked in a low acuity pod with nurses I trusted. The hospital that employs me is the hospital where I trained; I know the ins and outs even after a three-month absence. I am four years into independent practice. I have a robust support system that includes grandparents, siblings, and close friends. My baby is healthy, and I am healthy. My husband and I have money for luxuries like night nurses and Snoo bassinets. Despite an extraordinary amount of support and thoughtful planning, returning to work was harder than I had ever anticipated. Anxious to leave my baby, worried my clinical skills had disintegrated, running on three months of broken sleep, I felt like a fish out of water. The care I provided was adequate, but I was slow and out of practice.
Weeks later, when I had the bandwidth to reflect, I put myself in the shoes of a postpartum resident physician who is only promised six weeks of paid leave, may be unpartnered or training in a place far from family support, and has limited financial means. This same resident is expected not only to return to work but also to learn to care for patients during the grueling educational process that is residency. It’s hard to fathom how this is possible, yet hundreds of women do it every year.
We have made progress in supporting postpartum residents. ACGME requires six weeks of paid leave. Lactation is better recognized and supported. Tangible fixes have been made to support postpartum residents’ clinical work, but residency is both a job and an education. What are the barriers to learning during the postpartum period? How can we optimize learning for postpartum residents experiencing major hormonal, physical, and emotional shifts?
Sleep deprivation is an obvious one. Even one night without sleep affects cognitive performance. Prolonged sleep deprivation is known to cause executive function decline and memory impairment. The average six-week-old wakes up every two to three hours at night. Even at three months old, multiple night awakenings for feeding and soothing are common. Combine this with a resident’s work schedule, and it’s easy to imagine how one might have difficulty concentrating on a shift or in a didactic session.
There are structural neurological changes. Studies show hippocampal size degeneration during pregnancy that continues into the postpartum period, leading to fluctuations in memory capabilities. Connections between the amygdala and prefrontal cortex strengthen in the postpartum period, strengthening the “reward” circuit that drives women to care for their babies. Meaning, mothers are hard-wired to be thinking about our babies, even when doing something as important as caring for patients.
Neurobiological and hormonal effects aside, social interactions can distract from clinical work and learning. While we hope our colleagues are supportive of postpartum mothers returning to work, there may be limited understanding of the specific challenges they face. Bias against postpartum mothers continues to exist, whether it’s the perception of “dumping work” onto coresidents or seeming “distracted” on shift. While lactation spaces are more readily available, colleagues may not understand the timing and schedule required for expressing milk. Navigating these interactions is just another distraction from the goal of learning to take care of patients.
Ultimately, as leaders in GME, our main responsibility should be to ensure that postpartum residents receive the educational support they need to overcome the unique barriers to learning they face as they transition back to clinical practice.
Speaking from personal experience, the greatest gift you can give a postpartum mother is sleep. Avoiding night shifts and undue circadian rhythm shifts during the first months back from leave, when mothers’ sleep is already fragmented, is essential. Aligned with this, urge residents to take as much parental leave time as they need, more than the paid six weeks. Returning to the demands of residency just six weeks postpartum may be necessary for some, but in most cases, it is asking too much, too soon. Create a supportive parent culture within residency programs. Encouraging mothers to communicate their pregnancies early enables planning in advance to optimize resident schedules, avoiding undue pressure on new mothers to return to work before they are physically and emotionally ready. Extending residency should be normalized and accommodated. Lastly, allow remote or asynchronous didactic options, as permitted by AGCME. A quality online lecture during baby’s nap time may temporarily provide more educational benefit to postpartum mothers than joining their colleagues for morning rounds after a sleepless night awake with their baby.
Supporting postpartum residents requires more than meeting minimum requirements—it demands intentional, flexible approaches that recognize the real cognitive, physical, and emotional challenges of this transition. We must design training environments where new mothers are set up not just to return, but to succeed
About the Authors
Graci Gorman, MD is the Program Director of the Medical Education Fellowship at Regions Hospital where she is also a clinical faculty member.
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