Ashley Miller is a child psychiatrist and family therapist at BC Children's Hospital. She lives with her husband and two children in Vancouver.
I entered medical school in much the same way I later entered parenthood: without any real clue. In Quebec, we had the option to apply to medical school at the age of 18, straight from CEGEP. In the blur that would follow from age 19 (the start of medical school) to age 29 (graduation from a child psychiatry fellowship), I moved across the country, got married and had my first child. There is nothing remotely spectacular in these events, except for the lack of time I had to notice them. Now that my children (mostly) sleep through the night, I’ve developed the time and capacity to remember and reflect on the first of my 10 years of motherhood.
I got pregnant with my son during my 4th year of Psychiatry Residency. It happened faster than I expected and after the initial excitement had passed, I started worrying about the timing. How would I complete my residency? Could I afford to be in training longer and carry more debt? How would I study for exams with a toddler? Compared to my counterparts in other specialties, I had more flexibility. I was very fortunate to have the option of part-time residency, and if anyone begrudged my call-shift absences, they never admitted it. I still remember apologizing to my Child Psychiatry director for needing to take time off. He laughed and assured me that I would never learn more about children at work than I would at home with my own kids.
The first six months after the birth of my first child were by far the most difficult. I had enough clinical experience with labour and delivery that the prospect of childbirth wasn’t actually that frightening to me. I knew enough about the uncertainty of labour that I never made my own birth plan, but I guess I did have a plan for life with a baby. To my great surprise, my baby did not want to go to mom and baby yoga on my schedule. In fact, I was lucky in those first postpartum weeks if I both took a shower and left the house on the same day. A large part of the difficulty was breastfeeding. It didn’t go well at first, and I was hesitant to supplement. Social pressure was part of it, but so was the memory of everything I’d been taught in medical school about the substantial advantages of breast milk. Although I had never breastfed an infant before, I was used to picking things up quickly, to being considered an “expert” as soon as I put on the uniform. Floundering at something so natural was not part of the plan. The most helpful person was a wonderful lactation consultant at BC Women’s Hospital. I can’t remember what she said, but I’ll always remember how compassionate and kind she was, and how she reassured me that I was doing a good job as a mother.
When my son was three months old and still waking every hour, I realized that “normal sleep” wasn’t going to return anytime soon and that I would have to tolerate my new level of brain-fog. By the time he was six months old, I got sick with an infection that just wouldn’t clear. My husband and I were beyond exhausted. I read every book on infant sleep that I could manage. Although several physicians had written about the medically sound justifications for allowing a baby cry to sleep, this felt really uncomfortable for me. Pediatricians also advised that co-sleeping was a bad idea due to the risk of SIDS. In my mind, there was an unsolvable riddle: I did not want to let my baby cry himself to sleep (though maybe I should), I must continue to breastfeed, and I should not co-sleep. The advice from different books contradicted each other, and sometimes the medical advice conflicted with my instincts as a mother. Finally, ashamed and on the verge of collapse, I asked my senior colleague, an infant psychiatrist and mother, about how to handle our baby’s sleep. She assured me that there really is no one right method, only what works for a family at that point in time. Although I can’t say this alleviated all my concerns, her calm presence and years of experience helped tremendously.
When I returned to work after maternity leave, I started studying for my Royal College exam. Like most doctors, I had an excellent ability to compartmentalize my thoughts and feelings. I still felt enough to stay modestly connected to my son and present for bedtime stories and bath, but I mostly let my husband do the parenting. When the exam was over and the haze lifted, I was lucky that my beautiful son was still there and still in love with me. Soon after graduation, I took over teaching the medical student course on infant attachment (“teach what you want to learn”) and tried to pay closer attention to my little teacher at home.
In medicine, we are first and foremost trained to be experts. Most of us have been acting like experts for years before we become one. For me, being knowledgeable was a source of both identity and pride. When I crossed the threshold into motherhood, I still felt as though I should know exactly what to do. After all, I was training to be a child therapist. When I found myself at a loss, my first impulse was to research an answer. But no amount of internet searching or reading could teach me how to soothe my baby or answer any of the hundreds of tiny unknowns parents deal with every day. Parenting, I learnt, is an emotional practice. There have been times to gather information, but mostly, it has been a process of learning to let go of expectations, listen to instincts and accept practical support. It has been difficult to have so few answers, but wonderful to feel so much more comfortable having questions.