59. Dr. Susan McIlvaine returns to talk having a baby as a new attending, infertility, and more

Key topics In this episode, Susan explains that getting pregnant with Nicholas took about a year, similar to her experience conceiving Maddie, but for different reasons. She shares that after Maddie’s birth she had prolonged bleeding, which led to a DNC after a retained piece of placenta was found. Susan describes how that earlier procedure likely contributed to Asherman syndrome, with significant scar tissue in the uterus discovered during fertility workup. We discuss the repeated procedures she needed to clear scar tissue, including use of a Foley balloon to keep the uterus open while it healed. Susan talks about the emotional stress of fertility treatment while starting her first attending job and trying to manage clinic schedules, OR time, and appointments. She reflects on how hard it was to feel like a responsible new attending while also dealing with fertility care and early pregnancy visits. Susan compares postpartum anxiety with her first baby to the second time around, saying she was less overwhelmed, less intrusive-thought driven, and more able to recognize hard phases as temporary. She talks how the second baby changed the logistics of parenting, especially with a toddler already at home and less free time to ruminate. We discuss the difference between emotional and logistical difficulty when returning to work, including the intense feelings around daycare dropoff the first time. Susan explains how her family planned childcare coverage around the reality of daycare sickness by splitting parental leave and saving time for sick days. She talks through the weekly division of labor at home, including dropoffs, pickups, bottle prep, meals, and the constant negotiation between flexibility and structure. Susan shares that outsourcing more tasks, like laundry, feels like the next step, even though she still struggles with guilt about paying for help. Susan discusses how hard it can be to accept help with tasks you are technically capable of doing yourself. Susan says one of the biggest mindset shifts has been redefining what a successful day looks like, especially when parenting young children and working long hours. She names watching her two children interact as one of the most meaningful parts of parenting now. Susan also reflects on the strange, awe-inspiring biology of motherhood, including thinking about the eggs that existed in her body long before her children were born. Timestamps 00:00 - Reconnecting with Susan and introducing the second-baby conversation 00:41 - Nicholas turns one and the family keeps his birthday low-key 01:30 - Getting pregnant with Nicholas took another long road 03:47 - The postpartum bleeding after Maddie and the retained placenta 04:44 - Fertility testing leads to an unexpected diagnosis 05:18 - Discovering scar tissue and Asherman syndrome 06:14 - Multiple procedures with Foley balloons to reopen the uterus 07:16 - What it felt like to hear grim fertility statistics at nearly 40 08:32 - Managing pregnancy while starting a new attending job 09:47 - Balancing fertility appointments with clinic days and OR scheduling 10:47 - Why pregnancy felt hard to fully believe until much later 12:36 - Nicholas arrives and the second postpartum experience begins 13:02 - Less anxiety, fewer intrusive thoughts, and more emotional ease 14:28 - Why the second baby phase felt more peaceful overall 15:19 - Postpartum anxiety, vigilance, and intrusive thoughts 16:39 - Breastfeeding with less pressure the second time around 18:21 - The emotional pain of first daycare dropoff 19:41 - Why returning to work was harder logistically than emotionally 20:58 - Leaving a child at daycare versus leaving with familiar help 23:57 - Leave policy discussion gets cut from the conversation 24:57 - Why childcare planning starts with backup support 25:56 - Splitting parental leave and saving time for sick days 27:22 - Weekly dropoff and pickup coordination between parents 28:16 - The daily battle over meals, bottles, and night versus morning tasks 31:17 - Why outsourcing laundry feels like a realistic next step 32:31 - Hiring help for meal prep and folding laundry, and still feeling weird about it 35:29 - Relearning that not every productive task is the right task 36:27 - Redefining a successful day beyond housework and to-do lists 37:32 - Cleaning as a way to regain control in a chaotic season 38:29 - Favorite and least favorite parts of parenting 39:19 - Watching siblings interact and the wonder of family biology 40:40 - The “baby store” joke and closing thoughts Support the show