OBJECTIVE Family medicine residency programs are training more women; pregnancy and childbirth during residency have become more common. The purpose of this study was to examine childbirth during residency from the perspectives of the new mother, her female colleagues who did not give birth during training, and program directors. METHODS We surveyed female residents and program directors of 457 family medicine residency programs in the United States by mail. Questions were primarily quantitative with Likert and yes/no responses. We analyzed data using Statit-EQC. RESULTS Response rates were 40% (program directors), 25% (birthing residents), and 13% (non-birthing female residents), regionally reflecting program density. According to program directors, 52% of the residents were female, 17% of these had given birth and returned to work, and 75% of those who gave birth planned to extend their residency. The average time off for maternity leave was 6.5 weeks while the optimum time off was thought to be significantly greater (7-12 weeks). Higher satisfaction of birthing residents was associated with greater satisfaction with childcare. Lower satisfaction was associated with earlier termination of breast-feeding due to demands of residency. A smaller percentage of birthing residents plan to work full-time after graduation than non-birthing residents. CONCLUSIONS Perceptions that the newborns' needs are met influence the satisfaction and self-ranked performance of birthing residents. Programs with a higher percentage of women accommodate more time off after delivery. Childbirth during residency may influence future work plans.