Surgical training is particularly rough on pregnant residents. This was made very clear in a recent study of women who were pregnant during surgical residency, which found that 39% of women surveyed considered leaving residency and 30% would advise female medical students against pursuing a surgical career.1 With so much focus on retaining and promoting women in surgery, what can we do to improve the experiences of pregnant residents and new moms so that they can continue on their path to becoming surgeons?
This question is close to my heart as a surgeon who decided to have a child during residency and struggled with many of the stressors identified in the study. Here are some of my thoughts on how we can support pregnant residents and new moms so that they are able to complete their residency and remain content with their choice to become surgeons.
- Child care: Access to child care is limited and waiting lists are often long. This is particularly challenging when both parents are residents, with limited time for parental leave. In institutions with residents, there should be some priority for the children of residents to get into daycare slots so that they can go back to work after the short time allowed for maternity leave. Moreover, daycare facilities that do cater to residents should have hours conducive to their schedules. It is no good to a resident to have a daycare that opens at 9 am and closes at 4 pm. In addition, hospitals should offer 24-hour drop-off services that allow on call residents to have childcare covered if they need to come into the hospital and have no one available to care for their child.
- Lactation support: Having lactation rooms close to the ORs or surgical patient floors makes pumping more convenient. Adding workstations to those rooms so residents can catch up on writing notes and orders while pumping is an added bonus. Lactation can also be supported by assigning breastfeeding moms shorter cases or setting the precedent that scrubbing out to pump at non-demanding portions of longer cases is acceptable. Pumping while the patient is undergoing anesthesia or when the surgical procedure is done and they are waking up is another way surgical residents can pump without missing cases. Residents may feel obligated not walk away right after the case or show up after the patient has been prepped because of the perception that they are not engaged. While it might seem awkward, they should be encouraged to have a discussion about the best times to pump with their attendings so both parties can be on the same page about how to make this work.
- Maternity leave: One of the options from the American Board of Surgery for maternity leave is to use vacation time, which is a total of 12 weeks over the first 3 years of residency or 8 weeks over the last 2 years. In order to maximize this, a resident has to save up the time over a couple of years in anticipation of maybe becoming pregnant. The second option is to extend training by a year, thereby being able to take a year off of training for maternity leave. The time off is not paid so this option does not work for many residents. The ABS is now allowing for extension of training in chief year based on the amount of time taken off, which allows for more flexibility. The next hurdle is to have flexible starting dates for fellowship so that maternity leave does not negatively affect the next stage of female surgeons’ careers.
- Flexibility in rotations: My chief year rotation schedule was set over a year in advance and was very hard to alter. I was lucky that I had my child right before a rotation with a lot of resident support so I was not missed. Having rotations with varying degrees of demand, difficulty, time commitment and resident redundancy, and the flexibility to change rotations when a resident has a compelling reason can help make coming back into residency after maternity leave easier. Having residents start back in a rotation that allows time for pumping if desired, has less tendency to have erratic hours and less frequency of overnight cases and consults can help them make the transition back into clinical work more manageable.
I am happy to report that I have a healthy, happy 2-year-old who survived not only my chief year but has also made it through my almost-completed transplant surgery fellowship. Pregnancy during residency was a challenge. Just because I managed to make it work, mostly because of the commitment and dedication of my amazing husband, I don’t believe that it should remain a struggle. We should find ways to support pregnant residents and new moms (and dads) so that they can be successful surgeons and parents.
Rangel EL, Smink DS, Castillo-Angeles M, Kwakye G, Changala M, Haider AH, Doherty GM. Pregnancy and Motherhood During Surgical Training. JAMA Surg. Published online March 21, 2018. doi:10.1001/jamasurg.2018.0153