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Original Investigation
March 21, 2018

Pregnancy and Motherhood During Surgical Training

Author Affiliations
  • 1Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
  • 2Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, Massachusetts
  • 3Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
  • 4Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis
  • 5University of California, San Francisco School of Medicine, San Francisco
JAMA Surg. Published online March 21, 2018. doi:10.1001/jamasurg.2018.0153
Key Points

Question  What is the perception and experience of pregnant general surgery residents?

Findings  This national survey of 347 general surgeons who have had 1 or more pregnancies during residency revealed concerns about unmitigated work schedules during pregnancy, negative stigma associated with pregnancy during training, dissatisfaction with maternity leave options, inadequate lactation and childcare support, and desire for greater mentorship on work-life integration. These challenges were associated with 39% of participants seriously considering leaving residency and 30% reporting they would advise a female medical student against pursuing a career in surgery.

Meaning  Multiple challenges facing pregnant surgical residents may negatively influence career satisfaction and must be addressed to attract and retain the most talented workforce.

Abstract

Importance  Although family priorities influence specialty selection and resident attrition, few studies describe resident perspectives on pregnancy during surgical training.

Objective  To directly assess the resident experience of childbearing during training.

Design, Setting, and Participants  A self-administered 74-question survey was electronically distributed in January 2017 to members of the Association of Women Surgeons, to members of the Association of Program Directors in Surgery listserv, and through targeted social media platforms. Surgeons who had 1 or more pregnancies during an Accreditation Council for Graduate Medical Education–accredited US general surgery residency program and completed training in 2007 or later were included. Important themes were identified using focus groups of surgeons who had undergone pregnancy during training in the past 7 years. Additional topics were identified through MEDLINE searches performed from January 2000 to July 2016 combining the keywords pregnancy, resident, attrition, and parenting in any specialty.

Main Outcomes and Measures  Descriptive data on perceptions of work schedule during pregnancy, maternity leave policies, lactation and childcare support, and career satisfaction after childbirth.

Results  This study included 347 female surgeons (mean [SD] age, 30.5 [2.7] years) with 452 pregnancies. A total of 297 women (85.6%) worked an unmodified schedule until birth, and 220 (63.6%) were concerned that their work schedule adversely affected their health or the health of their unborn child. Residency program maternity leave policies were reported by 121 participants (34.9%). A total of 251 women (78.4%) received maternity leave of 6 weeks or less, and 250 (72.0%) perceived the duration of leave to be inadequate. The American Board of Surgery leave policy was cited as a major barrier to the desired length of leave by 268 of 326 respondents (82.2%). Breastfeeding was important to 329 (95.6%), but 200 (58.1%) stopped earlier than they wished because of poor access to lactation facilities and challenges leaving the operating room to express milk. Sixty-four women (18.4%) had institutional support for childcare, and 231 (66.8%) reported a desire for greater mentorship on integrating a surgical career with motherhood and pregnancy. A total of 135 (39.0%) strongly considered leaving surgical residency, and 102 (29.5%) would discourage female medical students from a surgical career, specifically because of the difficulties of balancing pregnancy and motherhood with training.

Conclusions and Relevance  The challenges of having children during surgical residency may have significant workforce implications. A deeper understanding is critical to prevent attrition and to continue recruiting talented students. This survey characterizes these issues to help design interventions to support childbearing residents.

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