Implications of a pregnancy during a medical specialisation

A study investigated USA general surgery residents' experiences, highlighting the needs to protect maternal and foetal health, and promote gender equity.

The difficulty of being a (parenting) surgeon

Family tasks and managing children are critical aspects for many people who wish to fulfil career plans. Among them, doctors engaged in surgical specialities often face unique challenges, with professional demands that can complicate these aspects of life. Indeed, general surgery requires a significant commitment, with long and unpredictable hours that can make managing family responsibilities difficult.

In particular, female surgical residents often face occupational risks during pregnancy (risks of pre-eclampsia and placental insufficiency due to long shifts and night work, prolonged standing, exposure to radiation and toxic agents, injuries or biological risks); and may find it difficult to reconcile the demands of medical training with those of motherhood. In addition, the traditionally male-dominated and hierarchical culture in surgery may amplify the challenges for female residents, who may find themselves unsupported in their parenting.

Previous studies have shown that female surgical residents report higher rates of obstetric complications and postpartum depression than the general population. Furthermore, female surgical residents frequently experience violence and discrimination related to pregnancy and parenting.

Are there gender differences?

The main objective of the study was to examine the experiences of pregnancy and parenting among general surgery residents in the United States, with a focus on the burnout caused by pregnancy and parenthood, obstetrical outcomes, and resident well-being. The study aimed to identify gender disparities in these areas and to assess the impact of these experiences on burnout and thoughts of leaving the profession.

5,962 responses to the US national survey

General surgery is the surgical specialty with the largest number of doctors in training in the United States. It therefore provides an ideal context for examining the pregnancy and parenting experiences of medical residents.

The study was based on a national survey designed to collect data from all general surgery residents in the United States. The study population included all residents enrolled in programmes accredited by the Accreditation Council for Graduate Medical Education (ACGME). Data collection took place immediately following the American Board of Surgery's 2021 In-Training Examination via an online survey. The survey achieved a response rate of 81.2%, with 5,692 residents participating. 

Among the variables measured, the study included the incidence of pregnancy during clinical training and the delay in the decision to have children due to training. Data were collected on the frequency and type of pregnancy and parenting-related violence, including discrimination and professional obstacles. In addition, obstetric outcomes such as obstetric complications and the incidence of postpartum depression among trainees and their partners were examined.

To assess trainees' well-being, the survey measured levels of burnout, the presence of thoughts of leaving the profession and suicidal thoughts.

Defining violence

In the article, pregnancy- and parenting-related ‘violence’ is defined through various negative and discriminatory behaviours that residents may experience during their surgical training.

• Direct discrimination: unfair or disadvantageous treatment based on the fact of being pregnant or having children. This may include inappropriate comments, ridicule or unjustified criticism.
• Stereotypes and prejudices: negative assumptions and stereotypes about those who are expecting children or are parents, such as the idea that they cannot perform their duties as efficiently as colleagues without children.
• Professional obstacles: limitations or denial of professional opportunities, such as the reduction of operational responsibilities, denial of participation in projects or lack of consideration for promotions or career advancement.
• Inadequate support: lack of support from colleagues, such as lack of reasonable support during pregnancy (e.g. more frequent breaks) or lack of flexibility in work shifts to allow work-life balance.
• Hostile working environment: creation of a hostile working environment through intimidating behaviour, social exclusion or pressure to conceal pregnancy or avoid discussions about parenthood.
• Devaluation of parenthood: diminishing the value of parenthood, making trainees feel guilty or inadequate for the time and energy devoted to their family.

Having children during specialisation is particularly a challenge for women

The main study results showed that 22.3% of male and 10.2% of female residents experienced pregnancy during their clinical training. Female residents experienced pregnancy/parenting-related violence to a greater extent (58.1%) than male residents (30.5%). Furthermore, female residents were more likely to experience obstetric complications (OR 1.42) and postpartum depression (OR 1.63). Pregnancy/parenting violence was associated with increased burnout (OR 2.03) and thoughts of abandonment (OR 2.50). Postpartum depression was associated with burnout (OR 1.93), thoughts of abandonment (OR 2.32) and suicidality (OR 5.58).

Gender integration in surgery

The study results underline the need for systematic change to protect maternal and foetal health and promote gender equity in surgical specialties. It is imperative that surgical training programmes implement pregnancy and parenting support policies, offering support to pregnant and child-bearing residents. In addition, it is critical to promote an inclusive work culture that values and supports trainees' family responsibilities.