Handling the Neurosurgical Pregnancy: Tips for the Surgeon and Her Team
“I wish I could say ‘congratulations’, but this is a disaster,” said my co-resident when I dropped the news on him over an afternoon coffee. I was neither surprised nor bothered by his reaction; I too had no frame of reference for how a neurosurgical resident would survive her year as chief resident pregnant, deliver the baby and start a skull base fellowship in a foreign country. It seemed certain that disaster would ensue.
“Neurosurgical pregnancy” was an oxymoron for most of our field’s history. However, a variety of cultural forces active today mean that this can no longer be the case. Women represent 50 percent of medical students and 15 percent of neurosurgical residents, and that number is slowly increasing. Culturally, men and women in their 20s and 30s are likely to support a more egalitarian approach to careers and child rearing. National medical organizations, like the ACGME and AMA are recognizing and combating physician burnout in part by recognizing the need for doctors to lead more balanced lives, with an emphasis on personal fulfillment blended with professional success. While the data is not readily available, neurosurgical pregnancies are undoubtedly on the rise.
Unfortunately, surgeons have an unusually high risk of pregnancy complications. This issue is under-recognized by both men and women in the field. Some of this problem is age related; the average age of a first birth amongst U.S. women is 24, but the average age of first birth amongst female surgeons is 34. The issue of advanced maternal age is notable, with 30 percent of female surgeons who seek to become pregnant requiring treatment for infertility. In terms of both time and finances, this is an expensive problem for the individual and for her practice, and this should draw attention to the fact that assuming women should wait to have children until training is complete may be shortsighted.
Even more troubling is the fact that female surgeons have a rate of pregnancy complications of 32 percent, compared to 15 percent for the average U.S. woman. Adjusting for age, race, underlying health status and socioeconomic status, female surgeons have a relative risk of pregnancy complications of 2.5 (95 percent CI 1.3-4.6). Factors correlated to increased risk include longer work hours, demanding physical postures, high job-related strain and low social support. While some of these factors are difficult to mitigate, I believe there are steps we can take to improve the chances that female neurosurgeons can be successful in both childbearing and career.
To the Pregnant Neurosurgeon:
Logistically you have much to do, but I submit that few people are as fit to handle complex logistical problems as female neurosurgeons.
First, spend some time familiarizing yourself with state and federal law regarding your eligibility for maternity leave. For trainees and employed neurosurgeons, institutional policies should be readily available through the human resources department. Many pregnant neurosurgeons will not yet be board-certified and should carefully review the policies of the ABNS regarding family and medical leave, which are notably fair and supportive.
Next, once you understand your rights and responsibilities, approach your supervisor with a tentative plan of how you believe you can best merge your medical/personal needs with those of your patients and colleagues. This should include not only a plan for maternity leave, but also a strategy to handle doctor’s appointments, both planned and unexpected. Understand that there may be occupational exposures, such as teratogenic bone cements or fluoroscopy, which you need to manage. Let scientific evidence be your guide; while pregnant neurosurgeons may be unusual, pregnant healthcare workers are not and most of these issues will have been carefully studied with policies based on occupational health regulations. Build in flexibility within your operative days to accommodate the physical demands of pregnancy, whether it be the need for a quick snack break during a long case or using an alternate type of chair or patient position to accommodate new ergonomic demands. Recognize that you can’t be an effective surgeon without feeling generally comfortable and ready to focus on the critical task at hand.
Finally, recognize that every pregnancy is different. When you seek advice from mentors or support from friends, remember that you will need to be flexible in this process. Becoming a mother is a major identity shift, especially for women who have chosen to spend their professional lives in a male-dominated world. Allow yourself to grow into that new duel identity and accept that your needs may change in unpredictable ways.
To the Neurosurgical Community:
Department and practice leaders can build transparent policies for family and medical leave before issues arise. Work with legal advisors, human resources or the GME lead at your university to ensure that the policy you create is legal and fair. Encourage all members of your group to take appropriate leave to care for their own health and that of their families. Much of the angst that maternity leave creates comes from the sense that pregnant women are getting a break that men or women without children are not. Create a culture where personal needs are defined by the individual and supported by the leadership. Pregnancy and parenthood are but two of the many personal challenges colleagues will face; try to greet them all with grace.
Remember, mentors come in many forms and seldom the best mentor mirrors ourselves. The mentors that showed me how to be a neurosurgeon-parent are men. They taught me to embrace my new identity with joy (eventually!). Like many within our field, I often fear abrupt and unexpected change. And yet, neurosurgeons are resilient. We are problem-solvers and planners. We don’t like being told that something cannot be done; in fact, we sometimes find that notion to be a personal challenge. “Neurosurgical pregnancy” is a challenge that our community can choose to embrace, and we will be stronger for it.
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2. Brown, E. G., Galante, J. M., Keller, B. A., Braxton, J., & Farmer, D. L. (2014). Pregnancy-Related Attrition in General Surgery. JAMA Surgery, 149(9), 893.
3. Chen, M. M., Yeo, H. L., Roman, S. A., Bell, R. H., & Sosa, J. A. (2013). Life events during surgical residency have different effects on women and men over time. Surgery, 154(2), 162-170.
4. Sandler, B. J., Tackett, J. J., Longo, W. E., & Yoo, P. S. (2016). Pregnancy and Parenthood among Surgery Residents: Results of the First Nationwide Survey of General Surgery Residency Program Directors. Journal of the American College of Surgeons, 222(6), 1090-1096.
5. Hamilton, A. R., Tyson, M. D., Braga, J. A., & Lerner, L. B. (2012). Childbearing and Pregnancy Characteristics of Female Orthopaedic Surgeons. The Journal of Bone and Joint Surgery-American Volume, 94(11).
6. Turner, P. L., Lumpkins, K., Gabre, J., Lin, M. J., Liu, X., & Terrin, M. (2012). Pregnancy Among Women Surgeons. Archives of Surgery, 147(5).
Chicago Review Course in Neurological Surgery
Jan. 24-Feb. 3, 2019; Chicago
Richard Lende Winter Neurosurgery Conference
Feb. 1-5, 2019; Snowbird, Utah
2019 NASBS Annual Meeting
Feb. 15-17, 2019; Orlando, Fla.
12th Annual International Symposium on Stereotactic Body Radiation Therapy and Stereotactic Radiosurgery
Feb. 22-24, 2019; Lake Buena Vista, Fla.
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