Pregnancy during Otolaryngology Residency: Experience and Recommendations

Abstract

Pregnancy during graduate medical training became a pertinent issue in the United States during the 10-year interval between 1992 and 2002 as the number of female residents trended steadily upward to over 25 per cent. Surgical training programs characteristically present unique challenges and stressors for all trainees, and pregnancy introduces additional physical, professional, and emotional demands for the pregnant woman and her coworkers. A qualitative study was performed using in-person interviews of female otolaryngology residents who had given birth within the previous 12 months. Items addressed included the pregnancy course and its complications, specific stressors during and after pregnancy, and solutions implemented by the resident and her program director. Reactions and level of support from coworkers were also discussed. Five pregnancies were reported among three residents interviewed. One resident experienced preterm delivery, which necessitated a week-long stay in the neonatal intensive care unit for her infant. Another had chorioamnionitis during delivery of two infants. One child had low birth weight. The third resident had a miscarriage during the first trimester of her first pregnancy and sustained a minor head injury after fainting in the operating room during her second pregnancy. Overall, long hours, unpredictable work demands, and guilt over colleagues’ increased workloads and altered schedules were noted as significant sources of stress among these residents; the women also described high expectations of themselves, along with misgivings over their ability to balance pregnancy and parenthood with career demands. The most significant postpartum stress indicator was the matter of child care, especially as it related to finding adequate coverage for on-call periods ranging from 3 to 14 days per month. Maintaining breastfeeding was an additional concern in the postpartum period. Pregnancy during surgical residency is a significant source of conflict for the pregnant resident and her colleagues. Our study illustrates how program directors can pre-emptively address challenges this event presents. When policies on maternity leave, call issues during pregnancy, and flexible rotation schedules are in place before pregnancy occurs, the process may be smoother and more rewarding for all involved.

Fertility and Childbearing Among American Female Physicians

“…This suggests positive changes over time: a 1988 national survey 12 indicated that only 16% of physicians found their workplace to be supportive of pregnancy and 12% to be supportive during their child's infancy. Although this may reflect an impact of cultural and legislative changes over time, such as the U.S. Family and Medical Leave Act of 1993, it is important to note that a 2009 survey 29 reported that 36% of program directors actively discouraged pregnancy during residency and department chairs viewed pregnancy during residency as a hardship on other residents and an interference on the smooth functioning of a department. Thus, although heartening, it is possible that self-selection effects (by which primarily those women training in supportive programs chose to pursue pregnancy during training) may influence our findings.…”

Female trainees believe that having children will negatively impact their careers: results of a quantitative survey of trainees at an academic medical center

“…[ 25 ] Other stressors include an unpredictable work schedule and the difficulty of breastfeeding after maternity leave. [ 26 , 27 ] The inherent stress of early parenthood is compounded by the lack of institutional resources, as only 38% of academic hospitals have on-site childcare and less than 60% have lactation spaces. [ 10 ] Workplace stigma against pumping breast milk at work and the lack of time to do so may impact the duration of breastfeeding.…”

Reproductive health and burn-out among female physicians: nationwide, representative study from Hungary

“…The metaanalysis of Finch became a cornerstone in the field of studying fertility disorders among female physicians, since it showed that health problems during pregnancy occurred more frequently among house officers and young female doctors [ 7 ]. A higher rate of health disorders during pregnancy was confirmed by two quantitative investigations [ 8 , 9 ], and a higher rate of preterm births was found in a survey of Canadian female surgeons [ 8 – 10 ]. Hamilton et al also found a higher rate of preterm deliveries among female surgeons, compared with the general female population [ 11 ].…”