Women surgeons are at greater risk of pregnancy loss, study finds

Dr. Eveline Shue has always been an outstanding surgeon, but her happiest moment in the hospital came when she was finally able to share some good personal news with her colleagues: After five rounds of IVF she was pregnant. of twins. At 24 weeks pregnant, she and her husband started making plans for their future family, buying car seats and choosing names. During this time, Dr. Shue continued to work 60 hours per week in the hospital.

At 34 weeks, she realized that operating room shifts were taking a toll on her body and took a brief leave of absence. Two days later, her mother entered her home and found her unable to speak. Dr Shue, 39, had suffered from preeclampsia and a stroke. She was rushed to hospital, had an emergency cesarean, and then had brain surgery.

Her babies survived, as did Dr. Shue, but it was a wake-up call for his surgical team. “I started to wonder, what could we have done as a group to prevent this from happening? Said his colleague, Dr. Eugene Kim, professor of surgery and pediatrics at the Keck School of Medicine at the University of Southern California.

Last year, Dr Kim set out with a group of doctors and researchers to study the factors contributing to pregnancy complications in American female surgeons. The article he co-wrote, published in JAMA surgery Wednesday, showed that female surgeons are more likely to delay pregnancy, use assisted reproduction techniques, have non-elective cesarean sections and have a miscarriage compared to women who are not surgeons.

The study, which interviewed 692 surgeons, found that 42% had suffered a miscarriage, more than double the rate of the general population, and nearly half had experienced major complications during pregnancy.

As US medical schools approach gender parity, even stubborn male specialties like surgery are starting to look more like the general population. Women now represent 38 percent of surgical residents and 21 percent of practicing surgeons. But the challenges of balancing the professional demands of surgery and the process of creating a family remain deeply rooted.

Between the stigma associated with pregnancy during surgical training and the paltry options for maternity leave, many women delay pregnancy beyond residency, when their age makes them more vulnerable to adverse pregnancy outcomes. In medical school, said Brigham and women’s surgeon Dr Erika Rangel, the common joke among potential female surgeons was that they would almost all face “geriatric pregnancies.” The new JAMA Surgery study found that the median age of female surgeons to give birth was 33 years, compared to a national median of 30 years for women with tertiary education, and a quarter of female surgeons surveyed used techniques for giving birth. assisted reproduction like IVF. 2 percent of infants born in the United States each year are conceived using assisted reproductive technologies.

This increased reliance on IVF among female surgeons, the study authors noted in interviews, comes at a significant financial cost – often over $ 12,000 per cycle for up to six cycles. It is also associated with risks such as placental dysfunction.

According to the study, the surgeons most at risk of pregnancy complications were those who continued to operate for 12 hours or more per week until the last trimester. Performing surgeries is more physically intense than other clinical tasks because it means standing with little access to food and water. More than half of the female surgeons surveyed worked more than 60 hours per week during pregnancy, 37 percent took more than 6 night calls each month, and only 16 percent reduced their working hours.

“There is a bravado that comes with surgical personality,” said Dr. Rangel, 44, one of the co-authors of the article. “There is a culture of not asking for help, but it tells us that there is a health risk. “

Surgical residents often fear that asking for help could breed resentment because colleagues have to provide coverage in addition to their own demanding schedules. Dr Rangel and his co-authors recommend a number of hospital policy changes that would allow surgeons to seek help without fear of backfire, such as good compensation for those who offer coverage and increased commitment to do so. call in doctors, moonlighting nurse practitioners and physician assistants who can help when trainees are overworked.

But the culture shift needed to better support surgeons won’t come without a large-scale policy change, the study authors said. Parental leave now varies according to residency programs. Many female residents take six weeks (some of which are reserved for vacations) while male residents often only take one week. The newspaper called for at least six weeks of paid parental leave, not counting vacation, for both men and women. The authors also noted that when residents use their vacations as parental leave, they end up with an increased risk of burnout.

Areas like surgery that rely on rigid standards and grueling training rites may be resistant to large-scale change. But the authors of the article noted that over the past two decades, the estate has done what was once considered impossible by capping residents’ working hours at 80 hours per week; residents had previously worked sometimes over 100 hours per week.

“People said it couldn’t be done, but then management implemented it from top to bottom,” Dr Rangel said. “And the culture change follows this policy change. “

In some cases, this culture change is already modeled by the authors themselves. One of the authors of the article, Dr. Sarah Rae Easter, became pregnant while in intensive care. Her water broke one day while she was on patrols. She got out, put on new scrubs and got ready to go back to work. But then she ran into her supervisor, Dr. Rangel.

“Erika Rangel was standing there with her arms crossed and she said, ‘I think labor and delivery are the other way around,’ Dr Easter recalls. ‘She said to me,’ Go take care of it. about you is important not only for you but for the example you set. ‘”

This kind of leadership, continued Dr. Easter, could help make the field more accommodating to women: “It illustrates the kind of culture change we need in order to optimize outcomes for our specialty and for our patients. “

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