Female Surgeons at Greater Risk of Pregnancy Loss, Study Finds


Eveline Shue had always been a standout surgeon, but her happiest moment at the hospital came when she was finally able to share some personal good news with her colleagues: After five cycles of IVF, she was pregnant with twins. At 24 weeks pregnant, she and her husband began making plans for their future family, buying car seats and choosing names. All this time, Dr. Shue continued to work 60 hours a week at the hospital.

At 34 weeks, she realized that the operating room shifts were wearing down her body and took a short time off. Two days later, her mother broke into her house and found her unable to speak. 39-year-old Dr. Shue had suffered from preeclampsia and a stroke. He was hospitalized, had an emergency cesarean section, and then had brain surgery.

Babies, Dr. Like Shue, he survived, but it was a wake-up call for the surgical team. “I started asking myself, What could we do as a group to prevent this from happening?” D., who is professor of surgery and pediatrics at the University of Southern California Keck School of Medicine. Eugene Kim said.

Last year Dr. Kim set out with a group of doctors and researchers to investigate factors that contribute to pregnancy complications in American female surgeons. The article he co-authored JAMA Surgery Wednesday showed that female surgeons were more likely to delay pregnancy, use assisted reproductive technology, have a non-elective cesarean section and experience pregnancy loss compared to non-surgeon women.

The study of 692 female surgeons found that 42 percent experienced pregnancy loss at more than twice the rate of the general population, and nearly half experienced major pregnancy complications.

As American medical schools approach gender equality, even stubborn male specialties like surgery are starting to look more like the wider population. Women now make up 38 percent of surgical assistants and 21 percent of surgeons. But the challenges of balancing the professional demands of surgery with the process of starting a family are deeply rooted.

Amongst the stigma associated with pregnancy during surgical training and the trivial options for maternity leave, many women delay pregnancy until they become resident, at which point their age makes them more vulnerable to adverse pregnancy outcomes. Brigham and female surgeon Dr. Erika Rangel said the joke that circulated among female surgeon candidates in medical school was that nearly all of them would encounter “geriatric pregnancies.” The new JAMA Surgery study found that the median age of giving birth for female surgeons was 33, compared to the national median for advanced women of 30, and a quarter of female surgeons surveyed used assisted reproductive technology such as IVF. 2 percent Percentage of babies born in the US each year are conceived with assisted reproductive technology.

As the study’s authors noted in interviews, this increased reliance on IVF among female surgeons comes at a significant financial cost – often more than $12,000 per cycle for up to six cycles. associated with such risks. placental dysfunction.

According to the study, the female surgeons most at risk for pregnancy complications were those who operated 12 hours or more per week during their last trimester. Performing surgery is more physically intense than other clinical tasks because it means being on your feet with little access to food and water. More than half of the female surgeons surveyed worked more than 60 hours a week during pregnancy, 37 percent had 6 night calls each month, and only 16 percent cut their working hours.

One of the authors of the paper, 44-year-old Dr. “There is a bravado that comes with the surgical personality,” Rangel said. “There’s a culture of not asking for help, but that tells us there’s a health risk involved.”

Surgical assistants often fear that asking for help can fuel resentments because their colleagues must provide coverage in addition to their own demanding schedules. Rangel and his co-authors propose a series of hospital policy changes that will allow female surgeons to seek help without fear of backlash; for example good compensation to those providing coverage and increased commitment to hire moonlight doctors, nurse practitioners. and physician assistants who can help when trainees are overloaded.

But the study’s authors stressed that the change in culture needed to better support female surgeons will not come without wide-ranging policy change. Parental leave now varies according to residency programs. Most female residents take six weeks (including some leaving for vacation), while male residents usually only last a week. The newspaper called for at least six weeks of paid parental leave for both men and women, excluding vacation time. The authors also noted that the risk of burnout increased when residents used vacation time as parental leave.

Areas built on strict norms and rigorous educational rituals, such as surgery, can be resistant to wide-ranging change. But the paper’s authors noted that over the past two decades, the field has done what was once thought impossible to limit established working hours to 80 hours per week; residents had previously worked sometimes more than 100 hours a week.

Dr. “People said it couldn’t be done, but then the leadership implemented it from the ground up,” Rangel said. “And culture change follows that policy change.”

In some cases, this culture change is already modeled by the authors themselves. One of the paper’s authors, Dr. Sarah Rae Easter got pregnant during her ICU fellowship. One day while managing the tours his water broke. He went out, put on new aprons, and got ready to go back to work. But then he met his supervisor – Dr. rangel.

Dr. “Erika Rangel was standing there with her arms crossed and she said, ‘I think birth and birth are opposites,'” Easter said. “Go take care of yourself, it’s not only important for you, it’s important for you to emulate,” she said.

Dr. Easter added that this kind of leadership can help make the field more women-friendly: “This illustrates the kind of culture shift we need to optimize outcomes for our specialty and our patients.”


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