A Common Silence: Perspectives on Pregnancy Loss During General Surgery Residency

by Cleo Siderides, MD and Caitlin J. Cain-Trivette, MD

Pregnancy loss is a painfully common experience among surgical trainees, yet our institutions remain poorly equipped to respond with support and compassion. Surgical trainees are more than twice as likely to experience pregnancy loss than the general population,1 yet no formal safeguards exist to protect trainees enduring these sentinel events.

Cleo’s first pregnancy ended in a missed miscarriage at 9 weeks, followed by six weeks of medical and surgical management amidst the relentless pace of residency.

The day after I took medication to induce a miscarriage I was on a 24-hour trauma call, bleeding through my scrubs to the point that I tied a jacket around my waist between cases. I emphatically stated that no, I did not feel like I needed to step away from work. I saw the hardship as a way to prove my grit and worth as a resident, emulating stories I’d heard of the heroics of female surgeons who had worked through similar circumstances, putting surgery above all else. I was silent, alone, and unmoored. Only after my second loss would I understand the scars left behind and the hurt that came with neglecting my wellbeing in the name of preserving my reputation. Seeking some sense of catharsis, I told my story to anyone in the residency who would listen and found comfort in shared experience–faculty and peers alike reflected the healing that can be found in collective hardship.

Caitlin’s first pregnancy ended in a missed miscarriage requiring medical management early in her research years when she was simultaneously completing a clinical fellowship.

The emotional and physical distress of miscarriage was compounded by anxiety about privacy and my new clinical responsibilities. I hesitated to ask for formal leave, unsure how to navigate disclosure. Despite these fears, I found myself surrounded by colleagues and mentors who quietly offered understanding and flexibility, allowing me to cope without forcing me to share more than I was ready to. Although my institution lacked formal policies, I was deeply appreciative of the informal professional support that softened that difficult period, all while realizing this is not the norm. When a subsequent complicated pregnancy led to my month-long hospitalization and three months spent with my child in the NICU, this network continued to make a profound difference—reminding me how important compassionate, responsive support is, and how much more accessible and formalized support should be for every trainee, particularly for pregnancy loss.

Our stories are not anomalous; they are the endured reality for far too many surgical trainees and evidence that we must do better. We developed a pregnancy loss policy at our institution and published a call to action for other general surgery residency programs to establish policies supporting residents through pregnancy loss.2 Our continued research seeks to bring every surgeon’s experience and priorities forward, transforming individual struggle into collective advocacy at the institutional and national level. By emphasizing what is broken and demanding better we can forge a culture that honors both our profession and our humanity.

References

1. Rangel EL, Castillo-Angeles M, Easter SR, et al. Incidence of Infertility and Pregnancy Complications in US Female Surgeons. JAMA Surg. 2021;156(10):905-915. doi:10.1001/jamasurg.2021.3301

2. Siderides C, Cain-Trivette CJ, Garrett KA. Addressing Pregnancy Loss in Surgical Residency—A Call for Policy Protection. JAMA Surg. Published online January 22, 2025. doi:10.1001/jamasurg.2024.6045

Cleo Siderides, MD is a second-year research fellow in the Trauma Surgery and Surgical Critical Care Department at NewYork Presbyterian/Weill Cornell Medicine. Her research focuses on health disparities in trauma outcomes and residency program education and improvement. In addition, she is also pursuing a Master’s in Public Health in Epidemiology and Biostatistics. Her hope is to become a trauma surgeon dedicated to caring for underserved communities and to be actively involved in health policy. She is a mother to a one-year-old daughter Elliot and is passionate about changing our training culture to support and empower residents pursuing parenthood.

Caitlin J. Cain-Trivette, MD is a second-year Pediatric ECMO Fellow at NewYork-Presbyterian Morgan Stanley Children’s Hospital and an aspiring pediatric surgeon dedicated to improving outcomes for critically ill infants and the systems that care for them. Her work centers on pediatric critical care, ECMO, and the creation of supportive policies for surgical trainees—particularly around pregnancy loss, parental leave, and trainee wellbeing. A mother and humanities-informed clinician, she believes in the power of narrative to drive institutional change.

Twitter: @joelle_caitlin