As a female surgeon, can I actually have a child-and when?

by Dr. Deepa Patel

This is a special edition blog post presented in partnership with the Society of Asian Academic Surgeons in celebration of Asian American and Pacific Islander Heritage Month.

Female surgeons serving a dual role as mothers are no longer a rarity, as over one third of us have a child during residency. Despite these statistics, I continue to hear that many female medical students avoid careers in surgery as they think that pursuing such a career would hinder their ability to have children. Hearing these concerns surprises me. I have always considered my career a top priority but did know that at some point, I also wanted children. I never considered these goals in opposition. As a young attending about to have her first child within 2 years of finishing a colorectal fellowship, I have found that balancing pregnancy with a career is possible-but needs to be approached with some consideration.

So when is the best time to have a child?

Advanced maternal age (considered 35 years or older) has been associated with infertility, cesarean delivery (longer recovery time), low birth-weight infants, and neonatal intensive care unit admission. Compared to residents, however, attendings have significantly more financial resources and more flexibility to shape their daily schedules (but still must worry about lost referrals and discontinuity of patient care during maternity leave). Residents, while younger (and often not of advanced maternal age), do not have quite this level of freedom. However, the American Board of Surgery (ABS) does allow 6 weeks off per year in either of the last 2 years of residency without prior approval. Residents can also take an additional 2 weeks off during the first 3 years of residency to accommodate medical conditions including pregnancy. In addition, options exist to extend chief year through the end of August or to extend 5 years of clinical residency to 6, although this requires prior approval from the ABS. I did see multiple residents have children during elective research years taken in the middle of residency. Others considered saving eggs during their residency/fellowship years, although I personally did not as my insurance at the time did not cover assisted fertility procedures.

Is pregnancy difficult?

Each woman’s experience is wildly different. Nobody will be able to predict your individual experience-including you. Prior to pregnancy, I never had a serious medical condition that precluded or limited my ability to work. I subsequently think that I did not take concerns associated with pregnancy seriously. While it has been quite possible to work through the majority of my pregnancy, I did personally find abdominal cramping and round ligament syndrome to impede adequate sleep for multiple months (warm packs and chamomile tea just prior to bedtime were tremendously helpful for me). Other women report the following: first trimester-morning sickness, nausea, emesis, and fatigue; second trimester-more frequent urination, increased reflux, round ligament pain, lower extremity cramps; third trimester-constipation, edema, back pain, insomnia, and carpal tunnel syndrome. These symptoms sound minor but can actually be quite debilitating when they happen to a severe extent on a daily basis (and especially if you have not frequently experienced them before).

Practical Considerations

I do have to admit that I only considered certain aspects of advanced planning associated with pregnancy more recently. I only point out the following because I did not immediately consider them when I was planning my pregnancy:

– When will I stop taking general surgery call? (1 month prior to my expected due date? A few days prior to my expected due date?) How long will I stop taking general surgery call for? (1 month after birth? 3 months?)

– When will I stop booking cases? My OB-Gyn suggested stopping “longer” cases after the 37th gestational week.

– How will I maintain a specific number of relative value units? How important is earning a productivity bonus for this year (if that is part of your pay/job structure/contract)? If the bonus is important, do I want to increase/double up my call shifts when I return to work?

– Who will manage my patients while I am away?

– How will I regain referrals when I come back?

– Should I have negotiated a maternity leave into my contract when initially signing?

– Will-and how-will I monitor my cumulative radiation exposure during pregnancy? (Most state guidelines consider exposures under 50 mrem/month to be a safe dose, which corresponds to 100-1,000 fluoroscopic examinations of 5 minutes each.)

As a woman, it is your right to have a child/children if you so choose. Nobody should make you feel otherwise. However, on a practical note, it is also important to notify your partners early of the above considerations and to express gratitude for their flexibility and willingness to cover you. Remember to eat, stay hydrated, relax between cases, sit in the OR (if possible), and have others lift patients if needed. Despite the additional considerations involved, pregnancy has been an incredibly rewarding experience. I am incredibly excited to have my first child within the next 2 to 3 weeks.

About the Author

Deepa Patel is currently a general surgeon in Chicago, Illinois. After graduating from medical school in Newark, New Jersey, she completed her General Surgery residency in Mobile, Alabama as well as a Minimally Invasive Colorectal Fellowship in Houston, Texas.