Making It Work

27 Nov 2019

By Joy Alvarado

It’s not on everyone’s mind as they contemplate going into a surgical residency, but it was on my mind: Could I handle the physical challenges of this new diagnosis under the ergonomic pressures of being a surgeon? How would my coworkers perceive me when they find out about my new diagnosis? Will they become angry when I take time off to heal? Would they think it irresponsible that during my general surgery residency … I chose to become pregnant?

As an older-than-average female medical student who desires children one day, these questions are very important as I contemplate my future in medicine.

On the one hand, there are my imagined challenges to being pregnant during general surgery training that are associated with the condition itself: the extra exhaustion I’ll feel while carrying an extra 20 pounds during long cases, the inability to run to the bathroom when I get an unexpected kick to my bladder in the OR, or the hormone-induced nausea and vomiting I’ll experience while trying to complete a 48-hour shift. On the other hand, I’ve learned about the very real challenges that being pregnant can bring to residency programs: absences that have to be covered when I am having morning sickness or going to obstetrics appointments, and OR accommodations that have to be made around my protruding belly. What about the potential resentment that can build when coworkers take on more cases or codes because I physically cannot run as fast or stand as long? When would I arrange make-up rotations for the lost training during maternity leave? 

As we strive to increase the number of women in surgery, it’s clear that we have to consider these challenges in our recruitment process. A 2018 study by Rangel et al. surveyed 347 general surgery residents who had been pregnant during residency. Their average age was 30.5 years, and all of them completed residency in 2007 or later. Only 34.9% of them stated that their programs had established maternity leave policies, and 72% perceived the duration of their maternity leave to be inadequate. 63.6% were concerned that their work schedule adversely affected their health or the health of their unborn child. Nearly 40% reported that they strongly considered leaving surgical residency, and nearly 30% indicated they would discourage female medical students from a surgical career, “specifically because of the difficulties of balancing pregnancy and motherhood with training.”

One piece of advice I received from many surgeons, male and female, is that, “There is no perfect time to have a baby. If you want a baby, just have it. There will always be challenges. But, you can make it work.” This idea to “make it work” might be the same mantra that everyone recites in handling pregnancy or children, no matter the career or lack thereof. Many women surgeons are turning to technologies like egg-freezing in order to extend their window of optimum fertility for a few more years. In doing so, they can decrease the complications associated with advanced maternal age should they wait until residency is over before attempting pregnancy. However, this option is not easy, nor is it guaranteed. Dr. Arghavan Salles, surgeon and writer for the AWS Blog explains the ups and downs of her own egg-freezing journey in a piece called, Peri-Menopause. If I waited until residency was over, I would be approaching 40 years of age before having my first child.

We can all agree that pregnancy is not easy. It affects nearly every aspect of life, and undoubtedly influences the male/female ratios in many professions. As a woman medical student in her 30s who desires a family one day, I would be remiss to not consider the challenges of being a pregnant resident in my specialty choice. And while there is something appealing in the challenge of “making it work,” we have to take these factors into consideration as we continue our efforts to increase the number of women in surgery.

Joy Alvarado holds a Bachelors of Arts in English from the University of Texas at Austin and a Masters of Health Science from Johns Hopkins Bloomberg School of Public Health. She is  a fourth year medical student at the University of Texas Rio Grande Valley School of Medicine. She is also a 2nd Lieutenant in the US Army, and founder of the UTRGV SOM Student-Run Clinic. She is passionate about alleviating health disparities, and is an avid oil/acrylic painter. See her work at Twitter handle: @thejoyalvarado


Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

6 Replies to “Making It Work”

  1. As a junior resident, I gave birth three months before completing my fourth year. The only issue I had during pregnancy was having to stay off clinical service on the transplant unit till my labs came back showing that I was already immune to (I think) EB virus & one other (it’s only been 35 years!). Even though some of the other female residents expressed concern that I’d lose my job, the opposite was true: the entire department was very supportive throughout my pregnancy &, fortunately, I didn’t have any major issues with fatigue or morning sickness. The support level was even greater when our son (now aged 36) was born with a right-sided diaphragmatic hernia. I took 3 months off to care for him & arranged for excellent child care through one of my resident friends in ER medicine. We even have unique “baby photos”, taken intraop of his hernia & its repair

    1. How wonderful that you were so well supported! And with such enthusiasm for the hernia repair! What a fun story, and a great example for how we should support our expecting surgeons.

  2. The best advice i can give female surgical residents is to freeze your eggs. I am an attending cardiac surgeon who completed my general surgery residency in 2010. As someone who trains female residents, i can tell you that, like it or not, having a child during residency detracts from your training. Period. If you freeze your eggs and wait until you have completed an uninterrupted training program, you will be much better off. The difference in quality between my female residents who did and did not have children in med school or residency is really obvious. And, truthfully, i don’t think the difference in competence can be made up longterm.

    I waited until after training to have my kids. Granted I was a bit older, and i did use my frozen eggs, but the amount of professional stress that i avoided by feeling competent and confident at my job allowed me to really enjoy being a mother more fully. I am certainly more present for my children as a result.

    I know this may be a highly unpopular opinion, but really, you cannot have it all.

    1. I’ve heard the same advice many times over from accomplished women surgeons at conferences; many of them emphasized freezing eggs preemptively vs. going through the stress of IVF later. It’s a topic I hope to blog about in the future. Thank you for sharing your advice and experience- it’s much appreciated. The most popular opinion to me is a truthful one.

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