By Allison Letica-Kriegel and Erika Rangel
From a young age, I wanted to be a doctor. First a veterinarian, then a pediatrician, and finally a surgeon. I think, actually, I’ve always identified as a doctor, well before I was one. Shortly after I stepped into the operating room, I knew this was where I wanted to spend my career. And from that moment, my identity as a surgeon started to form. As the years of medical school and residency passed by, my identity became so strongly tied to being a surgeon, and being a resident, that it was hard to imagine there was space for anything else, although I also always knew that I wanted to have kids. The mantra in my head, whether self- or externally-imposed, had always been work first, everything else after.
I imagine many of us in surgery share this sentiment, and sometimes that makes it difficult to conceive of starting and maintaining a family as a surgeon, especially when there are not adequate policies in place to support childbearing. Recognizing the need for better parental support, the American Board of Surgery (ABS) recently changed their family leave policy to allow four weeks of parental leave, separate from vacation, and the Accreditation Council for Graduate Medical Education (ACGME) now requires institutions to provide at least 6 weeks of paid parental leave at least once during training. I’m hopeful that these changes will encourage more women to consider having babies during training. However, delivery and postpartum are discrete periods in the spectrum of childbearing and we need to continue to consider other factors, such as becoming pregnant, sustaining a safe pregnancy, and supporting women beyond the “fourth trimester” during their return to work.
We now know that female surgeons, compared to non-surgeon counterparts, are more likely to delay childbearing, require assisted reproductive technology to have children, and experience major pregnancy complications. Female surgeons have more than double the rate of miscarriages compared to the general population of similar age. The measurable obstetric health risks should make us question if we are creating a safe environment for women to conceive and carry a baby to full-term. When female surgeons do experience infertility, miscarriage, or complications, we should ensure that they receive the time and coverage to attend to their health.
After returning to work postpartum, many surgeon mothers struggle to find time and space for lactation, with many ceasing breastfeeding earlier than they wished due to these challenges. We should work to ensure that all hospitals have adequate lactation spaces and accept that breastfeeding mothers must take periodic breaks from the operating room to pump. While we have made progress in supporting surgeon mothers, including significant recent improvements in protected leave, we still have work to do.
I was and am lucky to have role models ahead of me that have shown me that your identity as a mom does not need to come at the cost of your identity as a surgeon, and vice versa. But that doesn’t mean that balancing both isn’t tough. It does not serve surgeon mothers to ignore or undermine these challenges, and I hope that we can continue to pave a smoother path for those that follow.
Please join us on Monday, November 15th from 8:00-9:00 pm for an AWS Tweetchat about Being a surgeon and mother. This chat will focus on fertility, breastfeeding, and motherhood. The chat will be moderated by Dr. Allison Letica-Kriegel (@AllisonLetica), Dr. Erika Rangel (@ErikaRangelMD), Lyndsay Kandi (@lyndsaykandi), and Dr. Mecker Möller (@MeckeritaMoller). The questions will be posted directly from the @WomenSurgeons Twitter account. You can also find them by following the hashtag #AWSchat. If you have not participated in a tweet chat with us before, check out this tutorial written by Dr. Heather Yeo (@heatheryeomd) to know more. We will be discussing the following topics during our tweet chat: (1) infertility, (2) pregnancy, and (3) breastfeeding and the postpartum period.
Questions to be discussed:
- What are the biggest challenges that pregnant surgeons face? What type of accommodations do you think are ideal for pregnant surgeons, specifically trainees? How do we implement these without unfairly increasing workload for trainees who are not having children?
- Assisted reproductive technology is time-consuming and expensive. How can female surgeons manage ART, especially while in training?
- What were the biggest challenges you had trying to breastfeed while you were a surgical resident? Do you think lactation policies are helpful to set expectations for faculty that they support postpartum residents? What policies or accommodations should be in place to ensure that surgeon mothers can continue to breastfeed for as long as they wish?
- What tools have surgeon mothers used to balance work and life?
- There has been a lot of attention on improving parental leave. Are there other aspects of parental support that you feel would be helpful?
- How do you think the current environment surrounding parenting affects resident burnout and wellbeing?
Allison Letica-Kriegel, MD, finished her PGY3 year at Massachusetts General Hospital (MGH) in June 2020 and has been working as the Surgical Quality & Safety Fellow at Memorial Sloan Kettering Cancer Center since that time. Aside from patient safety and experience, she is interested in physician well being and improving policies for female surgeons who choose to have children during training and beyond. Alli plans to apply for a pediatric surgery fellowship shortly after her return to residency next June. She currently lives in NYC with her husband (a cardiothoracic surgery resident) and their 15-month-old son.
Erika Rangel, MD, MS, FACS, is a general surgeon and surgical intensivist at the Brigham and Women’s Hospital. Her academic interests center on defining the challenges facing surgeons starting a family, demonstrating how these impact burnout and career dissatisfaction, and using evidence to inform policy change to better support alignment of personal and professional priorities. Some of her initiatives are now used nationally in the Wellness Toolkit for Supporting Parenthood in Surgery as part of the SECOND Trial. As half of a dual-surgeon couple and the mother of a residency-born child and two NICU babies, she is passionate about supporting surgical trainees in navigating competing family and career demands. She lives near Boston with her husband, Shawn, a pediatric surgeon at Children’s Hospital Boston, her two boys, a golden retriever, and two pandemic cats.
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.
what time zone for the 8-9 pm? there should be a way to add to the calendar automatically?
I am retired , so my world was quite different!.
I worked in a small rural US hospital. The community was part of the hospital staff. I had such amazing support through fainting in OR , when unaware of being pregnant, being resuscitated by OR supervisor who said” when I fainted, I was pregnant. Are you?”. I did not know, but I was.
Next accommodation was expressing milk in the shower room, after bathing after surgery.
Thirdly, when Grandma was away; (She lived with us, ) and husband on a work trip, I got called to a patient on floor and had to bring 3 kids under 5yo to hospital in deep snowy winter… the Nurse Supervisor put them in empty gurneys in Maternity. No patients in Dept. She gave them jello and housekeeping never said an upset word having to clean up!
Those were the uncertain days!!!!
I stayed 10 years until the politics changed funding to hospitals!!
I am inspired at how well you all manage surgery and children.. Networks are imperative…
Clare Wilmot
It is not easy. I had twins in 1986. Both are doctors a surgeon and an anesthesiologist . It was difficult at times as my husband was a colorectal surgeon I would not have changed any thing in my life . You Need to keep your sense of humor !
Wow
You did well not to put them off!
Clare
The pediatric nurses were the key to my being able to nurse both my kids for 12 months while doing level 1 Ortho trauma call. The less floor was the only place with a pump!