Perinatal policy could fix high obstetric complication rates among pregnant physicians
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Key takeaways:
- Working 60 to 70 hours per week linked to fourfold higher odds for preterm delivery.
- Researchers developed a policy for surgeons that can be expanded to include any procedural or call-heavy specialty.
Pregnant surgeons experienced significantly higher rates of obstetric complications compared with the general U.S. pregnant population, according to results of a literature review.
Therefore, researchers recommend adoption of a newly created policy to address the complications rates among the pregnant physician population.
Support needed
“Most pregnant surgeons have either directly experienced a complication during their pregnancy, or they know someone who has,” Tiffany A. Glazer, MD, FACS, associate professor and residency program director of head and neck oncology and microvascular reconstruction at University of Wisconsin Hospital and Clinics, told Healio. “Most pregnant surgeons are also unlikely to understand all the risks they face at work and advocate for themselves.
“Trainees face even greater pressures given their vulnerability within the hierarchy of training programs,” Glazer added. “Many surgical departments now address the postpartum period with parental leave and lactation policies, which is a significant advancement from even a decade ago, but very few offer any education or support for pregnant surgeons in the perinatal period.”
For this reason, researchers aimed to create an evidence-based policy to protect pregnant surgeons and their unborn fetuses, and attract and retain talented students into the surgical field.
“We felt that backing our perinatal policy up with as much data as is available would help with universal acceptance and application,” Glazer said.
Researchers then individually analyzed common risks faced by pregnant surgeons, including:
- missed prenatal care;
- musculoskeletal hazards (eg, prolonged standing, lifting and bending);
- prolonged work hours;
- overnight shifts;
- exposure to teratogenic agents (eg, ionizing radiation, anesthetic gases, chemotherapy agents); and
- psychological stress and discrimination associated with balancing motherhood and professional life.
High rates
Researchers found obstetric complication rates between 25% and 82% among pregnant surgeons compared with rates between 5% and 15% among the average U.S. population.
“What is concerning is that most, if not all, of the individual risks that pregnant surgeons face at work are modifiable by doing things like taking breaks, being aware of surroundings and ergonomics, or alternating one’s workload,” Glazer said. “Some of the most concerning data were those on prolonged work hours where the data showed four times the odds for preterm delivery if one works between 60 and 70 hours per week or more.”
Researchers then organized the data into individual risk groups according to pregnant surgeons’ experiences at work. They came up with an evidence-based policy regarding perinatal care for surgeons, including:
- Physical accommodations: Use floor mats and sit-stand workstations, wear compression stockings and supportive shoes, be aware of and report any musculoskeletal issues (carpal tunnel, sciatica) to obstetrician.
- Work hours, including overnight shifts: Monitor number of total work hours and operative hours per week, paying particular attention to longer operative cases.
- Environmental risk factors: Understand the teratogenic environmental risk factors experienced at work.
- Postexposure prophylaxis for injuries: Follow procedures known to mitigate injuries in the operating room.
- Bereavement for miscarriage: Use available mental health services.
- Compliance with medical board: Work with program director to identify whether extended training is needed if a competency is not met or if extended time is taken off during pregnancy or postpartum period.
“Visualizing these data in a categorical fashion and understanding their implications, such as potential harm to both the pregnant surgeon and their fetus, is impactful. Our goal was to take this data and create an evidence-based framework of protection for pregnant surgeons,” Glazer said. “With such a policy in place, pregnant surgeons do not have to struggle to find their balance between maintaining personal safety and continuing work responsibilities. Creating a policy backed by data paves the path for acceptance and makes it easier for departments and institutions to operationalize it.”
Researchers additionally provided recommendations for institutions and nonchildbearing colleagues in support of pregnant surgeons.
Glazer acknowledged that certain recommendations require shared decision-making between the pregnant surgeon and their employer.
“For example, the recommendation to wear compression stockings or the recommendation to operate 12 hours or less in the third trimester,” Glazer said. “We felt it was important for the pregnant surgeon to maintain autonomy in their decisions when safe and appropriate to do so if they have been properly educated on the risks in the workplace. This is why we created a separate listing of recommendations that can be followed to the degree a surgeon feels comfortable.”
Next steps
Based on these findings, Glazer and colleagues recommend next steps to include a universal adoption of the perinatal policy and recommendations.
“Due to the culture of medicine — particularly surgery — most pregnant physicians do not advocate enough for themselves, and a policy such as [the one we created] is necessary to protect them,” Glazer said. “Although the policy was written with surgeons in mind, it can certainly be expanded to include any procedural or call-heavy specialty, such as interventional radiology, cardiology, critical care, anesthesiology, emergency medicine and more. Universal adoption of a policy such as this is necessary to institute a cultural change in medicine.”
She referenced a similar situation that occurred in 2003 with the restriction of 80-hour work weeks mandated by the Accreditation Council for Graduate Medical Education, for all U.S. residents.
“Although there was some initial resistance to the 80-hour work week at the time, since its adoption there have been meaningful improvements in resident safety, health and well-being and we feel that a similar mandate is needed to protect pregnant physicians,” Glazer said.
For more information:
Tiffany A. Glazer, MD, FACS, can be reached at glazer@surgery.wisc.edu.
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