The Importance of Parental Leave and Lactation Support for Surgeons

Abstract

Despite the growing population of surgeons who will spend the bulk of their potential childbearing years in medical school, training, or early in practice, the stigma associated with pregnancy remains. The challenges of childbearing for surgeons also extend to the pregnancy experience from a health perspective including increased rates of infertility, miscarriage, and preterm labor. Given the unique demands of a surgical practice, surgeons may experience pressure to minimize the disruption of their work during and after pregnancy. This may include attempts at carrying a full workload until the day of delivery, reducing the length of planned parental leave, and not requesting accommodations for time to express milk. Concern for discrimination, clinical productivity expectations, and promotion timelines can limit a surgeon's ability to receive pregnancy-related support and adequate parental leave. Though not all surgeons will choose to pursue pregnancy, we must still acknowledge the need to support these individuals. Furthermore, this support should not be limited to the pregnancy alone but include postpartum support including that related to family leave and lactation. Here, we provide an overview of just some of the challenges faced by surgeons in the pursuit of parenthood and present the arguments for accommodations related to pregnancy, parental leave, and lactation.

Keywords

parental leave - maternity leave - lactation - breastfeeding - pregnancy

Publication History

Article published online:
02 August 2023

• References

• 1 Giantini Larsen AM, Pories S, Parangi S, Robertson FC. Barriers to pursuing a career in surgery: an institutional survey of Harvard Medical School students. Ann Surg 2021; 273 (06) 1120-1126
• 2 Rangel EL, Smink DS, Castillo-Angeles M. et al. Pregnancy and motherhood during surgical training. JAMA Surg 2018; 153 (07) 644-652
• 3 Scully RE, Davids JS, Melnitchouk N. Impact of procedural specialty on maternity leave and career satisfaction among female physicians. Ann Surg 2017; 266 (02) 210-217
• 4 Phillips EA, Nimeh T, Braga J, Lerner LB. Does a surgical career affect a woman's childbearing and fertility? A report on pregnancy and fertility trends among female surgeons. J Am Coll Surg 2014; 219 (05) 944-950
• 5 Cai C, Vandermeer B, Khurana R. et al. The impact of occupational shift work and working hours during pregnancy on health outcomes: a systematic review and meta-analysis. Am J Obstet Gynecol 2019; 221 (06) 563-576
• 6 Takeuchi M, Rahman M, Ishiguro A, Nomura K. Long working hours and pregnancy complications: women physicians survey in Japan. BMC Pregnancy Childbirth 2014; 14 (01) 245
• 7 Anderson K, Nisenblat V, Norman R. Lifestyle factors in people seeking infertility treatment - a review. Aust N Z J Obstet Gynaecol 2010; 50 (01) 8-20
• 8 Pham DT, Stephens EH, Antonoff MB. et al. Birth trends and factors affecting childbearing among thoracic surgeons. Ann Thorac Surg 2014; 98 (03) 890-895
• 9 AAMC report on residents. Published 2022. Accessed November 19, 2022 at: https://www.aamc.org/data-reports/students-residents/report/report-residents
• 10 AAMC faculty roster. U.S. Medical School Faculty. Published 2021. Accessed November 19, 2022 at: https://www.aamc.org/data-reports/faculty-institutions/interactive-data/2021-us-medical-school-faculty
• 11 Bamdad MC, Hughes DT, Englesbe M. Safe and supported pregnancy: a call to action for surgery chairs and program directors. Ann Surg 2022; 275 (01) e1-e2
• 12 World Health Organization. Infant and young child feeding. Published June 9, 2021. Accessed November 13, 2022 at: https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding
• 13 Centers for Disease Control and Prevention. Breastfeeding report card. Published 2022. Accessed November 13, 2022 at: https://www.cdc.gov/breastfeeding/pdf/2022-Breastfeeding-Report-Card-H.pdf
• 14 Melnitchouk N, Scully RE, Davids JS. Barriers to breastfeeding for US physicians who are mothers. JAMA Intern Med 2018; 178 (08) 1130-1132
• 15 Sandler BJ, Tackett JJ, Longo WE, Yoo PS. Pregnancy and parenthood among surgery residents: results of the first nationwide survey of general surgery residency program directors. J Am Coll Surg 2016; 222 (06) 1090-1096
• 16 ACGME. ACGME Common Program Requirements (Residency). Accessed March 29, 2023 at: https://www.acgme.org/globalassets/PFAssets/ProgramRequirements/CPRResidency_2022v2.pdf
• 17 Livingston-Rosanoff D, Shubeck SP, Kanters AE, Dossett LA, Minter RM, Wilke LG. Got milk? Design and implementation of a lactation support program for surgeons. Ann Surg 2019; 270 (01) 31-32
• 18 Robbins JB, Shubeck SP, Kanters AE, Greenwood GM. Lactation policy and resources for trainees in the department of radiology. J Am Coll Radiol 2019; 16 (03) 365-368
• 19 Aitken Z, Garrett CC, Hewitt B, Keogh L, Hocking JS, Kavanagh AM. The maternal health outcomes of paid maternity leave: a systematic review. Soc Sci Med 2015; 130: 32-41
• 20 Ruhm CJ. Parental leave and child health. J Health Econ 2000; 19 (06) 931-960
• 21 Itum DS, Oltmann SC, Choti MA, Piper HG. Access to paid parental leave for academic surgeons. J Surg Res 2019; 233: 144-148
• 22 American Board of Medical Specialties. Policy on parental, caregiver and medical leave during training. Published July 1, 2021. Accessed November 19, 2022 at: https://www.abms.org/policies/parental-leave/
• 23 American College of Surgeons. Statement on the importance of pregnancy, parental leave, and workplace accommodations for surgical residents and fellows. Published July 29, 2021. Accessed November 19, 2022 at: https://www.facs.org/about-acs/statements/importance-of-pregnancy-parental-leave-and-workplace-accommodations-for-surgical-residents-and-fellows/
• 24 The American Board of Surgery. ABS announces more flexible family leave policy for general and vascular surgery trainees. Published October 20, 2021. Accessed November 19, 2022 at: https://www.absurgery.org/default.jsp?news_familyleave1021
• 25 The American Board of Surgery. Leave policy - general surgery. Published June 2022. Accessed November 19, 2022 at: https://www.absurgery.org/default.jsp?policygsleave
• 26 Slama EM, Johnson HM, Yu YR, Sumra H, Altieri MS. Paid parental leave for surgeons in the United States. Am J Surg 2022; 223 (01) 218-220
• 27 ACS Bulletin. Statement on the importance of parental leave. Published April 1, 2016. Accessed November 19, 2022 at: https://bulletin.facs.org/2016/04/statement-on-the-importance-of-parental-leave/
• 28 Gaines T, Harkhani N, Chen H, Malik RD. Current policies and practicing surgeon perspectives on parental leave. Am J Surg 2019; 218 (04) 772-779
• 29 Huerta MC, Adema W, Baxter J. et al. Fathers' leave and fathers' involvement: evidence from four OECD countries. Eur J Soc Secur 2014; 16 (04) 308-346
• 30 Johnson HM, Irish W, Strassle PD. et al. Associations between career satisfaction, personal life factors, and work-life integration practices among US surgeons by gender. JAMA Surg 2020; 155 (08) 742-750
• 31 Buddeberg-Fischer B, Stamm M, Buddeberg C. et al. The impact of gender and parenthood on physicians' careers–professional and personal situation seven years after graduation. BMC Health Serv Res 2010; 10: 40
• 32 Lyu HG, Davids JS, Scully RE, Melnitchouk N. Association of domestic responsibilities with career satisfaction for physician mothers in procedural vs nonprocedural fields. JAMA Surg 2019; 154 (08) 689-695