Fertility and pregnancy

Pregnancy and neonatal complications are higher in surgical Trainees. What are we doing about it?

Medicine can be a demanding profession, with long working hours and years spent training to become a specialist consultant. The majority of the training time is during a period when many also want to plan and raise a family. This may present as a major impediment to equal opportunity in medicine or specific sub-specialties within medicine. As we rapidly try to move away from medicine being a male dominated profession, there is a need to support women to achieve both family and professional goals. A recent publication1 in the USA highlighted not just work-life balance difficulties for women surgeons, but, alarmingly, also markedly increased risks of infertility and pregnancy complications. There are several factors contributing to this including delaying pregnancy because of the demands and inflexibility of surgical training, long working hours, and lack of parental leave options. The mere thought that our surgical training program could be increasing both the risks of infertility and neonatal complications has inspired Dr Jasmina Kevric researched the effects in Australia and Aotearoa New Zealand and started an awareness and mentorship campaign. Dr Kevric’s Australian-first survey investigated the incidence of fertility, pregnancy complications and breastfeeding practices among Australian and Aotearoa New Zealand doctors. The results are currently under peer-review. However, the findings indicate a similar worrisome picture to that in the United States. Delaying family planning due to training requirements can increase age-related pregnancy complications. Long working hours increases the risks of neonatal complications, while options for parttime training are limited and only suit those in early pregnancy who can arrange flexible training for the following year. With the additional systemic stresses brought to bear upon public hospitals due to COVID-19, surgical Trainees and younger Fellows are under pressure to work longer hours—in a busier environment—with reduced time for family planning and safe spaces to breastfeed or express. Dr Kevric was conscious of the age-related infertility and pregnancy complications and chose to start her family during surgical training. She was lucky to secure a week-on/week-off flexible training position through her training hub (Austin/Northern) and found working in the third trimester demanding, but less physically challenging. Other issues that have been noticed or experienced by Dr Kevric’s research colleagues, Dr Russell Hodgson and Dr Grace Chew, include increased family, fertility, and pregnancy stress associated with rural and remote rotations, and a lack of paternity leave (both inside and outside of medicine) to support new mothers at home or returning to work. As a female surgeon and surgical mentor, Dr Chew has been privy to the difficulties experienced by Trainees faced with To better address this and improve support to medical parents, Dr Kevric has founded a mentorship program ROSE (Resource, Outreach, Support, Education) and is open to all Australian doctors. More information: RoseforMedicalParents.com Reference:

Dr Grace Chu and family juggling surgical training and family life. Residents and registrars have shared personal stories of pregnancy-associated complications such as miscarriage, unsuccessful IVF cycles, neonatal deaths, childhood illnesses and marriage stress. Surgical Trainees need more support to navigate training and parenthood. Education on fertility is crucial early in training. Good access to flexible training allows Trainees to navigate the physical challenges of long working hours during pregnancy, and safe space to express breastmilk will aid in preventing early weaning. In enabling our Trainees and indeed younger Fellows in their quest to start and care for their young families, we will reap the benefits of achieving diversity in surgery, maintaining a healthy balanced surgical workforce and encouraging women to pursue surgery as a sustainable career.

Dr Russell Hodgson and family

1. Rangel, E., et al., Incidence of Infertility and Pregnancy Complications in US Female Surgeons JAMA Surg 2021 Oct 1;156(10):905-915 Authors: Dr Jasmina Kevric (MBBS, MPH) - General Surgery SET 5 Trainee Dr Russell Hodgson - Research Director and Hepatobiliary Surgeon Dr Grace Chew - Breast and General Surgeon