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Pregnancy and Surgery

Working in Surgery While Pregnant

 

Congratulations! If you are reading this then you are either thinking about or have started planning a family. Being pregnant can be a really exciting time, but it can also be fraught with worry. Your health must be a priority over the peri-partum period, and whilst some women can remain symptom free, many will experience uncomfortable side effects which could make working in a surgical environment more difficult. Please don’t suffer in silence and feel that you need to hide or minimise your experiences. Your pregnancy is a short period in your career and looking after yourself and your baby is really important.

The first trimester

Surgery is not office work. The shifts are frequently busy and finding time for regular meals and toilet breaks can often be difficult. Pregnant women often experience a heightened sense of smell, particularly in the first trimester, which can make working in theatres very challenging. Nausea, vomiting and overwhelming fatigue are very common symptoms, and occur during a time when you might be trying to keep things a secret.

You might therefore want to disclose your pregnancy to a supervisor earlier than you feel comfortable with, to ensure you get some additional support. Your news should be treated as confidential until you decide to disclose it more widely.

Speak to Occupational Health early on in your pregnancy to organise a risk assessment. This will include looking at shift work, radiation exposure, working patterns etc and how things can be rearranged to support you best. Each trimester has its own challenges and your work can be adapted depending on your symptoms. If you are a trainee there is no shame in asking your AES and TPD to see if you can focus on a different area of your training for the duration of your pregnancy.

Miscarriage is unfortunately a common occurrence (approximately between 1 in 4 and 1 in 5 pregnancies in the general public) (1). Worryingly there is evidence that this rate is higher in female surgeons and shift workers (2-4) so asking for work adaptations is paramount as early as possible, so that your health is not compromised. If you do experience a miscarriage, don’t feel pressurised to get back to work too early. Take advice from your obstetric team and don’t underestimate the psychological as well as physical impact that this may have on you.

The second and third trimesters

Although the majority of women start to feel better in the second trimester, some do have symptoms that persist. Hypotension is common, and this can be problematic when standing up to operate for long periods of time. Remember that you are supporting a whole second circulation and you are not a failure for feeling faint. TED stockings can be helpful and ask to modify procedures or equipment so that you can operate sitting down if possible.

As you get towards the end of your pregnancy your physical size might become a barrier to getting close to the operating table, and standing for long periods may be very uncomfortable. If you are in a training post, you could ask about adapting your timetable so that you do more operating earlier on and more clinics towards the latter stages.

As surgery is moving towards competency-based accreditation, missing out on time in theatre will not necessarily mean that you have to repeat periods of time missed. Speak to your TPD about this in advance of your ARCP.

Radiation Advice

For surgeons who are exposed to ionising radiation in theatres, every hospital will have a radiation safety policy and a Radiation Protection Committee who can offer advice about what modifications need to be made. You may wish to wear a dosimeter and may need access to personalised leads to accommodate changes in bump and breast tissue. Occupational Health can help organise access for this. If you have concerns that your area of surgery might expose you to higher levels of radiation than you would be comfortable with then please raise this, and don’t feel you need to keep silent (5, 6).

Time off work

If you do not feel well enough to work then you may need some time off during your pregnancy. Please don’t feel ashamed by this. It is far safer for you, your baby and the patients you are looking after for you to stay off work if you do not feel well enough. No one will thank you if you make a clinical error when you feel unwell. Conditions such as PROM, pre-eclampsia and premature birth are much more common in pregnant surgeons and you do not want to risk the health of you and your baby (2).

Due to the nature of your symptoms you might struggle more at certain times of the day, e.g. night shifts, so coming off the on-call rota might be necessary for a short period. Speak to your supervisors and if you feel you are not getting support at work then you may need your GP to write you a sick note.

In the NHS, you will be entitled to six months full pay and six months half pay once you have worked for five years. Your maternity pay is calculated based on your average earnings for the eight weeks prior to your 26th week of your pregnancy, assuming you have been in continuous employment for a year by your 29th week of pregnancy. Therefore if you are pregnant during surgical training a period of sickness is unlikely to affect your maternity pay.

Sickness absence for pregnancy related conditions is also not counted against you in the same way that normal sickness is. Days off will still accrue but you will not be faced with disciplinary action. If you are off work at 36 weeks, your maternity leave will automatically start at this point (7).

How can the RCSEd support you during your pregnancy and maternity leave?

If you feel that you are not getting the support you need then speak to one of our Regional Surgical Advisors. If they are unable to help they will know who to contact within your region.

Let us know of any adaptations that have worked for you – we can help spread the message to other surgeons throughout the UK.

Did you know you are entitled to reduced membership rates for the RCSEd during your maternity leave and if you decide to go back LTFT? Click here for more details.

Finally, GOOD LUCK! Pregnancy can be tough but with the right support we hope that you will be able to combine the joys of motherhood and a long and happy surgical career.

Useful links

  1. Charity Ts. Miscarriage Statistics UK https://www.tommys.org/our-organisation/charity-research/pregnancy-statistics/miscarriage2019 [
  2. Behbehani S, Tulandi T. Obstetrical complications in pregnant medical and surgical residents. Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC. 2015;37(1):25-31.
  3. Cai C, Vandermeer B, Khurana R, Nerenberg K, Featherstone R, Sebastianski M, et al. The impact of occupational shift work and working hours during pregnancy on health outcomes: a systematic review and meta-analysis. American journal of obstetrics and gynecology. 2019.
  4. Rangel EL, Smink DS, Castillo-Angeles M, Kwakye G, Changala M, Haider AH, et al. Pregnancy and Motherhood During Surgical Training. JAMA surgery. 2018;153(7):644-52.
  5. McCollough CH, Schueler BA, Atwell TD, Braun NN, Regner DM, Brown DL, et al. Radiation exposure and pregnancy: when should we be concerned? Radiographics : a review publication of the Radiological Society of North America, Inc. 2007;27(4):909-17; discussion 17-8.
  6. Birnie AM, Keoghane SR. Radiation exposure to a pregnant urological surgeon - what is safe? BJU international. 2015;115(5):683-5.
  7. Association of Surgeons in Training. Pregnancy, maternity leave and less than full-time training during surgical training. In: https://www.asit.org/resources/archived-articles-documents/pregnancy-maternity-leave-and-less-than-full-time-training-during-surgical-training/res10462014.

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