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Lack of Workplace Support for Obstetric Health Concerns is Associated with Major Pregnancy Complications: A National Study of US Female Surgeons
Erika L. Rangel5, Manuel Castillo-Angeles5, Yue Yung Hu3, Ankush Gosain2, Sarah Rae Easter1, Zara Cooper5, Rachel Atkinson5, Eugene Kim4
1Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, United States, 2Children's Foundation Research Institute, University of Tennessee Health Science Center, Memphis, Tennessee, United States, 3Pediatric Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States, 4Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California, United States, 5Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States

Objective: Female surgeons, especially those who maintain rigorous operative schedules through the third trimester, are more likely to have major pregnancy complications than the partners of their male colleagues. Yet only 16% of surgeons reduce their work schedule during pregnancy. We sought to assess whether lack of workplace support for self-initiated or obstetrician-mandated clinical work reductions during pregnancy was associated with major pregnancy complications.
Methods: An electronic survey was distributed to U.S. surgeons through surgical societies and social media. Practicing and trainee female surgeons with at least one live birth were included. Lack of workplace support was defined as: (1) desiring reduction in clinical duties during pregnancy but feeling unable to due to concerns for financial penalties, being perceived as “weak,” burdening colleagues, being required to pay back missed call, or not being accommodated by the workplace or training program; (2) disagreeing that colleagues and/or leadership were supportive of obstetrician-mandated bedrest. Major pregnancy complications included the following: preeclampsia, placental abruption, placenta previa/accreta, intrauterine growth restriction, preterm labor, and placental insufficiency. Multivariate logistic regression determined the association between lack of workplace support and major pregnancy complications, controlling for age, work hours, frequency of overnight call, hours spent operating per week, practice setting, race, multiple gestation, and need for obstetrician-mandated bedrest.
Results: Of 692 surgeons, 311 (44.9%) experienced major pregnancy complications. 115 (16.6%) surgeons were prescribed obstetrician-mandated bedrest, of whom 40 (34.8%) disagreed that colleagues and/or leadership were supportive. 560 (80.1%) surgeons did not self-initiate work reductions during pregnancy; of these, 417 (74.5%) were deterred by lack of workplace support. 18 (2.6%) surgeons did not self-initiate work reductions due to lack of workplace support but were later placed on bedrest by their obstetrician and continued to feel unsupported. Overall, 439/692 (63.4%) surgeons perceived lack of workplace support during pregnancy. These surgeons were at higher risk of major pregnancy complications than those that did not perceive lack of workplace support (OR 2.44; 95%CI 1.59-3.75).
Conclusion: Poor workplace support for reduction in clinical duties for pregnant female surgeons is associated with adverse obstetric outcomes. This is a modifiable workplace obstacle that deters physicians from acting to optimize their infant’s and their own health. To ensure the health of expectant surgeons, departmental policies should support reduction of clinical workload in an equitable manner without creating financial penalties, requiring payback for missed call duties, or overburdening colleagues.


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