Advice to a pregnant surgical resident

As a profession, we’ve yet to standardize maternity leave and breastfeeding allowances for women. Given the length of medical training (seven-plus post-graduate years), timing (prime reproductive years) and slow increase in the ratio of female to male surgical residents, females choosing to start families during training are particularly afflicted.

We just celebrated my son’s first birthday. I had him during one of the busiest years of my surgical residency, and it’s been nothing short of a whirlwind.

Our departmental policy currently states, “Each new parent will be granted three days of maternity/paternity leave. Additional time off will be deducted from available vacation time.” In our program, we are allotted three weeks of vacation per year. Thus, I took three weeks off after having my child. No questions asked, no discussion of alternatives, and no idea how breastfeeding would work upon return.

Three weeks. I’d barely figured out breastfeeding and was still taking acetaminophen and ibuprofen around-the-clock for a perineal injury.

There is no substitute for self-advocacy. And martyrdom is not sexy. I wish I’d done things a bit differently.

Initially, I was nervous to tell my program about my pregnancy. I feared they’d look down on me for diverting attention away from work and towards family. I’d been hard-working and committed for three years, and I didn’t want that to change after I became a mother.

I had one brief discussion with my program director. I stated I was expecting my first child and planned to take my allotted three weeks of vacation after my delivery. We really didn’t discuss much afterward.

I worked until my due date, never asking for a break. I waddled through 80-hour work weeks, scrubbed 12-plus-hour cases during my third trimester and had to buy new shoes because my feet became so swollen from standing all day (despite thigh-high compression socks — every day.

I came back early (maybe too soon) — three weeks postpartum. I’d already decided to pursue fellowship and didn’t want to delay graduation if I elected to take longer than my allotted three vacation weeks.

I breastfed for four months. This was challenging, to say the least. I had my team round 20-minutes earlier, so I could pump immediately prior to OR cases. I carted refrigerated milk home at 10 p.m., only to be back at 5 a.m. the following day. I fought back the tears from the pain of engorgement while finishing lengthy OR cases, too nervous to ask to leave. I used shower stalls, public restrooms, and a vacant office to pump.

Pump, dump (into bag), cart, freeze … thaw, bottle, feed, repeat.

Being with my son made it all worth it. Even if I could only see him for the 2 a.m. feed/diaper change before he went back to sleep, he was my new everything. Priorities shifted. My heart grew. Something was different, and so much better. I felt complete.

The work still got done. I still rose early to scour the charts of my inpatients, prepped for OR cases in excruciating detail, rounded twice a day and served as a strong leader for my inpatient team. My new role as “mom” didn’t take away from my productivity or attention to detail at work.

In retrospect, I would have approached things differently. I wish I had been proud to announce my pregnancy, rather than scared. I should have inquired about the possibility of additional time off (borrowing vacation from the next year, etc.). I should have formulated a pumping game plan before returning to work. I could have been more vocal about my needs as a pregnant surgical resident and new, breastfeeding mother.

Here’s my advice to women starting a family during surgical training:

1. Be autocratic in deciding to start a family. It’s your body and your decision. Your decision to procreate shouldn’t be based on anything short of you and your partner’s readiness to become parents — when you’re both ready, go for it. Don’t ask for permission.

2. Have a (flexible) plan. Be intentional about conversations with your departmental leaders and co-residents. Proudly announce your pregnancy. Consider different options for maternity leave — weigh the pros and cons of less versus more time off. Make it known you’ll need time allowances for pumping, both from clinic and the operating room. Keep the lines of communication open.

3. Don’t apologize. You’re growing a human inside you — it’s OK to take breaks, eat more frequently than once every 12 hours, and occasionally sit at work. You’re bringing new life into the world — take time to cherish your new baby and allow your body to heal. You’re nourishing your child — schedule regular pump breaks into the day and make your team aware.

Everyone is searching for a solution to physician burnout. Lack of maternal support is a small piece of this big pie but seemingly has straightforward areas to improve upon. Support female residents who decide to start a family. Allow pregnant surgical residents to sit once or twice a day. Give mothers maternity leave. Allow residents to breastfeed their children.

Until standardization of maternity leave and breastfeeding allowances are adopted by the ACGME and programs across the country, it’s up to you to advocate for yourself. The next step will be working together and talking with programs, hospitals, and specialty societies about improved maternity policies.

Motherhood has been the biggest gamble of my adult life thus far. How was I going to operate for 12-plus hours while 39-weeks pregnant? Where would I be when I went into labor? How would was I going to return after three weeks? How would I pump during and in between OR cases?

I did it. It certainly wasn’t easy. And I would do it all over. My son is beautiful and healthy. I’ve never been prouder of anything I’ve ever done. He is the first thing I think about in the morning and the last thing I think about at night. He’s made me a better clinician and surgeon.

Lauren A. Umstattd is an otolaryngology resident.

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