Advice to pregnant surgical residents [PODCAST]

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“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 a facial plastic surgery fellow.

She shares her story and discusses her KevinMD article, “Advice to a pregnant surgical resident.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Lauren Umstattd. She is a facial plastic surgery fellow, and she wrote the KevinMD article “Advice to a pregnant surgical resident.” Lauren, welcome to the show.

Lauren A. Umstattd: Thank you so much for having me, Dr. Pho. I’m so excited to be here today.

Kevin Pho: We’ll get into your article a little bit, but first off, can you share your story and your journey to where you are today?

Lauren A. Umstattd: Sure. So, as you mentioned, I’m a fellow right now. I did a surgical residency in ENT at the University of Missouri, and then I decided to do a one-year fellowship in facial plastic surgery. So I’m currently in Memphis, Tennessee, and once I’m done, I’m actually going to open my own practice in Kansas City. So it’s been kind of a whirlwind of a year planning to open my own practice, but it’s been really exciting, and lots of good things are happening.

Kevin Pho: All right, so tell me some of the challenges that, you know, facial plastic surgery faces going forward. I don’t have a lot of facial plastic surgery fellows on my show, so tell me some of the challenges in your specific field, and maybe you could talk about some of the challenges of opening up your own practice eventually as well.

Lauren A. Umstattd: I think the biggest challenge is really understanding what the patient wants. You know, my fellowship is primarily cosmetic, and my practice will also be cosmetic, and it’s just a different take on medicine, right? There are no GOLD guidelines or infectious disease recommendations on what to prescribe. It’s really about you and the patient understanding what they want and what their goals are, and then you as a physician and surgeon describing to them what that process entails and whether their expectations are realistic, and then really deciding if they’re the right patient for you and if you’re the right provider for them. Because certainly nobody needs any of the procedures that I do, and that’s the great part about it. It’s all elective, and so it provides, you know, a unique surgeon-patient relationship.

Kevin Pho: And then eventually, when you do open your own practice, is it in a highly competitive market? What are some of the thought points that go into that decision of opening your own practice?

Lauren A. Umstattd: That’s a good question. There are a lot of thought points. So I would say it is a competitive market in certain components. For example, Botox and filler are so commonly offered by really anybody these days, and a lot of patients don’t really understand the risks that go along with certain fillers. You know, there have been reports of people going blind after getting filler. And I think, as a physician and a surgeon who’s trained for 6 years after medical school, you just have a unique view of the anatomy and of how injecting something will affect a patient, both in the short term and the long term.

So I think one of the bigger challenges is just educating patients in kind of a non-mean way. You know, I certainly don’t want to put down anybody who does any of these procedures, and certainly there are people out there who are educated differently than I am who are very good, and they have a lot more experience than I do at this point. So I never want to make anybody feel bad or say that one provider is better than another. But I just think it’s important for patients to understand the background of their provider and really the risks involved.

You know, you hear about people going to these parties and just signing up for Botox and filler, and it just makes you wonder. I mean, it is a procedure, there are risks involved, and I just wonder if people really know about all of those before they indulge.

Kevin Pho: All best wishes on finishing up fellowship and opening up your practice soon. So let’s transition now into your KevinMD article, and it’s titled “Advice to a pregnant surgical resident.” Now, for those who didn’t read the article, can you just walk my audience through it and share the story of why you decided to write it?

Lauren A. Umstattd: So I wrote this article about a year after I gave birth to my son. I gave birth during my fourth year of ENT residency, probably one of the busier years of our residency. And I wrote the article really to hopefully provide a voice to female residents who are in a similar situation.

When I was pregnant and during the postpartum period, I just felt, I don’t want to say embarrassed. It’s hard for me to find the right word, but I didn’t want the department to think that I wasn’t showing up at work at 100 percent. I didn’t want the patients to think that either, because I was totally committed to my training, the department, and the patients. But I had this weird sense that I had done something wrong, or that they wouldn’t look at me the same now that I had this new role as a mother.

And so the article talks about some of the challenges that I faced being pregnant during residency, with the long hours, taking call, being on your feet all day, and really not getting much of a break, especially in those last couple of months of pregnancy when your body is kind of pushed to the limit, as well as some of the challenges I had in the postpartum period, coming back to work so early. I came back after 3 weeks. And then there were the logistical challenges of breast pumping during clinic and just trying to fit all that in.

And so the article is kind of, you know, three points that I wanted to convey to trainees. My first point was being autocratic in your decision to start a family. I talk to premedical students or medical students or other residents, and they’re like, “Well, when’s the best time to have a child?” And my answer is always, “When you and your partner are ready.” Like, I really can’t stand that question, but it was also my question. And there’s no good time; there’s no perfect time. The perfect time is when you and your partner are ready, because they’re arguably going to be, you know, the biggest help during all of it. So I just don’t think the question should start with, “Well, when’s the best time?” and then work backwards in terms of an academic timeline.

My next point was to have a flexible plan. Residency is challenging in multiple ways, one being that you really don’t have a whole lot of control over your schedule. So be intentional about discussions with your department, your program director, and your other residents. My plan was to take more call towards the beginning of my pregnancy so that I didn’t miss any call that entire academic year, even though I took 3 weeks off. So be intentional about planning things. You hear it from moms and working dads all the time: Have a backup to a backup to a backup for child care, because you just can’t call in to work when the babysitter cancels.

And then the third point was to not apologize. You are an adult female, and it’s totally your right to have a child whenever you want to, whether it’s in medical school or residency or fellowship. I don’t know if it was necessarily because I was in a surgical residency, but the culture in surgery, sometimes at some institutions, is to be strong and to not ask for a break, you know, work all day, I don’t need to eat, kind of thing.

And I still remember the first time I had to tell my chair that I was pregnant. I was kind of syncopal, and I just kept apologizing. I was like, “Sorry, sir. I’m so sorry. I just need to sit down. I feel really light-headed.” At the end of the day, when I got home, I was like, “Why am I apologizing? Physiologically, my blood volume is expanding. I’m really hot in the operating room. I should have just said, ‘I just need to sit down.'” And I think you just don’t need to apologize for having a child during residency.

Kevin Pho: Well, I can’t imagine how challenging it was, certainly, to be pregnant, especially during an otolaryngology residency. Now, during those few months, how supportive was the program? Not just the program itself, but your colleagues and peers as well.

Lauren A. Umstattd: You know, I had a great residency program. I really look up to all of the attendings that I worked with and my co-residents. No one was not supportive, but they just didn’t really say anything, you know? And again, going back to the culture of residency in surgery, I wasn’t going to say anything either. So if I felt horrible during a 6-hour parotidectomy, I just felt horrible. I wasn’t going to ask to sit down, and my boss wasn’t going to say, “Hey, why don’t you take a 5-minute break? I’m cool for a while.”

So I just think that, from a trainee perspective, it’s good to speak up. But then, to anyone listening who does have trainees, it’s OK to say, “Hey, are you feeling OK?” or “Hey, why don’t you just take a 5-minute break? I’m good for it,” or “You don’t need to see the next clinic patient. Why don’t you go get a snack?” Or, you know, stop being patronizing. There are ways that you can hint at the fact that you recognize they’re pregnant. It’s not an easy process, you know, gaining all that weight with the child, and your body goes through a lot of change. And so there are ways that the department can really help residents through that process of being pregnant.

Kevin Pho: And as you were going through your pregnancy, there’s certainly no playbook for this. Now, where did you turn for guidance, mentorship, or just simply more information and people who were going through the same experiences as you were?

Lauren A. Umstattd: So I did have some female faculty that I worked with. There was only one of them who had had a child during residency, and she took 3 days off after she gave birth. My other attendings had given birth after they were done with training, and so they had a little bit longer, had more control over their schedule when they were pregnant, and then also more control over the postpartum time off. So honestly, I felt a little bit alone during the process. I didn’t have a great female mentor or male mentor who really walked me through the process and how to speak up for myself, which is why I felt the need to write the article.

Kevin Pho: We’re talking to Lauren Umstattd. She is a facial plastic surgery fellow. She wrote the KevinMD article “Advice to a pregnant surgical resident.” Now, after going through this experience, is there anything that you wish you had done differently, or anything that you know now that you wish you knew back before you wrote the story?

Lauren A. Umstattd: I think just being more open with my colleagues and my bosses during training, just telling them, “You know, I just don’t feel great right now. I’m just going to take a 5-minute break and drink some water.” No one would have faulted me for that, but for some reason I was nervous to do so. So yeah, I think looking back, I just would have been more vocal and open.

I also would have had a lengthier discussion with my program director about time off after I had given birth. Our departmental policy at the time said that each new parent will be granted 3 days of maternity or paternity leave, and additional time would be taken from available vacation. We had 3 weeks of vacation allotted per year, so when I told him I was pregnant, I said, “I’ll just be taking my 3 weeks of vacation starting the day I go into the hospital to deliver.” And he said, “OK.”

And again, I don’t fault him for that. I just don’t think we, neither of us, really opened up to the idea that maybe there was a better way to do it. Maybe we could have gotten creative and borrowed vacation time from another year or something, you know. I just wish that I would have been more open to discussing things with him.

Kevin Pho: For those residency directors who may be listening to you and your story, you did mention that you wish that perhaps more people could just ask you, “How are you doing? Are you feeling OK?” Structurally, what are some ways that residency programs can change to better accommodate expectant mothers during residency?

Lauren A. Umstattd: I think the first is through policy. Every department has a policy handbook. I had read that thing front to back, and I knew exactly how the department felt about me getting pregnant. I mean, it said it in black and white that I get 3 days off. To me, that basically told me, “Don’t get pregnant,” even though nobody ever said that. I still, again going back to the first point of my article, wanted to be autocratic in deciding when to start my family. And so my husband and I decided to.

So I think the first is the policy. If anyone in your program is thinking about having a child, you know, we’re all readers and researchers, and so we’re going to go look at the handbook. And so I think having a decent policy written down. But then I also think, as a program director, you have to be flexible, with, you know, no one pregnancy or adoption, or if it’s a father who’s going to become a new dad, no one trainee is going to have the same experience. What if a trainee goes on bed rest? What happens to their academic schedule? Are they going to have to delay their graduation?

So I think just being open and having scheduled discussions. Schedule a meeting, you know, a 15-minute meeting, three times during their pregnancy, just to check in, and give dedicated time to your schedule so it doesn’t keep getting pushed back. And not necessarily having the discussions in the open, because I think a lot of women don’t want to admit, “Oh, I don’t feel great today.” So sometimes it’s not the most appropriate time to ask them in the middle of a surgery how they are doing. One, you’re concentrating on what you’re doing. And two, there are a lot of other people in the room that you may not feel as comfortable around. So I think having those conversations in the hallway or in your office or something would give it more structure, if it was an intentional meeting just to check in. Ask if there’s anything they can do.

And then from a colleague standpoint, from a co-resident standpoint, again, just checking in. Just asking them is the biggest thing, just so they recognize that you see them, you see the challenges that they’re going through, and that you’re there for them if they need anything.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Lauren A. Umstattd: The biggest thing is that you have to be your own advocate. No one else is going to advocate for you like you. Whether it’s advocating for better maternity leave in your program, or becoming involved in the house staff organization as a trainee and implementing a new paging system at your hospital, whatever it may be, just define what you’re passionate about and what you think could be done better, talk to other people, and then advocate for your change, because that’s the way that we’re all going to get better together.

Kevin Pho: Lauren, thank you so much for sharing your story and insight, and thanks again for being on the show.

Lauren A. Umstattd: Thank you so much.

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