Pregnancy During Orthopaedic Surgery Residency: The Iowa Experience

Introduction

Family planning is a challenge for physicians at all stages of their careers, but particularly difficult during residency. Residency commonly occurs during prime childbearing years and is associated with long work hours and inflexible schedules. A commonly cited deterrent for women entering orthopaedic surgery is the inability to achieve a healthy and fulfilling work-life balance.¹ Further, those women who pursue starting a family during residency have been shown to have higher rates of pregnancy-related complications including infertility with complications rates as high as 30%.^2,3 In a recent AAOS article, a call to action for modified policies to prioritize the health of pregnant orthopaedic surgeons and their unborn children was made to decrease the overall risk to women who wish to have children during residency and early practice.⁴

The University of Iowa has a history of attracting women into the orthopedic training program. We asked past graduates of the University of Iowa Orthopedic Residency program who had children during residency to share their personal experiences and opinions. We asked past graduates to answer five questions surrounding their pregnancy during residency. We have included the good, the bad, and the ugly with real-life testimonies in hopes that despite the statistics, women in our field considering pregnancy will find comfort in those that have been through it.

Four prior residents were kind enough to share their experiences. Dr. Sarah Schippers (SS) completed residency in 2021 and is currently finishing a hand and upper extremity fellowship and will soon be starting private practice in Kansas. She shares on her experience regarding two pregnancies during residency. Dr. Tina Hajewski (TH) completed residency in 2021 and is also currently finishing a spine fellowship and will soon be starting private practice in Washington, sharing on her experience having two children during residency. Dr. Elizabeth Weldin (EW) completed residency in 2018 and is a current hand and upper extremity attending in Oklahoma and shares her experience having a child during residency and the contrast to having children during practice. Finally, Dr. Heather Campion (HW) completed residency in 2012 and is a current hand and upper extremity attending in Oregon and shares her experience as being the first Iowa orthopaedic resident to have a child during residency.

Level of Evidence: V

Panel Questions

Question 1: How would you describe your experience while being pregnant during residency?

SS: Overall, I could not have asked for a better experience. That said, I was blessed with easy pregnancies and healthy babies, which does make a huge difference. The rotations that I completed while pregnant were some of the more exhausting times in residency, but I was fortunate in that the culture, set by leadership, was that which promoted and supported women.

TH: As a resident I thought I was always tired, and that was redefined while pregnant. The physical difficulties being pregnant in residency were things I didn’t anticipate. With both pregnancies the fatigue and nausea in the first trimester were challenging, and those symptoms returned to rear their heads later in pregnancy too. Just when I thought I was in the clear, I distinctly remember having to scrub out of a call fasciotomy case to vomit outside of OR 26 in my third trimester. It seemed temperature regulation in the OR was important for my body to keep from going vasovagal and it was a delicate balance of nutrition and hydration as well.

EW: My experience was largely positive. As a senior resident, I had a reasonable call schedule and supportive residents on difficult rotations. I did have some negative experiences, such as staff disclosing my pregnancy without my consent, but this was in the minority.

HC: I remember how stressful it was to tell my co-residents, attendings, and staff that I was pregnant, because I didn’t know how they would react. Thankfully the program was very supportive. I remember Dr. Buckwalter and Dr. Marsh both making sure my rotations were re-arranged to allow for as little disruption as possible to my training. I was fortunate to have an ‘easy’ pregnancy where I was able to continue working, I only remember two instances where I needed to leave the OR for nausea.

SS with daughter Mary in her Kansas City gear.

SS with two daughters, Mary and Ruth.

Question 2: What barriers do you feel existed to being pregnant and then having a baby in residency?

SS: The biggest determinant of when we chose to have children was when I thought I could most easily take time away from rotations and call without causing too much of a burden on my co-residents. Luckily, the call schedule was such that you could plan months (even years) in advance.

TH: I think the stress of call and affiliated lack of sleep were what taxed my body the most during pregnancy. It is impossible to determine why I went into preterm labor but I think the frequency of call as a PGY-3 had something to do with it. Unfortunately, I do think pregnancy is the easy part, and being a new mother is a whole different ball game. Balancing the priorities of your new family and demands of your training is incredibly stressful and was probably the hardest thing I had to overcome during residency.

EW: Barriers included limited experience with pregnant residents (had been several years since the most recent pregnant resident), inflexibility of attendings to alter team structures (such as the 4th year resident on joints, I wished to avoid cement during my pregnancy. One staff member was very upset about this). Barriers to have a baby in residency (and really any time) was finding childcare that accommodated difficult residency hours, making appointments during regular business hours due to residency obligations.

HC: The ABOS does not allow residents to take more than 6 weeks off in a calendar year. (I’m not sure if that has changed). I wanted to make sure to finish residency on time! I was only able to take 5 weeks of maternity leave, which included recovering from a C-section. My first rotation back from maternity leave was rough. I remember getting two 3 hours ‘naps’ most nights, as I was up nursing or pumping at some point. Then having to get back to the hospital by 5am to round. I slept through my alarm a few times. Nursing and pumping also felt like a full-time job. I would find a stall in the locker room to pump in while dictating notes and checking patient labs. One of the ortho nurses let me borrow her office during clinic to take a pump break.

EW coming home from operating. Playing “doctor” with William and nursing Thomas.

EW with 3 children, William, Thomas, and Abigail at Easter.

Question 3: What did you find the most helpful or supportive while being pregnant during residency?

SS: Having a department chair who seemed genuinely happy for me when I announced the pregnancy and who never once made me feel like I was an inconvenience. Having female staff mentors who understood the trials of pregnancy and motherhood and could offer personal advice about how to balance that and the demands of our career. Having a supportive husband who did everything he could to make my transition back to work easier after maternity leave.

TH: The support of my co-residents with both pregnancies. There were times toward the end of my second pregnancy that I was not feeling well, and I feared going into preterm labor again. There were people who stepped up and offered to cover my call or strenuous cases and I am forever grateful. Also luckily at Iowa, there are faculty who are also mothers and having someone to talk to who has been through it really helped get me through. Although others are supportive, no one really understands what you are going through as a new mother and orthopedic surgeon other than the few who have also been through it.

TH and SS with their children during their senior resident year.

EW: I found it helpful to advocate for myself. One day on trauma team I went several hours without eating, drinking, or going to the bathroom. I had severe contractions at the end of the day. Following that incident, I made a point to take a break between each case to have a snack, drink water, and use the bathroom. I continued this practice while breastfeeding to advocate for times to express milk and never met resistance. It is also helpful to reach out to other physician moms for support.

HC: I was also stressed about not burdening my co-residents. (I will note all of the other residents I shared a call pool with were male. There were no female residents in the two classes above me, or in the class below me). In the 4th and 5th years of residency we averaged taking call every 12th night. I wanted to make sure to cover my share. I was able to arrange my call schedule so that I took no call one month before my due date, and I didn’t start taking call again until I was back from maternity leave. I also tried to avoid bone cement for total joints. I was able to have co-residents help cover cases so that I could leave the OR when cement was used. My co-residents were very supportive! Many of them had children too, so they understood the challenges I was having.

Question 4: What advice would you give to female residents considering timing of pregnancy during residency?

SS: While it is our ‘right’ to have children and there is a finite amount of time during which this can happen, I also feel strongly in that, as physicians, we make a commitment to our patients (both current and future) and our training program in terms of dedicating the amount of time necessary to be as best a provider as we can. While precise timing of something as monumental as a pregnancy is not always possible, it is important to try and take this into consideration given that in the grand scheme of life, five years of training passes quickly.

TH with two sons, Liam and Tristan, and their dog Murph.

HC with husband, Dan, and three children, Ella, Margo, and George.

When considering the call shifts that will be missed (or other duties that others will have to take on), remember that you are choosing to take time away and should be gracious about how you make up that time (ie, accepting a less desirable call shift or rotation schedule).

TH: Make decisions about what is best for you and your family. The rest will find a way to fall into place.

EW: Believe it or not, residency is a great time to have children. Having children in practice can be very expensive, it is difficult to leave your own patients, and leave policies are often nonexistent in private practice. Having had 2 children in practice, I can say that my least stressful maternity leave was in residency.

HC: Waiting until I was in the senior resident call pool made the most sense to me, since it was easier to arrange the call schedule around maternity leave.

Question 5: Would you do anything differently looking back?

SS: No. Two pregnancies in residency taught me that you have time for whatever you make time for, and everyone has their priorities.

TH: I feel I was more assertive about my needs to keep myself and my pregnancy healthy with my second pregnancy. Others will be supportive, but you must be your own best advocate and you can’t be afraid to ask for things you need (advice that should be followed outside of childbearing as well).

EW: No.

HC: I have had two more children since residency. My second daughter was born in my first year of private practice when I was on salary. My son was born after I had become partner. It was more stressful on my practice and more difficult financially having a child once I was a full-time hand surgeon! Looking back, having a child in residency was stressful but easier than having a child as a full-time surgeon. In residency you are taking care of your attending’s patients, out of training those patients become yours and your partners cover for you. My group has since revamped their policy on maternity leave, so that it is not as financially difficult.