By Emma Goldberg, July 28, 2021
Dr. Eveline Shue had always been a standout surgeon, but her most joyful moment at the hospital came when she could finally share some personal good news with her colleagues: After five cycles of in vitro fertilization, she was pregnant with twins. At 24 weeks of pregnancy, she and her husband began to make plans for their future family, purchasing car seats and picking out names. All the while Dr. Shue kept working 60-hour weeks in the hospital.
At 34 weeks, she realized that the operating room shifts were wearing on her body and took a brief leave. Two days later, her mother walked into her home and found her unable to speak. Dr. Shue, 39, had suffered pre-eclampsia and a stroke. She was rushed to the hospital, got an emergency cesarean section and then underwent brain surgery.
Her babies survived, as did Dr. Shue, but it was a wake-up call to her surgery team. “I began to ask myself, What could we as a group have done to prevent this from happening?” said her colleague Dr. Eugene Kim, a professor of surgery and pediatrics at the University of Southern California Keck School of Medicine.
Last year, Dr. Kim set out with a group of physicians and researchers to study the factors contributing to pregnancy complications in American female surgeons. The paper he co-authored, published in JAMA Surgery on Wednesday, showed that female surgeons are more likely to delay pregnancy, use assisted reproductive technology, undergo nonelective C-sections and suffer pregnancy loss compared to women who are not surgeons.
The study, which surveyed 692 female surgeons, found that 42 percent had suffered a pregnancy loss, more than twice the rate of the general population, and nearly half had experienced major pregnancy complications.
As American medical schools approach gender parity, even the stubbornly male specialties like surgery are starting to more closely resemble the broader population. Women now make up 38 percent of surgical residents and 21 percent of practicing surgeons. But the challenges in balancing the professional demands of surgery with the process of starting a family remain deeply entrenched.
Between the stigma associated with pregnancy during surgical training and the paltry options for maternity leave, many women delay pregnancy until after their residency, at which point their age makes them more vulnerable to adverse pregnancy outcomes. In medical school, said Brigham and Women’s surgeon Dr. Erika Rangel, the running joke among would-be women surgeons was that they would nearly all face “geriatric pregnancies.” The new JAMA Surgery study found that the median age for female surgeons to give birth was 33, compared to a national median of 30 for women with advanced degrees, and one-quarter of female surgeons surveyed used assisted reproductive technology like I.V.F. Less than 2 percent of infants born in the U.S. each year are conceived from assisted reproductive technology.
That increased reliance on I.V.F. among female surgeons, the study’s authors noted in interviews, comes at significant financial cost — often more than $12,000 per cycle for up to six cycles. It is also associated with risks like placental dysfunction.
Female surgeons most at risk for pregnancy complications were those who kept operating for 12 or more hours a week through their final trimester, according to the study. Performing surgeries is more physically intense than other clinical tasks because it means being on your feet with little access to food and water. More than half of female surgeons surveyed worked over 60 hours per week during pregnancy, 37 percent took over 6 overnight calls each month and only 16 percent reduced their working hours.