The challenges facing female surgical residents who become pregnant might have a significant effect on their career satisfaction and should be addressed "to attract and retain the most talented workforce," the authors of a new study warn.

In a survey of 347 female surgeons said the greatest obstacle they encountered when pregnant during residency included inadequate maternity leave, limited access to lactation facilities, and a lack of mentorship on balancing family and career responsibilities, Erika L. Rangel, MD and colleagues wrote.

Nearly one-third of the respondents said they would advise female medical students to avoid a career in surgery because of these difficulties, the reported researchers.

"For both factors such as health, drive, and an adequate support system were essential parts of the equation  Anticipatory planning has been critical, to ensure that whatever time is necessary, it meets the guidelines established by the Accreditation Council for Graduate Medical Education, "the authors of an invited commentary noted.

For the study, Rangel, Department of Surgery, Brigham and Women's Hospital and colleagues developed the 74-question survey. They distributed it electronically to professional associations of women surgeons, as well as to social media groups of female physicians and surgeons.

Eligible participants were women who had had at least one pregnancy during an Accreditation Council for Graduate Medical Education-accredited surgical residency in 2007 or later.

The 347 women who met the eligibility criteria had a mean age of 30.5 years (standard deviation, 2.7 years). 83% of the respondents had at least one pregnancy during clinical training, although 101 (22.3%) of the 452 pregnancies reported occurred during research years.

One common theme that surfaced in the responses was a stigma against pregnant trainees or childbearing during training. Nearly three quarters (253; 72.9%) of respondents reported hearing negative comments made by faculty members or other residents.

Programs with formal maternity leave policies were reported by 121 participants (34.9%), with leave policies established by the American Board of Surgery cited by 268 respondents as a major barrier to obtaining the desired length of the leave.

Although 95.6% of respondents affirmed the importance of breastfeeding, 58.1% reported that they stopped nursing sooner than they would have liked, because of the challenges of balancing work responsibilities with the need to express milk.

Even when lactation facilities were available, 85.2% of the participants said they felt uncomfortable asking for permission to scrub out during a case to express milk.

"135 respondents (39%) reported that their experience of pregnancy during residency made them strongly reconsider whether they wanted to continue their surgical training," the authors state. 

" Open discussion among surgical leaders and educators must develop strategies for workforce shortages, improvements in the working environment, flexible leave policies, and preservation of the integrity of education for the pregnant resident and her colleagues," they conclude.

"The current situation of women surgeons in the United States demands and requires change," Kelly L. McCoy, MD, and colleagues from the Division of Endocrine Surgery, University of Pittsburgh, wrote in their commentary.

Although it is possible to be both a surgeon and a mother, "if the prospect of leaving to the recital, fencing match, or tickle-fest to perform urgent surgery is enough to sway a young doctor away from a particular specialty, their gut may be guiding them in the right direction, " noted Kelly.