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Pilot Survey of Female Anesthesiologists’ Childbearing and Parental Leave Experiences

Pearson, Amy C. S. MD*; Dodd, Sarah E. MD; Kraus, Molly B. MD; Ondecko Ligda, Kristin M. MD§; Hertzberg, Linda B. MD, FASA; Patel, Perene V. MD; Chandrabose, Rekha K. MD

Author Information
doi: 10.1213/ANE.0000000000003802

Abstract

It is well established that the time of recovery after childbirth is an important physiological, social, and psychological period in a woman’s life.1 The American College of Surgeons, American College of Physicians, American College of Obstetricians and Gynecologists, American Academy of Pediatrics, and other professional societies have recognized that parental leave and breastfeeding support are important for physicians and have created related policy statements.2–5 With respect to resident physicians in these specialties, the corresponding American Board of Surgery, American Board of Internal Medicine, American Board of Pediatrics, and American Board of Obstetrics and Gynecology address parental leave in formal policies.6–9 In addition, American Board of Obstetrics and Gynecology and American Board of Internal Medicine specifically describe accommodations for lactating mothers.6,9 The Accreditation Council for Graduate Medical Education recently updated its program requirements to include time for personal care appointments.10 Currently, there are no statements or policies specific to parental leave or lactation from the American Society of Anesthesiologists (ASA).

The literature describes experiences of childbearing during and after training in various populations of surgeons. Major findings include longer delay of pregnancy, lower fertility rate, and higher rate of assisted reproductive technology compared to national averages.11 Many surgeons were concerned that pregnancy would adversely affect their career and/or that it would be viewed unfavorably by their superiors or peers.11 A survey of women surgical trainees revealed that the majority of those who took parental leave did not take >6 weeks’ leave, felt their leave was of inadequate duration, and stopped expressing breast milk earlier than desired.12,13

There are no studies of female anesthesiologists’ experiences regarding childbearing and parental leave. A 2010 study from the American Board of Anesthesiology reported that although women were less likely than men to complete certification in the shortest possible time, female sex was a positive predictor for board certification status.14 It is unknown whether childbearing and lactation status are related to a delay of board certification in anesthesiology.

We sought to obtain pilot data of women’s experiences and opinions regarding pregnancy, childbirth, recovery, and breastfeeding while working in the field of anesthesiology using a convenience sample of attendees at Women in Anesthesiology (WIA) event.

METHODS

This study was deemed exempt by the University of Iowa institutional review board (#201710724). The intention of this survey was to obtain pilot demographic data to inform future research. Participation in the survey was voluntary, and no incentive was offered for completion. Participants were female anesthesiologists and anesthesiology trainees attending a society event for WIA, a nonprofit organization devoted to the professional development of women physician anesthesiologists. The event was open to the public, and registration was completed on the WIA website or onsite. Advertising for the event occurred by postings on Facebook and Twitter, as well as through email and word-of-mouth. This non–continuing medical education non–ASA-sponsored event occurred on October 20, 2017 at a separate venue before the ASA annual meeting. Seventy-seven preregistered, and 74 were present at the time of survey distribution. Female attendees who wished to participate (n = 72) were administered the survey in paper format. This survey was announced and administered to all women present at the conference before commencement of the program. All surveys were collected as they were completed and received by the conclusion of the event. The meeting theme and speaker topic, “Diversity in Leadership: Leaning Together,” were not related to the topics of childbearing or lactation. Childbearing and lactation were not otherwise formally discussed.

The survey was developed based on similar surveys in the surgical literature and author consensus (Supplemental Digital Content, Document, https://links.lww.com/AA/C578).11–13 Demographic data included age, race, current job status, years in practice, country of medical school, degree, residency type and size, year of residency graduation, board certification and honor society status, marital status, number of children, and partner characteristics.

For respondents with children, mother’s work status at the time of birth, method of delivery and presence of complications, weeks of parental leave, weeks of training extended, months of lactation, and whether perinatal appointments were skipped due to work were collected for each child. Women were also asked questions regarding desired age and number of children, hardships encountered around the time of birth, and whether they would counsel future female trainees to choose anesthesiology as a career.

Because the objective of this study was to obtain pilot data, no primary outcomes were designated. Survey answers were reported in simple proportions. When applicable, means with standard deviation or median with interquartile range (IQR) were computed in addition to simple proportions. Missing data were not included in the final calculations. All data were collected in paper format and transposed into electronic format using Google Forms (Google Inc, Mountain View, CA, 2017). The results were exported to Microsoft Excel (Microsoft Inc, Redmond, WA, 2010). All data were calculated using Microsoft Excel.

RESULTS

The survey was offered to 72 participants, and 66 participants completed it (91.7% response rate). The majority (89.4%) were attending physician anesthesiologists, and 53% were in practice >10 years. Most (45.5%) had 2 children (18.2% had no children, 16.7% had 1 child, and 19.7% had ≥3 children). The majority (66.1%) had a partner who worked full time outside the home, and 27.4% had a partner who was also a physician.

T1
Table 1.:
Anesthesiologist Characteristicsa

Demographics are reported in Table 1.

Results From All Women Surveyed

T2
Table 2.:
Survey Results

Results are reported in Table 2. Of all women surveyed (n = 66), 42.1% felt that their desired number of children and desired age of childbearing (52.5%) were adversely affected by work demands. A total of 18.2% were encouraged by peers, superiors, and ancillary staff to become pregnant or to breastfeed, and 26.8% were discouraged. A total of 1.8% stated that they would counsel a female student against a career in anesthesiology due to obstacles related to parenthood, and 94.9% were in favor of a statement in support of parental leave, pregnancy, and lactation from ASA.

Results From Mothers Surveyed

Of the 66 women surveyed, 54 (81.8%) were mothers who gave birth to a total of 113 children. Twenty-eight (51.8%) women gave birth to their first child while they were residents or fellows. Thirty-one percent of births occurred by cesarean delivery, and 19.3% had complications. Average parental leave was 10.5 weeks (±9.2 weeks), and median parental leave was 8 weeks (IQR, 6–12).

Results From Births During Residency or Fellowship

Forty-four births (38.9%) occurred during residency or fellowship training. For pregnancies that occurred during training, 89.5% did not receive a modified work schedule. Average parental leave while an anesthesiology resident or fellow was 8.9 (±7.4) weeks, with a median of 6 weeks (IQR, 4–10.7). For their childbearing experiences in residency or fellowship, respondents reported affirmatively to adequate parental leave (43.2%), adequate lactation facilities (45.5%), and adequate lactation duration (47.7%).

Women who gave birth during training (n = 37) reported extending their training period (56.3%) and delaying board certification (9.7%). Some reported board certification fees adversely affecting their ability to support their family (16.1%). Of those who had a delay in training completion or board certification, 38.1% felt at a disadvantage when applying to a job or fellowship, and 26.3% felt their seniority was affected compared to their peers. Of the women who expressed breast milk during board certification examinations (n = 7), none (0%) reported adequate facilities or time in which to do so.

Results From Births While Mothers Were Attending Anesthesiologists

Fifty-four births (47.8%) occurred while mothers were attending anesthesiologists. For pregnancies that occurred while they were attending anesthesiologists, 84.9% did not receive a modified work schedule. Average parental leave while they were attending anesthesiologists was 10.4 weeks (±3.5 weeks) with a median of 12 weeks (IQR, 8–12). For their childbearing experiences as attending anesthesiologists, respondents reported affirmatively to adequate leave (64.2%), adequate lactation facilities (49.0%), and adequate lactation duration (68.6%).

DISCUSSION

This is the first pilot survey of opinions and experiences of female anesthesiologists regarding parental leave to date. While approximately half of respondents reported dissatisfaction with their colleagues’ and superiors’ handling of their parental leave and/or lactation needs, 98.2% would not counsel a female student against a career in anesthesiology. Our findings are similar to a recently presented study of general surgery residents in which 89.5% (anesthesiology residents, n = 37) vs 87% (general surgery residents, n = 272) did not receive a modified work schedule, 55% vs 64% reported inadequate lactation facilities, and 52% vs 56% had inadequate lactation duration.11 This survey has limitations: the survey population was a small, specific group of female anesthesiologists and trainees, which limited generalization. There is risk of selection and recall bias, results are not powered for significance, and the survey instrument is not validated. The cross-sectional, demographic nature of the study is not designed to determine causation. The main purpose of this report is to serve as groundwork for a larger, more comprehensive study of the effects of parenthood on female anesthesiologists’ careers. Such research may ultimately inform policies on parental leave, pregnancy, and lactation at national, state, and local levels.

DISCLOSURES

Name: Amy C. S. Pearson, MD.

Contribution: This author helped conceptualize and design the article, collect, analyze, and interpret the data, and draft and revise the manuscript.

Conflicts of Interest: A. C. S. Pearson is a board member of Women in Anesthesiology.

Name: Sarah E. Dodd, MD.

Contribution: This author helped conceptualize and design the article, interpret the data, and draft and revise the manuscript.

Conflicts of Interest: None.

Name: Molly B. Kraus, MD.

Contribution: This author helped conceptualize and design the article, interpret the data, and draft and revise the manuscript.

Conflicts of Interest: None.

Name: Kristin M. Ondecko Ligda, MD.

Contribution: This author helped collect the data and draft and revise the manuscript.

Conflicts of Interest: None.

Name: Linda B. Hertzberg, MD, FASA.

Contribution: This author helped interpret the data and draft and revise the manuscript.

Conflicts of Interest: None.

Name: Perene V. Patel, MD.

Contribution: This author helped interpret the data and the revise the manuscript.

Conflicts of Interest: None.

Name: Rekha K. Chandrabose, MD.

Contribution: This author helped conceptualize and design the article, collect and interpret the data, and draft and revise the manuscript.

Conflicts of Interest: R. K. Chandrabose is a board member of Women in Anesthesiology.

This manuscript was handled by: Jill M. Mhyre, MD.

REFERENCES

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11. Pham DT, Stephens EH, Antonoff MB, et al. Birth trends and factors affecting childbearing among thoracic surgeons. Ann Thorac Surg. 2014;98:890–895.
12. Rangel EL, Smink DS, Castillo-Angeles M, et al. Pregnancy and motherhood during surgical training. JAMA Surg. 2018;153:644–652.
13. Rangel EL, Castillo-Angeles M, Smink DS, Kwakye G, Haider AH, Doherty GM. Pregnancy and motherhood during surgical training: results of a nationwide survey of general surgery residents. Annual Meeting of the New England Surgical Society; September 8–10, 2017; Bretton Woods, NH. Available at: http://meeting.nesurgical.org/abstracts/2017/19.cgi. Accessed September 13, 2018.
14. McClintock JC, Gravlee GP. Predicting success on the certification examinations of the American Board of Anesthesiology. Anesthesiology. 2010;112:212–219.

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