Current State of Prenatal Safety Policies Within Surgical Training Programs

Introduction: As women comprise an increasingly larger proportion of surgical trainee positions, careful consideration of policies that promote a safe pregnancy in this population is necessary. This study details current prenatal policies in US surgical training programs.

Methods: A validated 20-question survey was emailed to surgical programs, including otolaryngology head & neck surgery (OHNS), plastic surgery, vascular surgery, and general surgery. The survey was issued in November and December 2022. Data were collected until January 2023. This study was approved for exemption by the Minimal Risk Research IRB at the University of Wisconsin-Madison (ID number 2022-1370).

Results: Surveys were emailed to 608 programs, and the response rate was 23.5% (143/608) including 45 OHNS programs. When asked if their program has a prenatal policy, 84.4% responded yes, and 82.4% responded that they were satisfied with their policy. Subsequent questions addressed individual risk factors facing pregnant trainees. Only 60.3% of programs provide time off for miscarriage. Only 36.9% inform pregnant trainees about exposures that pose a risk of fetal anomaly or miscarriage, like ionizing radiation or sevoflurane exposure. Only 47.1% incorporate rest breaks for pregnant trainees, and only 20% protect the hours a pregnant trainee operates per week. Only 24.2% adjust overnight shifts or calls for pregnant trainees (most within the third trimester only), and of those that limit calls, 20% require pregnant trainees to make these calls up. Less than half (40%) of programs have a contingency plan for supporting non-child-bearing residents who may take on the work of their pregnant colleagues.

Conclusions: While a majority of training programs have a prenatal policy in place, upon further questioning, most of these policies appear to be severely deficient in areas that place both fetus and mother at significant risk of complications. We offer a preliminary evidence-based protocol that can help make pregnancy safer for trainees. Implementation of such a protocol is critical to recruit and retain women into surgical specialties.