The productive pregnant surgical trainee

The productive pregnant surgical trainee
Work-life balance is a much lauded concept, but just how does a surgical trainee combine the challenge of maximising training with being pregnant? The logistical problems that the forthcoming delivery date bring to the wider surgical team can be anticipated and facilitated with adequate planning. This guide aims to inform trainees, their colleagues, and their trainers to ease this increasingly frequent situation.
Who needs to know?
Although there are no legal requirements for employees to tell their employers that they are pregnant, it should be borne in mind that employers are not required to take any specific action until written notification has been provided.[1] In addition,[link widoczny dla zalogowanych], if you want to take maternity leave and pay you must inform your employer by the 15th week before your due date.
However,[link widoczny dla zalogowanych], you may decide to divulge your good news earlier on the basis of other factors. If you are unwell during your first trimester and are likely to require some flexibility in attending sessions, it is best to inform your seniors. This is not only acting responsibly for the care of your patients; it will also maintain your reputation as a reliable colleague. Telling the most senior clinical line manager first and in person is most appropriate. You don want the clinical lead to hear from the scrub nurse that you have been disappearing at every morning list. The remainder of the people you may wish to inform (box 1) can be told via email, although sending a hard copy in the post ensures your important news doesn end up in a junk inbox.
Maternity leave
Maternity pay and leave entitlements are calculated on the basis of the conditions during the qualifying week, which is the post you are in during the 15th week before your due date. Annual leave, and in some cases statutory leave,[link widoczny dla zalogowanych], will continue to accrue during maternity leave,[link widoczny dla zalogowanych], and most trainees find it easiest to take pro rata leave at the start and end of this period. Study leave entitlements during maternity leave vary between regions and need to be agreed with your educational supervisor and postgraduate deanery in advance.
Health during pregnancy
Although pregnancy is not an illness,[link widoczny dla zalogowanych], there may be instances when you are not able to fulfil your duties, either as a result of pregnancy related ill health or because working conditions exacerbate the expected symptoms of pregnancy. The Health and Safety Executive recommends that a risk assessment should be undertaken by employers when they become aware of a woman pregnancy. This should take account of individual risks that may be present in the workplace. Employers should take steps to minimise the effect of these risks on the health of mother and baby; if these risks cannot be ameliorated, the employee should be suspended on full pay. If the latter is the case, your GP should issue you with a Med3, a form that documents the nature of the medical problem stopping you from working,[link widoczny dla zalogowanych], which will be required by your employer. There is some evidence to suggest that heavy shift working can result in preterm birth,[link widoczny dla zalogowanych], hypertension, and pre-eclampsia,[2] but these studies relate mainly to manual workers and the relevance of their findings to surgical trainees is questionable. The Health and Safety Executive advises that some particular working conditions may influence the ability of a pregnant person to continue to work safely (box 3).
Radiation exposure
Exposure to radiation may be a concern, particularly for trainees in orthopaedics and vascular surgery,[link widoczny dla zalogowanych], where procedures are performed with continuous fluoroscopy. When a pregnant woman has informed her employer about her pregnancy,[link widoczny dla zalogowanych], the employer must ensure that working conditions do not expose her to beyond 1 mSv for the remainder of the pregnancy.[3] To put that in context, using standard precautions (lead coats, wearing a dosimeter), the average annual dose for interventional radiologists (who have the greatest exposure of all clinicians) is 0.35 mSv, whereas for all other clinicians it is 0.08 mSv.[4] Again,[link widoczny dla zalogowanych], this should be addressed by your employer during your risk assessment,[link widoczny dla zalogowanych], but for most trainees the risk is at the lower level. If you feel you do not want to expose yourself and your baby to that risk, however,[link widoczny dla zalogowanych], arrangements to cover your duties would need to be agreed with your clinical line manager in advance.
Aspects of training
At the time of writing,[link widoczny dla zalogowanych], there is no facility on the Intercollegiate Surgical Curriculum Project website to record the period of time you will be on maternity leave. In the interim, plans should be recorded during meetings with your educational supervisor,[link widoczny dla zalogowanych], and the number of pro rata assessments to be performed should be agreed and recorded in advance. It is recommended that if a trainee attends an annual review of competency and performance during maternity leave, even if as a result of leave, the transition point from one level to the next becomes out of sync. The reaction of colleagues and patients to your pregnancy will be varied, and although you may experience some negative encounters, you may be surprised at the sources of support. There are some steps you can take to facilitate a positive workplace environment.
You are entitled to leave to attend antenatal appointments,[link widoczny dla zalogowanych], and these can be planned well in advance (box 4). Arrange with your rota coordinator to be free,[link widoczny dla zalogowanych], and leave plenty of time. Although you may only spend 10 minutes with the midwife or obstetrician, a whole session can be taken with parking, waiting times,[link widoczny dla zalogowanych], and travelling. Colleagues can cover but only if they are given warning, and with these appointments occurring with relative frequency, goodwill can quickly be lost. You are also entitled to time off to attend parentcraft or antenatal classes, but these occur mainly in the evening, when it is generally easier to swap shifts around.
Investing in a few good quality items of smart maternity wear and appropriate shoes is worthwhile,[link widoczny dla zalogowanych], because being comfortable will allow you to focus on the task at hand. In addition, theatre may become your new black, allowing maximum comfort with minimal effort.
Moving and handling patients can be difficult during pregnancy because strains on your back and joints are more likely with minimal force,[link widoczny dla zalogowanych]. It is best to let the senior nurse in theatre and on the ward know of your pregnancy so you are not put in the situation where you are responsible for moving a patient.
Conclusion
Pregnancy is a rewarding and fulfilling experience, and although combining this with surgical training takes planning and commitment, it can be done, and done well.
Health and Safety Executive. New and expectant mothers at work: a guide for employers HSG122 . Working conditions and adverse pregnancy outcome: a meta-analysis,[link widoczny dla zalogowanych]. Obstet Gynecol
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