Pregnancy and parenthood in surgical training: a cross-sectional survey in the UK | British Journal of Surgery

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class="al-author-info-wrap arrow-up"> <div class="info-card-author authorInfo_OUP_ArticleTop_Info_Widget"> <div class="name-role-wrap"> <div class="info-card-name"> Jessica Whitburn </div> </div> <div class="info-card-affilitation"> <div class="aff"><div class="institution">Nuffield Department of Surgical Sciences, University of Oxford</div>, <div class="addr-line">Oxford</div>, <div class="country">UK</div></div> </div> <div class="info-card-location"> <a id="contrib-orcid-0000-0001-8320-7725" href="https://orcid.org/0000-0001-8320-7725"> <img class="orchid-icon" alt="ORCID logo" aria-hidden="true" src="//oup.silverchair-cdn.com/Themes/Silver/app/img/mini-icon.png"/>  https://orcid.org/0000-0001-8320-7725 </a> </div> <div class="info-card-search-label"> Search for other works by this author on: </div> <div class="info-card-search info-card-search-internal"> <a href="/bjs/search-results?f_Authors=Jessica+Whitburn" rel="nofollow">Oxford Academic</a> </div> <div class="info-card-search info-card-search-google"> <a href="http://scholar.google.com/scholar?q=author:%22Whitburn Jessica%22">Google Scholar</a> </div> </div> </span> </span> <span class="al-author-name-more js-flyout-wrap"> <button type="button" class="linked-name js-linked-name-trigger btn-as-link">Saiful Miah</button><span class='delimiter'>, </span> <span class="al-author-info-wrap arrow-up"> <div class="info-card-author authorInfo_OUP_ArticleTop_Info_Widget"> <div class="name-role-wrap"> <div class="info-card-name"> Saiful Miah </div> </div> <div class="info-card-affilitation"> <div class="aff"><div class="institution">Department of Urology, Addenbrookes Hospital, Cambridge University Hospitals</div>, <div class="addr-line">Cambridge</div>, <div class="country">UK</div></div> </div> <div class="info-card-location"> <a id="contrib-orcid-0000-0001-5777-518X" href="https://orcid.org/0000-0001-5777-518X"> <img class="orchid-icon" alt="ORCID logo" aria-hidden="true" src="//oup.silverchair-cdn.com/Themes/Silver/app/img/mini-icon.png"/>  https://orcid.org/0000-0001-5777-518X </a> </div> <div class="info-card-search-label"> Search for other works by this author on: </div> <div class="info-card-search info-card-search-internal"> <a href="/bjs/search-results?f_Authors=Saiful+Miah" rel="nofollow">Oxford Academic</a> </div> <div class="info-card-search info-card-search-google"> <a href="http://scholar.google.com/scholar?q=author:%22Miah Saiful%22">Google Scholar</a> </div> </div> </span> </span> <span class="al-author-name-more js-flyout-wrap"> <button type="button" class="linked-name js-linked-name-trigger btn-as-link">Sarah A Howles</button><span class='delimiter'></span> <span class="al-author-info-wrap arrow-up"> <div class="info-card-author authorInfo_OUP_ArticleTop_Info_Widget"> <div class="name-role-wrap"> <div class="info-card-name"> Sarah A Howles <span class="info-card-footnote"><span class="xrefLink" id="jumplink-znad204-cor1"></span><a href="javascript:;" reveal-id="znad204-cor1" data-open="znad204-cor1" class="link link-ref link-reveal xref-default"></a></span> </div> </div> <div class="info-card-affilitation"> <div class="aff"><div class="institution">Nuffield Department of Surgical Sciences, University of Oxford</div>, <div class="addr-line">Oxford</div>, <div class="country">UK</div></div> </div> <div class="info-author-correspondence"> <div content-id="znad204-cor1"><em>Correspondence to:</em> Sarah Anne Howles, Nuffield Department of Surgical Sciences, Old Road Campus Research Building, Old Road, Headington, Oxford, OX3 9DU, UK (e-mail: <a href="mailto:sarah.howles@nds.ox.ac.uk" target="_blank">sarah.howles@nds.ox.ac.uk</a>)</div> </div> <div class="info-card-location"> <a id="contrib-orcid-0000-0001-6342-0895" href="https://orcid.org/0000-0001-6342-0895"> <img class="orchid-icon" alt="ORCID logo" aria-hidden="true" src="//oup.silverchair-cdn.com/Themes/Silver/app/img/mini-icon.png"/>  https://orcid.org/0000-0001-6342-0895 </a> </div> <div class="info-card-search-label"> Search for other works by this author on: </div> <div class="info-card-search info-card-search-internal"> <a href="/bjs/search-results?f_Authors=Sarah+A+Howles" rel="nofollow">Oxford Academic</a> </div> <div class="info-card-search info-card-search-google"> <a href="http://scholar.google.com/scholar?q=author:%22Howles Sarah A%22">Google Scholar</a> </div> </div> </span> </span> </div> </div> <div class="pub-history-wrap clearfix js-history-dropdown-wrap"> <div class="pub-history-row clearfix"> <div class="ww-citation-primary"><em>British Journal of Surgery</em>, Volume 110, Issue 12, December 2023, Pages 1628–1631, <a href='https://doi.org/10.1093/bjs/znad204'>https://doi.org/10.1093/bjs/znad204</a></div> </div> <div class="pub-history-row clearfix"> <div class="ww-citation-date-wrap"> <div class="citation-label">Published:</div> 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at-microsite-search-term" type="text" maxlength="255" placeholder="Search" id="OUP_ArticleToolbarSearchBox-mobile-microsite-search-term"> <a href="javascript:;" class="mobile-microsite-search-icon mobile-search-submit icon-menu_search"> <span class="screenreader-text">Search</span> </a> </div> </div> </div> </div> <div class="dropdown-panel mobile-nav-dropdown"> </div> </div> <div class="navbar"> <div class="center-inner-row"> <nav class="navbar-menu"> </nav> <div class="navbar-search-container js-navbar-search-container"> <a href="javascript:;" class="navbar-search-close js_close-navsearch">Close</a> <div class="navbar-search"> <div class="microsite-search"> <label for="OUP_ArticleToolbarSearchBox-navbar-search-filter" class="screenreader-text js-navbar-search-filter-label"> Navbar Search Filter </label> <select class="navbar-search-filter js-navbar-search-filter at-navbar-search-filter" id="OUP_ArticleToolbarSearchBox-navbar-search-filter"> <option class="navbar-search-filter-option at-navbar-search-filter-option" value="">British Journal of Surgery</option><option class="navbar-search-filter-option at-navbar-search-filter-option" value="Issue">This issue</option><option class="navbar-search-filter-option at-navbar-search-filter-option" value="bjs/9">Acute Care Surgery</option><option class="navbar-search-filter-option at-navbar-search-filter-option" value="bjs/1">Breast Surgery</option><option class="navbar-search-filter-option at-navbar-search-filter-option" value="bjs/17">Cardiothoracic Surgery</option><option class="navbar-search-filter-option at-navbar-search-filter-option" value="bjs/11">Education</option><option class="navbar-search-filter-option at-navbar-search-filter-option" value="bjs/12">Endocrine</option><option class="navbar-search-filter-option at-navbar-search-filter-option" value="bjs/2">General Surgery</option><option class="navbar-search-filter-option at-navbar-search-filter-option" value="bjs/3">Hepato-Pancreato-Biliary Surgery</option><option class="navbar-search-filter-option at-navbar-search-filter-option" value="bjs/4">Lower Gastrointestinal Surgery</option><option class="navbar-search-filter-option at-navbar-search-filter-option" value="bjs/10">Orthopaedics</option><option class="navbar-search-filter-option at-navbar-search-filter-option" value="bjs/7">Paediatric Surgery</option><option class="navbar-search-filter-option at-navbar-search-filter-option" value="bjs/8">Plastic Surgery</option><option class="navbar-search-filter-option at-navbar-search-filter-option" value="bjs/14">Transplantation</option><option class="navbar-search-filter-option at-navbar-search-filter-option" value="bjs/15">Trauma</option><option class="navbar-search-filter-option at-navbar-search-filter-option" value="bjs/5">Upper Gastrointestinal Surgery</option><option class="navbar-search-filter-option at-navbar-search-filter-option" value="bjs/16">Urology</option><option class="navbar-search-filter-option at-navbar-search-filter-option" value="bjs/6">Vascular Surgery</option><option class="navbar-search-filter-option at-navbar-search-filter-option" value="Parent">BJS Foundation Journals</option> <optgroup class="navbar-search-optgroup" label="Search across Oxford Academic"> <option class="navbar-search-filter-option at-navbar-search-filter-option" value="AcademicSubjects/MED00910">Surgery</option><option class="navbar-search-filter-option at-navbar-search-filter-option" value="Books">Books</option><option class="navbar-search-filter-option at-navbar-search-filter-option" value="Journals">Journals</option><option class="navbar-search-filter-option at-navbar-search-filter-option" value="Umbrella">Oxford Academic</option> </optgroup> </select> <label for="OUP_ArticleToolbarSearchBox-microsite-search-term" class="screenreader-text js-microsite-search-term-label"> Enter search term </label> <input class="navbar-search-input microsite-search-term js-microsite-search-term at-microsite-search-term" type="text" maxlength="255" placeholder="Search" id="OUP_ArticleToolbarSearchBox-microsite-search-term"> <a href="javascript:;" class="microsite-search-icon navbar-search-submit icon-menu_search"> <span class="screenreader-text">Search</span> </a> </div> </div> <div class="navbar-search-advanced"><a href="/bjs/advanced-search" class="advanced-search js-advanced-search">Advanced Search</a></div> </div> <div class="navbar-search-collapsed"><a href="javascript:;" class="icon-menu_search js_expand-navsearch"><span class="screenreader-text">Search Menu</span></a></div> </div> </div> <input id="routename" name="RouteName" type="hidden" value="bjs" /> </div> </div> </div> </div> <div id="ContentTab" class="content active"> <div class="widget widget-ArticleFulltext widget-instance-OUP_Article_FullText_Widget"> <div class="module-widget"> <div class="widget-items" data-widgetname="ArticleFulltext"> <p class="chapter-para">Women were first admitted to medical schools in the late 19th century and, since then, female representation in the medical profession has gradually increased<sup><span class="xrefLink" id="jumplink-znad204-B1"></span><a href="javascript:;" reveal-id="znad204-B1" data-open="znad204-B1" class="link link-ref link-reveal xref-bibr">1</a></sup>. Female representation within surgical specialties, remains poor, with females making up only 13 per cent of consultant surgeons in England and 27 per cent of the surgical workforce as a whole<sup><span class="xrefLink" id="jumplink-znad204-B2"></span><a href="javascript:;" reveal-id="znad204-B2" data-open="znad204-B2" class="link link-ref link-reveal xref-bibr">2</a></sup>.</p><p class="chapter-para">There has been a drive to understand the causes of this gap between the sexes. Studies have reported that surgery may be seen as an unattractive career for female undergraduates due to perceived difficulties in maintaining family life, limited opportunities for flexible training, and a lack of role models<sup><span class="xrefLink" id="jumplink-znad204-B3 znad204-B4 znad204-B5 znad204-B6"></span><a href="javascript:;" reveal-id="znad204-B3 znad204-B4 znad204-B5 znad204-B6" data-open="znad204-B3 znad204-B4 znad204-B5 znad204-B6" class="link link-ref link-reveal xref-bibr">3–6</a></sup>. Furthermore, data from the USA and Ireland indicate that female surgeons have fewer children, are more likely to delay parenthood, are at greater risk of pregnancy-associated complications, and have higher rates of infertility<sup><span class="xrefLink" id="jumplink-znad204-B7 znad204-B8 znad204-B9 znad204-B10"></span><a href="javascript:;" reveal-id="znad204-B7 znad204-B8 znad204-B9 znad204-B10" data-open="znad204-B7 znad204-B8 znad204-B9 znad204-B10" class="link link-ref link-reveal xref-bibr">7–10</a></sup>.</p><p class="chapter-para">To increase understanding of experiences of parenthood and pregnancy-associated risks in surgical training in the UK, an anonymized, online, cross-sectional survey of 416 surgical trainees/residents (346 females and 70 males; approximately 5 per cent response rate) was undertaken between 24 June and 24 December 2022 (<em><span class="link link-data-supplement" data-supplement-target="sup1"></span><span class="content-section supplementary-material"><a path-from-xml="sup1" href="https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/bjs/110/12/10.1093_bjs_znad204/1/znad204_supplementary_data.docx?Expires=1734694910&Signature=4oCcsx0lD5dXP6sN-1U8-f69xFEM3u~X~CYGC6HN-bgPOh58IhFVzgX0J-GG0IHSDGm9WEMNaNLnu7kMeJvuxrysUhgKjkan8mnG~JEja68qHHLXtddxe~ZoOf1pVnDFM-WNtJLM7frfE3RrVun3YkSdC5wU1jPaxJSETmGYdxW3DMp7WCEONNfDtCDnsc-9tUVI0KmyValkxvxtToYgjEbXZl7HiX1q93cpxpqT2SuD~MU-AaRUSF06NKFkZn7eu3zZhgK6dpVZTiIDdVDFrLhreGBgq6sTDpFdH4yAqfPRUeUXkGloVIPiphpPIQ40SEhss~PCnhTiJRkVvMLKmA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA">Fig. S1</a></span></em>, <span class="link link-data-supplement" data-supplement-target="sup1"></span><span class="content-section supplementary-material"><a path-from-xml="sup1" href="https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/bjs/110/12/10.1093_bjs_znad204/1/znad204_supplementary_data.docx?Expires=1734694910&Signature=4oCcsx0lD5dXP6sN-1U8-f69xFEM3u~X~CYGC6HN-bgPOh58IhFVzgX0J-GG0IHSDGm9WEMNaNLnu7kMeJvuxrysUhgKjkan8mnG~JEja68qHHLXtddxe~ZoOf1pVnDFM-WNtJLM7frfE3RrVun3YkSdC5wU1jPaxJSETmGYdxW3DMp7WCEONNfDtCDnsc-9tUVI0KmyValkxvxtToYgjEbXZl7HiX1q93cpxpqT2SuD~MU-AaRUSF06NKFkZn7eu3zZhgK6dpVZTiIDdVDFrLhreGBgq6sTDpFdH4yAqfPRUeUXkGloVIPiphpPIQ40SEhss~PCnhTiJRkVvMLKmA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA">Appendix S1, Supplementary Methods</a></span>). This research was conducted under ethical approval granted via the Central University Research Ethics Committee, University of Oxford (Ref: R80778/RE001).</p><p class="chapter-para">Surgeons spanned all training grades (5 per cent CT1-2, 45 per cent ST3-5, 35 per cent ST6-8, and 16 per cent out of programme/other). A total of 352 live births during surgical training were reported by 171 childbearing and 41 non-childbearing individuals (<em><span class="xrefLink" id="jumplink-znad204-T1"></span><a href="javascript:;" reveal-id="znad204-T1" data-open="znad204-T1" class="link link-reveal link-table xref-fig">Table 1</a></em>). Childbearing and non-childbearing trainee surgeons had similar numbers of children (mean(s.d.) = 0.84(0.99) <em>versus</em> 1.04(0.10), median = 1 (95 per cent c.i. 0 to 1) <em>versus</em> 1 (95 per cent c.i. 1 to 1); <em><span class="xrefLink" id="jumplink-znad204-T1"></span><a href="javascript:;" reveal-id="znad204-T1" data-open="znad204-T1" class="link link-reveal link-table xref-fig">Table 1</a></em>). A total of 56 per cent of childbearing and 40 per cent of non-childbearing surgical trainees delayed parenthood due to their training, and both male and female surgeons underwent infertility investigations more frequently than would be expected in the general UK population (<em><span class="xrefLink" id="jumplink-znad204-T1"></span><a href="javascript:;" reveal-id="znad204-T1" data-open="znad204-T1" class="link link-reveal link-table xref-fig">Table 1</a></em>)<sup><span class="xrefLink" id="jumplink-znad204-B11"></span><a href="javascript:;" reveal-id="znad204-B11" data-open="znad204-B11" class="link link-ref link-reveal xref-bibr">11</a></sup>. The majority (greater than 80 per cent) of trainee surgeons regretted their decision to delay parenthood. The risks of increased infertility and obstetric complications with increasing maternal age are well recognized. Cultural change and open discussion may enable surgical trainees to make better informed decisions about timing of attempts to become a parent.</p> <a id="424826661" scrollto-destination="424826661"></a> <div content-id="znad204-T1" class="table-modal table-full-width-wrap"><div class="table-wrap table-wide standard-table"><div class="table-wrap-title" id="znad204-T1" data-id="znad204-T1"><span class="label title-label" id="label-77699">Table 1</span><div class="
 graphic-wrap table-open-button-wrap
 "><a class="fig-view-orig at-tableViewLarge openInAnotherWindow btn js-view-large" role="button" target="_blank" href="
 /view-large/424826661" aria-describedby="label-77699"> Open in new tab </a></div><div class="caption caption-id-" id="caption-77699"><p class="chapter-para">Characteristics of the survey participants</p></div> </div><div class="table-overflow"><table role="table" aria-labelledby="
 label-77699" aria-describedby="
 caption-77699"><thead><tr><th><span aria-hidden="true" style="display: none;"> . </span></th><th>Childbearing surgeon, <em>n</em> = 346<span aria-hidden="true" style="display: none;"> . </span></th><th>Non-childbearing surgeon, <em>n</em> = 70<span aria-hidden="true" style="display: none;"> . </span></th><th><em>P</em><span aria-hidden="true" style="display: none;"> . </span></th></tr></thead><tbody><tr><td><strong>Relationship status</strong></td><td></td><td></td><td></td></tr><tr><td> Single, never married</td><td>31 (9)</td><td>0 (0)</td><td rowspan="3">0.015</td></tr><tr><td> Married/civil partnership/significant other</td><td>308 (89)</td><td>70 (100)</td></tr><tr><td> Divorced/separated and single</td><td>7 (2)</td><td>0 (0)</td></tr><tr><td><strong>Race or ethnicity</strong></td><td></td><td></td><td></td></tr><tr><td> White/Caucasian</td><td>273 (79)</td><td>46 (66)</td><td rowspan="6">0.022</td></tr><tr><td> Asian/Asian British</td><td>38 (11)</td><td>17 (24)</td></tr><tr><td> Mixed/multiple ethnic groups</td><td>18 (5)</td><td>3 (4)</td></tr><tr><td> Black, African, Caribbean/black British</td><td>13 (4)</td><td>1 (1)</td></tr><tr><td> Other</td><td>4 (1)</td><td>2 (3)</td></tr><tr><td> Not stated</td><td>0 (0)</td><td>1 (1)</td></tr><tr><td><strong>Age (years)</strong></td><td></td><td></td><td></td></tr><tr><td> 25–29</td><td>37 (11)</td><td>6 (9)</td><td rowspan="5">0.672</td></tr><tr><td> 30–34</td><td>171 (49)</td><td>38 (54)</td></tr><tr><td> 35–39</td><td>122 (35)</td><td>22 (31)</td></tr><tr><td> 40–44</td><td>15 (4)</td><td>3 (4)</td></tr><tr><td> >45</td><td>1 (1)</td><td>1 (1)</td></tr><tr><td><strong>Surgical specialty</strong></td><td></td><td></td><td></td></tr><tr><td> Cardiothoracic Surgery</td><td>2 (1)</td><td>0 (0)</td><td rowspan="12"><0.001</td></tr><tr><td> Ear, Nose, and Throat Surgery</td><td>31 (9)</td><td>12 (17)</td></tr><tr><td> General Surgery</td><td>42 (12)</td><td>3 (4)</td></tr><tr><td> Neurosurgery</td><td>6 (2)</td><td>1 (1)</td></tr><tr><td> Obstetrics and Gynaecology</td><td>107 (31)</td><td>1 (1)</td></tr><tr><td> Oral and Maxillofacial Surgery</td><td>9 (3)</td><td>2 (3)</td></tr><tr><td> Paediatric Surgery</td><td>8 (2)</td><td>0 (0)</td></tr><tr><td> Plastic Surgery</td><td>12 (3)</td><td>3 (4)</td></tr><tr><td> Trauma and Orthopaedics</td><td>27 (8)</td><td>3 (4)</td></tr><tr><td> Urology</td><td>75 (22)</td><td>42 (60)</td></tr><tr><td> Vascular Surgery</td><td>16 (5)</td><td>3 (4)</td></tr><tr><td> Other</td><td>11 (3)</td><td>0 (0)</td></tr><tr><td><strong>Partner occupation</strong></td><td></td><td></td><td></td></tr><tr><td> Physician</td><td>80 (26)</td><td>39 (56)</td><td rowspan="5"><0.001</td></tr><tr><td> Surgeon</td><td>40 (13)</td><td>2 (3)</td></tr><tr><td> Other</td><td>183 (59)</td><td>28 (40)</td></tr><tr><td> Unemployed</td><td>4 (1)</td><td>1 (1)</td></tr><tr><td> Prefer not to answer</td><td>1 (0)</td><td>0 (0)</td></tr><tr><td><strong>Partners working hours/week (excluding domestic obligations)</strong></td><td></td><td></td><td></td></tr><tr><td> 0–19 h</td><td>7 (2)</td><td>8 (11)</td><td rowspan="4">0.001</td></tr><tr><td> 20–39 h</td><td>79 (26)</td><td>24 (34)</td></tr><tr><td> 40–59 h</td><td>184 (60)</td><td>37 (52)</td></tr><tr><td> >60 h</td><td>38 (11)</td><td>1 (1)</td></tr><tr><td><strong>Number of biological children</strong></td><td></td><td></td><td></td></tr><tr><td> 0</td><td>172 (50)</td><td>26 (37)</td><td rowspan="4">0.283</td></tr><tr><td> 1</td><td>81 (23)</td><td>21 (30)</td></tr><tr><td> 2</td><td>70 (20)</td><td>18 (26)</td></tr><tr><td> ≥3</td><td>23 (7)</td><td>5 (7)</td></tr><tr><td>Number of children, mean</td><td>0.84</td><td>1.04</td><td>0.125</td></tr><tr><td>Age of child bearer at first live birth (years), mean</td><td>31.9</td><td>31.2</td><td>0.097</td></tr><tr><td>Undergone infertility testing</td><td>53 (24)</td><td>11 (22)</td><td>0.855</td></tr></tbody></table></div><div class="table-modal"><table><thead><tr><th><span aria-hidden="true" style="display: none;"> . </span></th><th>Childbearing surgeon, <em>n</em> = 346<span aria-hidden="true" style="display: none;"> . </span></th><th>Non-childbearing surgeon, <em>n</em> = 70<span aria-hidden="true" style="display: none;"> . </span></th><th><em>P</em><span aria-hidden="true" style="display: none;"> . </span></th></tr></thead><tbody><tr><td><strong>Relationship status</strong></td><td></td><td></td><td></td></tr><tr><td> Single, never married</td><td>31 (9)</td><td>0 (0)</td><td rowspan="3">0.015</td></tr><tr><td> Married/civil partnership/significant other</td><td>308 (89)</td><td>70 (100)</td></tr><tr><td> Divorced/separated and single</td><td>7 (2)</td><td>0 (0)</td></tr><tr><td><strong>Race or ethnicity</strong></td><td></td><td></td><td></td></tr><tr><td> White/Caucasian</td><td>273 (79)</td><td>46 (66)</td><td rowspan="6">0.022</td></tr><tr><td> Asian/Asian British</td><td>38 (11)</td><td>17 (24)</td></tr><tr><td> Mixed/multiple ethnic groups</td><td>18 (5)</td><td>3 (4)</td></tr><tr><td> Black, African, Caribbean/black British</td><td>13 (4)</td><td>1 (1)</td></tr><tr><td> Other</td><td>4 (1)</td><td>2 (3)</td></tr><tr><td> Not stated</td><td>0 (0)</td><td>1 (1)</td></tr><tr><td><strong>Age (years)</strong></td><td></td><td></td><td></td></tr><tr><td> 25–29</td><td>37 (11)</td><td>6 (9)</td><td rowspan="5">0.672</td></tr><tr><td> 30–34</td><td>171 (49)</td><td>38 (54)</td></tr><tr><td> 35–39</td><td>122 (35)</td><td>22 (31)</td></tr><tr><td> 40–44</td><td>15 (4)</td><td>3 (4)</td></tr><tr><td> >45</td><td>1 (1)</td><td>1 (1)</td></tr><tr><td><strong>Surgical specialty</strong></td><td></td><td></td><td></td></tr><tr><td> Cardiothoracic Surgery</td><td>2 (1)</td><td>0 (0)</td><td rowspan="12"><0.001</td></tr><tr><td> Ear, Nose, and Throat Surgery</td><td>31 (9)</td><td>12 (17)</td></tr><tr><td> General Surgery</td><td>42 (12)</td><td>3 (4)</td></tr><tr><td> Neurosurgery</td><td>6 (2)</td><td>1 (1)</td></tr><tr><td> Obstetrics and Gynaecology</td><td>107 (31)</td><td>1 (1)</td></tr><tr><td> Oral and Maxillofacial Surgery</td><td>9 (3)</td><td>2 (3)</td></tr><tr><td> Paediatric Surgery</td><td>8 (2)</td><td>0 (0)</td></tr><tr><td> Plastic Surgery</td><td>12 (3)</td><td>3 (4)</td></tr><tr><td> Trauma and Orthopaedics</td><td>27 (8)</td><td>3 (4)</td></tr><tr><td> Urology</td><td>75 (22)</td><td>42 (60)</td></tr><tr><td> Vascular Surgery</td><td>16 (5)</td><td>3 (4)</td></tr><tr><td> Other</td><td>11 (3)</td><td>0 (0)</td></tr><tr><td><strong>Partner occupation</strong></td><td></td><td></td><td></td></tr><tr><td> Physician</td><td>80 (26)</td><td>39 (56)</td><td rowspan="5"><0.001</td></tr><tr><td> Surgeon</td><td>40 (13)</td><td>2 (3)</td></tr><tr><td> Other</td><td>183 (59)</td><td>28 (40)</td></tr><tr><td> Unemployed</td><td>4 (1)</td><td>1 (1)</td></tr><tr><td> Prefer not to answer</td><td>1 (0)</td><td>0 (0)</td></tr><tr><td><strong>Partners working hours/week (excluding domestic obligations)</strong></td><td></td><td></td><td></td></tr><tr><td> 0–19 h</td><td>7 (2)</td><td>8 (11)</td><td rowspan="4">0.001</td></tr><tr><td> 20–39 h</td><td>79 (26)</td><td>24 (34)</td></tr><tr><td> 40–59 h</td><td>184 (60)</td><td>37 (52)</td></tr><tr><td> >60 h</td><td>38 (11)</td><td>1 (1)</td></tr><tr><td><strong>Number of biological children</strong></td><td></td><td></td><td></td></tr><tr><td> 0</td><td>172 (50)</td><td>26 (37)</td><td rowspan="4">0.283</td></tr><tr><td> 1</td><td>81 (23)</td><td>21 (30)</td></tr><tr><td> 2</td><td>70 (20)</td><td>18 (26)</td></tr><tr><td> ≥3</td><td>23 (7)</td><td>5 (7)</td></tr><tr><td>Number of children, mean</td><td>0.84</td><td>1.04</td><td>0.125</td></tr><tr><td>Age of child bearer at first live birth (years), mean</td><td>31.9</td><td>31.2</td><td>0.097</td></tr><tr><td>Undergone infertility testing</td><td>53 (24)</td><td>11 (22)</td><td>0.855</td></tr></tbody></table></div><div class="table-wrap-foot"><span id="fn-znad204-tblfn1"></span><div content-id="znad204-tblfn1" class="footnote"><span class="fn"><p class="chapter-para">Values are <em>n</em> (%) unless otherwise stated.</p></span></div></div></div></div><div class="table-full-width-wrap"><div class="table-wrap table-wide standard-table"><div class="table-wrap-title" id="znad204-T1" data-id="znad204-T1"><span class="label title-label" id="label-77699">Table 1</span><div class="
 graphic-wrap table-open-button-wrap
 "><a class="fig-view-orig at-tableViewLarge openInAnotherWindow btn js-view-large" role="button" target="_blank" href="
 /view-large/424826661" aria-describedby="label-77699"> Open in new tab </a></div><div class="caption caption-id-" id="caption-77699"><p class="chapter-para">Characteristics of the survey participants</p></div> </div><div class="table-overflow"><table role="table" aria-labelledby="
 label-77699" aria-describedby="
 caption-77699"><thead><tr><th><span aria-hidden="true" style="display: none;"> . </span></th><th>Childbearing surgeon, <em>n</em> = 346<span aria-hidden="true" style="display: none;"> . </span></th><th>Non-childbearing surgeon, <em>n</em> = 70<span aria-hidden="true" style="display: none;"> . </span></th><th><em>P</em><span aria-hidden="true" style="display: none;"> . </span></th></tr></thead><tbody><tr><td><strong>Relationship status</strong></td><td></td><td></td><td></td></tr><tr><td> Single, never married</td><td>31 (9)</td><td>0 (0)</td><td rowspan="3">0.015</td></tr><tr><td> Married/civil partnership/significant other</td><td>308 (89)</td><td>70 (100)</td></tr><tr><td> Divorced/separated and single</td><td>7 (2)</td><td>0 (0)</td></tr><tr><td><strong>Race or ethnicity</strong></td><td></td><td></td><td></td></tr><tr><td> White/Caucasian</td><td>273 (79)</td><td>46 (66)</td><td rowspan="6">0.022</td></tr><tr><td> Asian/Asian British</td><td>38 (11)</td><td>17 (24)</td></tr><tr><td> Mixed/multiple ethnic groups</td><td>18 (5)</td><td>3 (4)</td></tr><tr><td> Black, African, Caribbean/black British</td><td>13 (4)</td><td>1 (1)</td></tr><tr><td> Other</td><td>4 (1)</td><td>2 (3)</td></tr><tr><td> Not stated</td><td>0 (0)</td><td>1 (1)</td></tr><tr><td><strong>Age (years)</strong></td><td></td><td></td><td></td></tr><tr><td> 25–29</td><td>37 (11)</td><td>6 (9)</td><td rowspan="5">0.672</td></tr><tr><td> 30–34</td><td>171 (49)</td><td>38 (54)</td></tr><tr><td> 35–39</td><td>122 (35)</td><td>22 (31)</td></tr><tr><td> 40–44</td><td>15 (4)</td><td>3 (4)</td></tr><tr><td> >45</td><td>1 (1)</td><td>1 (1)</td></tr><tr><td><strong>Surgical specialty</strong></td><td></td><td></td><td></td></tr><tr><td> Cardiothoracic Surgery</td><td>2 (1)</td><td>0 (0)</td><td rowspan="12"><0.001</td></tr><tr><td> Ear, Nose, and Throat Surgery</td><td>31 (9)</td><td>12 (17)</td></tr><tr><td> General Surgery</td><td>42 (12)</td><td>3 (4)</td></tr><tr><td> Neurosurgery</td><td>6 (2)</td><td>1 (1)</td></tr><tr><td> Obstetrics and Gynaecology</td><td>107 (31)</td><td>1 (1)</td></tr><tr><td> Oral and Maxillofacial Surgery</td><td>9 (3)</td><td>2 (3)</td></tr><tr><td> Paediatric Surgery</td><td>8 (2)</td><td>0 (0)</td></tr><tr><td> Plastic Surgery</td><td>12 (3)</td><td>3 (4)</td></tr><tr><td> Trauma and Orthopaedics</td><td>27 (8)</td><td>3 (4)</td></tr><tr><td> Urology</td><td>75 (22)</td><td>42 (60)</td></tr><tr><td> Vascular Surgery</td><td>16 (5)</td><td>3 (4)</td></tr><tr><td> Other</td><td>11 (3)</td><td>0 (0)</td></tr><tr><td><strong>Partner occupation</strong></td><td></td><td></td><td></td></tr><tr><td> Physician</td><td>80 (26)</td><td>39 (56)</td><td rowspan="5"><0.001</td></tr><tr><td> Surgeon</td><td>40 (13)</td><td>2 (3)</td></tr><tr><td> Other</td><td>183 (59)</td><td>28 (40)</td></tr><tr><td> Unemployed</td><td>4 (1)</td><td>1 (1)</td></tr><tr><td> Prefer not to answer</td><td>1 (0)</td><td>0 (0)</td></tr><tr><td><strong>Partners working hours/week (excluding domestic obligations)</strong></td><td></td><td></td><td></td></tr><tr><td> 0–19 h</td><td>7 (2)</td><td>8 (11)</td><td rowspan="4">0.001</td></tr><tr><td> 20–39 h</td><td>79 (26)</td><td>24 (34)</td></tr><tr><td> 40–59 h</td><td>184 (60)</td><td>37 (52)</td></tr><tr><td> >60 h</td><td>38 (11)</td><td>1 (1)</td></tr><tr><td><strong>Number of biological children</strong></td><td></td><td></td><td></td></tr><tr><td> 0</td><td>172 (50)</td><td>26 (37)</td><td rowspan="4">0.283</td></tr><tr><td> 1</td><td>81 (23)</td><td>21 (30)</td></tr><tr><td> 2</td><td>70 (20)</td><td>18 (26)</td></tr><tr><td> ≥3</td><td>23 (7)</td><td>5 (7)</td></tr><tr><td>Number of children, mean</td><td>0.84</td><td>1.04</td><td>0.125</td></tr><tr><td>Age of child bearer at first live birth (years), mean</td><td>31.9</td><td>31.2</td><td>0.097</td></tr><tr><td>Undergone infertility testing</td><td>53 (24)</td><td>11 (22)</td><td>0.855</td></tr></tbody></table></div><div class="table-modal"><table><thead><tr><th><span aria-hidden="true" style="display: none;"> . </span></th><th>Childbearing surgeon, <em>n</em> = 346<span aria-hidden="true" style="display: none;"> . </span></th><th>Non-childbearing surgeon, <em>n</em> = 70<span aria-hidden="true" style="display: none;"> . </span></th><th><em>P</em><span aria-hidden="true" style="display: none;"> . </span></th></tr></thead><tbody><tr><td><strong>Relationship status</strong></td><td></td><td></td><td></td></tr><tr><td> Single, never married</td><td>31 (9)</td><td>0 (0)</td><td rowspan="3">0.015</td></tr><tr><td> Married/civil partnership/significant other</td><td>308 (89)</td><td>70 (100)</td></tr><tr><td> Divorced/separated and single</td><td>7 (2)</td><td>0 (0)</td></tr><tr><td><strong>Race or ethnicity</strong></td><td></td><td></td><td></td></tr><tr><td> White/Caucasian</td><td>273 (79)</td><td>46 (66)</td><td rowspan="6">0.022</td></tr><tr><td> Asian/Asian British</td><td>38 (11)</td><td>17 (24)</td></tr><tr><td> Mixed/multiple ethnic groups</td><td>18 (5)</td><td>3 (4)</td></tr><tr><td> Black, African, Caribbean/black British</td><td>13 (4)</td><td>1 (1)</td></tr><tr><td> Other</td><td>4 (1)</td><td>2 (3)</td></tr><tr><td> Not stated</td><td>0 (0)</td><td>1 (1)</td></tr><tr><td><strong>Age (years)</strong></td><td></td><td></td><td></td></tr><tr><td> 25–29</td><td>37 (11)</td><td>6 (9)</td><td rowspan="5">0.672</td></tr><tr><td> 30–34</td><td>171 (49)</td><td>38 (54)</td></tr><tr><td> 35–39</td><td>122 (35)</td><td>22 (31)</td></tr><tr><td> 40–44</td><td>15 (4)</td><td>3 (4)</td></tr><tr><td> >45</td><td>1 (1)</td><td>1 (1)</td></tr><tr><td><strong>Surgical specialty</strong></td><td></td><td></td><td></td></tr><tr><td> Cardiothoracic Surgery</td><td>2 (1)</td><td>0 (0)</td><td rowspan="12"><0.001</td></tr><tr><td> Ear, Nose, and Throat Surgery</td><td>31 (9)</td><td>12 (17)</td></tr><tr><td> General Surgery</td><td>42 (12)</td><td>3 (4)</td></tr><tr><td> Neurosurgery</td><td>6 (2)</td><td>1 (1)</td></tr><tr><td> Obstetrics and Gynaecology</td><td>107 (31)</td><td>1 (1)</td></tr><tr><td> Oral and Maxillofacial Surgery</td><td>9 (3)</td><td>2 (3)</td></tr><tr><td> Paediatric Surgery</td><td>8 (2)</td><td>0 (0)</td></tr><tr><td> Plastic Surgery</td><td>12 (3)</td><td>3 (4)</td></tr><tr><td> Trauma and Orthopaedics</td><td>27 (8)</td><td>3 (4)</td></tr><tr><td> Urology</td><td>75 (22)</td><td>42 (60)</td></tr><tr><td> Vascular Surgery</td><td>16 (5)</td><td>3 (4)</td></tr><tr><td> Other</td><td>11 (3)</td><td>0 (0)</td></tr><tr><td><strong>Partner occupation</strong></td><td></td><td></td><td></td></tr><tr><td> Physician</td><td>80 (26)</td><td>39 (56)</td><td rowspan="5"><0.001</td></tr><tr><td> Surgeon</td><td>40 (13)</td><td>2 (3)</td></tr><tr><td> Other</td><td>183 (59)</td><td>28 (40)</td></tr><tr><td> Unemployed</td><td>4 (1)</td><td>1 (1)</td></tr><tr><td> Prefer not to answer</td><td>1 (0)</td><td>0 (0)</td></tr><tr><td><strong>Partners working hours/week (excluding domestic obligations)</strong></td><td></td><td></td><td></td></tr><tr><td> 0–19 h</td><td>7 (2)</td><td>8 (11)</td><td rowspan="4">0.001</td></tr><tr><td> 20–39 h</td><td>79 (26)</td><td>24 (34)</td></tr><tr><td> 40–59 h</td><td>184 (60)</td><td>37 (52)</td></tr><tr><td> >60 h</td><td>38 (11)</td><td>1 (1)</td></tr><tr><td><strong>Number of biological children</strong></td><td></td><td></td><td></td></tr><tr><td> 0</td><td>172 (50)</td><td>26 (37)</td><td rowspan="4">0.283</td></tr><tr><td> 1</td><td>81 (23)</td><td>21 (30)</td></tr><tr><td> 2</td><td>70 (20)</td><td>18 (26)</td></tr><tr><td> ≥3</td><td>23 (7)</td><td>5 (7)</td></tr><tr><td>Number of children, mean</td><td>0.84</td><td>1.04</td><td>0.125</td></tr><tr><td>Age of child bearer at first live birth (years), mean</td><td>31.9</td><td>31.2</td><td>0.097</td></tr><tr><td>Undergone infertility testing</td><td>53 (24)</td><td>11 (22)</td><td>0.855</td></tr></tbody></table></div><div class="table-wrap-foot"><span id="fn-znad204-tblfn1"></span><div content-id="znad204-tblfn1" class="footnote"><span class="fn"><p class="chapter-para">Values are <em>n</em> (%) unless otherwise stated.</p></span></div></div></div></div><p class="chapter-para">Of the 222 childbearing surgical trainees who had been pregnant, 36 per cent had experienced a pregnancy loss, with a pregnancy loss rate of 31 per cent. These findings are comparable to data from non-surgeon partners, which may reflect the fact that nearly 60 per cent of childbearing partners of surgical trainees in this survey were doctors (<em><span class="xrefLink" id="jumplink-znad204-T2"></span><a href="javascript:;" reveal-id="znad204-T2" data-open="znad204-T2" class="link link-reveal link-table xref-fig">Table 2</a></em>). In all age groups, rates of pregnancy loss in surgeons were higher than those reported in a large registry-based study (<em><span class="xrefLink" id="jumplink-znad204-T2"></span><a href="javascript:;" reveal-id="znad204-T2" data-open="znad204-T2" class="link link-reveal link-table xref-fig">Table 2</a></em>)<sup><span class="xrefLink" id="jumplink-znad204-B13"></span><a href="javascript:;" reveal-id="znad204-B13" data-open="znad204-B13" class="link link-ref link-reveal xref-bibr">13</a></sup>. Of note, loss rates were 35 per cent in those aged under 35 years at the time of survey completion, a rate that is over three times that which would be expected in this age group (<em><span class="xrefLink" id="jumplink-znad204-T2"></span><a href="javascript:;" reveal-id="znad204-T2" data-open="znad204-T2" class="link link-reveal link-table xref-fig">Table 2</a></em>). After pregnancy loss, one in three childbearing surgical trainees did not take any time off work, and only 47 per cent disclosed their loss to a colleague. In general, surgical trainees who did share their loss with colleagues found them to be supportive (<em><span class="link link-data-supplement" data-supplement-target="sup1"></span><span class="content-section supplementary-material"><a path-from-xml="sup1" href="https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/bjs/110/12/10.1093_bjs_znad204/1/znad204_supplementary_data.docx?Expires=1734694910&Signature=4oCcsx0lD5dXP6sN-1U8-f69xFEM3u~X~CYGC6HN-bgPOh58IhFVzgX0J-GG0IHSDGm9WEMNaNLnu7kMeJvuxrysUhgKjkan8mnG~JEja68qHHLXtddxe~ZoOf1pVnDFM-WNtJLM7frfE3RrVun3YkSdC5wU1jPaxJSETmGYdxW3DMp7WCEONNfDtCDnsc-9tUVI0KmyValkxvxtToYgjEbXZl7HiX1q93cpxpqT2SuD~MU-AaRUSF06NKFkZn7eu3zZhgK6dpVZTiIDdVDFrLhreGBgq6sTDpFdH4yAqfPRUeUXkGloVIPiphpPIQ40SEhss~PCnhTiJRkVvMLKmA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA">Table S1</a></span></em>).</p> <a id="424826663" scrollto-destination="424826663"></a> <div content-id="znad204-T2" class="table-modal table-full-width-wrap"><div class="table-wrap table-wide standard-table"><div class="table-wrap-title" id="znad204-T2" data-id="znad204-T2"><span class="label title-label" id="label-13580">Table 2</span><div class="
 graphic-wrap table-open-button-wrap
 "><a class="fig-view-orig at-tableViewLarge openInAnotherWindow btn js-view-large" role="button" target="_blank" href="
 /view-large/424826663" aria-describedby="label-13580"> Open in new tab </a></div><div class="caption caption-id-" id="caption-13580"><p class="chapter-para">Pregnancy loss and complications in surgical training</p></div> </div><div class="table-overflow"><table role="table" aria-labelledby="
 label-13580" aria-describedby="
 caption-13580"><thead><tr><th><span aria-hidden="true" style="display: none;"> . </span></th><th>Childbearing surgeon<span aria-hidden="true" style="display: none;"> . </span></th><th>Non-surgeon partner<span aria-hidden="true" style="display: none;"> . </span></th><th><em>P</em> value or expected pregnancy loss rate*<span aria-hidden="true" style="display: none;"> . </span></th></tr></thead><tbody><tr><td>Individuals who experienced pregnancy loss</td><td>80 (36)</td><td>19 (40)</td><td>0.619</td></tr><tr><td><strong>Gestation at pregnancy loss</strong></td><td></td><td></td><td></td></tr><tr><td> Losses at <12 weeks</td><td>114 (90)</td><td>24 (83)</td><td rowspan="3">0.287</td></tr><tr><td> Losses at 12–24 weeks</td><td>13 (10)</td><td>5 (17)</td></tr><tr><td> Still births</td><td>0 (0)</td><td>0 (0)</td></tr><tr><td><strong>Pregnancy loss rate, %</strong></td><td></td><td></td><td></td></tr><tr><td> All ages (410<sup>†</sup>)</td><td>31</td><td>30 (19)</td><td>‡</td></tr><tr><td> <30 years<sup>§</sup> (4<sup>†</sup>)</td><td>25</td><td>‡</td><td>10</td></tr><tr><td> 30–34 years<sup>§</sup> (115<sup>†</sup>)</td><td>35</td><td>‡</td><td>11</td></tr><tr><td> 35–39 years<sup>§</sup> (246<sup>†</sup>)</td><td>30</td><td>‡</td><td>17</td></tr><tr><td> ≥40 years<sup>§</sup> (45<sup>†</sup>)</td><td>36</td><td>‡</td><td>32</td></tr><tr><td><strong>Pregnancy complications</strong></td><td></td><td></td><td></td></tr><tr><td> Pregnancy with complication requiring bedrest</td><td>50 (18)</td><td>10 (14)</td><td>0.596</td></tr><tr><td> Pregnancy with one or more minor complications</td><td>175 (62)</td><td>35 (51)</td><td>0.100</td></tr><tr><td> Pregnancy with one or more major complications</td><td>87 (31)</td><td>6 (9)</td><td>0.001</td></tr><tr><td> Delivery with one or more intrapartum complications</td><td>60 (21)</td><td>9 (13)</td><td>0.132</td></tr><tr><td> Delivery with one or more postpartum complications</td><td>27 (10)</td><td>4 (6)</td><td>0.477</td></tr><tr><td><strong>Neonatal complications</strong></td><td></td><td></td><td></td></tr><tr><td> NICU stay</td><td>17 (6)</td><td>3 (4)</td><td rowspan="2">0.741</td></tr><tr><td> Delivery <38 weeks</td><td>35 (12)</td><td>7 (10)</td></tr></tbody></table></div><div class="table-modal"><table><thead><tr><th><span aria-hidden="true" style="display: none;"> . </span></th><th>Childbearing surgeon<span aria-hidden="true" style="display: none;"> . </span></th><th>Non-surgeon partner<span aria-hidden="true" style="display: none;"> . </span></th><th><em>P</em> value or expected pregnancy loss rate*<span aria-hidden="true" style="display: none;"> . </span></th></tr></thead><tbody><tr><td>Individuals who experienced pregnancy loss</td><td>80 (36)</td><td>19 (40)</td><td>0.619</td></tr><tr><td><strong>Gestation at pregnancy loss</strong></td><td></td><td></td><td></td></tr><tr><td> Losses at <12 weeks</td><td>114 (90)</td><td>24 (83)</td><td rowspan="3">0.287</td></tr><tr><td> Losses at 12–24 weeks</td><td>13 (10)</td><td>5 (17)</td></tr><tr><td> Still births</td><td>0 (0)</td><td>0 (0)</td></tr><tr><td><strong>Pregnancy loss rate, %</strong></td><td></td><td></td><td></td></tr><tr><td> All ages (410<sup>†</sup>)</td><td>31</td><td>30 (19)</td><td>‡</td></tr><tr><td> <30 years<sup>§</sup> (4<sup>†</sup>)</td><td>25</td><td>‡</td><td>10</td></tr><tr><td> 30–34 years<sup>§</sup> (115<sup>†</sup>)</td><td>35</td><td>‡</td><td>11</td></tr><tr><td> 35–39 years<sup>§</sup> (246<sup>†</sup>)</td><td>30</td><td>‡</td><td>17</td></tr><tr><td> ≥40 years<sup>§</sup> (45<sup>†</sup>)</td><td>36</td><td>‡</td><td>32</td></tr><tr><td><strong>Pregnancy complications</strong></td><td></td><td></td><td></td></tr><tr><td> Pregnancy with complication requiring bedrest</td><td>50 (18)</td><td>10 (14)</td><td>0.596</td></tr><tr><td> Pregnancy with one or more minor complications</td><td>175 (62)</td><td>35 (51)</td><td>0.100</td></tr><tr><td> Pregnancy with one or more major complications</td><td>87 (31)</td><td>6 (9)</td><td>0.001</td></tr><tr><td> Delivery with one or more intrapartum complications</td><td>60 (21)</td><td>9 (13)</td><td>0.132</td></tr><tr><td> Delivery with one or more postpartum complications</td><td>27 (10)</td><td>4 (6)</td><td>0.477</td></tr><tr><td><strong>Neonatal complications</strong></td><td></td><td></td><td></td></tr><tr><td> NICU stay</td><td>17 (6)</td><td>3 (4)</td><td rowspan="2">0.741</td></tr><tr><td> Delivery <38 weeks</td><td>35 (12)</td><td>7 (10)</td></tr></tbody></table></div><div class="table-wrap-foot"><span id="fn-znad204-tblfn2"></span><div content-id="znad204-tblfn2" class="footnote"><span class="fn"><p class="chapter-para">Values are <em>n</em> (%) unless otherwise stated. *Pregnancy loss rates as reported in ages 25–29, 30–34, 35–39, and 40–44 years in Magnus <em>et al</em>.<sup><span class="xrefLink" id="jumplink-znad204-B12"></span><a href="javascript:;" reveal-id="znad204-B12" data-open="znad204-B12" class="link link-ref link-reveal xref-bibr">12</a></sup> †Participant age at time of survey completion. ‡Data not available. §Total number of pregnancies in childbearing surgeons in this age group. NICU, neonatal intensive care unit.</p></span></div></div></div></div><div class="table-full-width-wrap"><div class="table-wrap table-wide standard-table"><div class="table-wrap-title" id="znad204-T2" data-id="znad204-T2"><span class="label title-label" id="label-13580">Table 2</span><div class="
 graphic-wrap table-open-button-wrap
 "><a class="fig-view-orig at-tableViewLarge openInAnotherWindow btn js-view-large" role="button" target="_blank" href="
 /view-large/424826663" aria-describedby="label-13580"> Open in new tab </a></div><div class="caption caption-id-" id="caption-13580"><p class="chapter-para">Pregnancy loss and complications in surgical training</p></div> </div><div class="table-overflow"><table role="table" aria-labelledby="
 label-13580" aria-describedby="
 caption-13580"><thead><tr><th><span aria-hidden="true" style="display: none;"> . </span></th><th>Childbearing surgeon<span aria-hidden="true" style="display: none;"> . </span></th><th>Non-surgeon partner<span aria-hidden="true" style="display: none;"> . </span></th><th><em>P</em> value or expected pregnancy loss rate*<span aria-hidden="true" style="display: none;"> . </span></th></tr></thead><tbody><tr><td>Individuals who experienced pregnancy loss</td><td>80 (36)</td><td>19 (40)</td><td>0.619</td></tr><tr><td><strong>Gestation at pregnancy loss</strong></td><td></td><td></td><td></td></tr><tr><td> Losses at <12 weeks</td><td>114 (90)</td><td>24 (83)</td><td rowspan="3">0.287</td></tr><tr><td> Losses at 12–24 weeks</td><td>13 (10)</td><td>5 (17)</td></tr><tr><td> Still births</td><td>0 (0)</td><td>0 (0)</td></tr><tr><td><strong>Pregnancy loss rate, %</strong></td><td></td><td></td><td></td></tr><tr><td> All ages (410<sup>†</sup>)</td><td>31</td><td>30 (19)</td><td>‡</td></tr><tr><td> <30 years<sup>§</sup> (4<sup>†</sup>)</td><td>25</td><td>‡</td><td>10</td></tr><tr><td> 30–34 years<sup>§</sup> (115<sup>†</sup>)</td><td>35</td><td>‡</td><td>11</td></tr><tr><td> 35–39 years<sup>§</sup> (246<sup>†</sup>)</td><td>30</td><td>‡</td><td>17</td></tr><tr><td> ≥40 years<sup>§</sup> (45<sup>†</sup>)</td><td>36</td><td>‡</td><td>32</td></tr><tr><td><strong>Pregnancy complications</strong></td><td></td><td></td><td></td></tr><tr><td> Pregnancy with complication requiring bedrest</td><td>50 (18)</td><td>10 (14)</td><td>0.596</td></tr><tr><td> Pregnancy with one or more minor complications</td><td>175 (62)</td><td>35 (51)</td><td>0.100</td></tr><tr><td> Pregnancy with one or more major complications</td><td>87 (31)</td><td>6 (9)</td><td>0.001</td></tr><tr><td> Delivery with one or more intrapartum complications</td><td>60 (21)</td><td>9 (13)</td><td>0.132</td></tr><tr><td> Delivery with one or more postpartum complications</td><td>27 (10)</td><td>4 (6)</td><td>0.477</td></tr><tr><td><strong>Neonatal complications</strong></td><td></td><td></td><td></td></tr><tr><td> NICU stay</td><td>17 (6)</td><td>3 (4)</td><td rowspan="2">0.741</td></tr><tr><td> Delivery <38 weeks</td><td>35 (12)</td><td>7 (10)</td></tr></tbody></table></div><div class="table-modal"><table><thead><tr><th><span aria-hidden="true" style="display: none;"> . </span></th><th>Childbearing surgeon<span aria-hidden="true" style="display: none;"> . </span></th><th>Non-surgeon partner<span aria-hidden="true" style="display: none;"> . </span></th><th><em>P</em> value or expected pregnancy loss rate*<span aria-hidden="true" style="display: none;"> . </span></th></tr></thead><tbody><tr><td>Individuals who experienced pregnancy loss</td><td>80 (36)</td><td>19 (40)</td><td>0.619</td></tr><tr><td><strong>Gestation at pregnancy loss</strong></td><td></td><td></td><td></td></tr><tr><td> Losses at <12 weeks</td><td>114 (90)</td><td>24 (83)</td><td rowspan="3">0.287</td></tr><tr><td> Losses at 12–24 weeks</td><td>13 (10)</td><td>5 (17)</td></tr><tr><td> Still births</td><td>0 (0)</td><td>0 (0)</td></tr><tr><td><strong>Pregnancy loss rate, %</strong></td><td></td><td></td><td></td></tr><tr><td> All ages (410<sup>†</sup>)</td><td>31</td><td>30 (19)</td><td>‡</td></tr><tr><td> <30 years<sup>§</sup> (4<sup>†</sup>)</td><td>25</td><td>‡</td><td>10</td></tr><tr><td> 30–34 years<sup>§</sup> (115<sup>†</sup>)</td><td>35</td><td>‡</td><td>11</td></tr><tr><td> 35–39 years<sup>§</sup> (246<sup>†</sup>)</td><td>30</td><td>‡</td><td>17</td></tr><tr><td> ≥40 years<sup>§</sup> (45<sup>†</sup>)</td><td>36</td><td>‡</td><td>32</td></tr><tr><td><strong>Pregnancy complications</strong></td><td></td><td></td><td></td></tr><tr><td> Pregnancy with complication requiring bedrest</td><td>50 (18)</td><td>10 (14)</td><td>0.596</td></tr><tr><td> Pregnancy with one or more minor complications</td><td>175 (62)</td><td>35 (51)</td><td>0.100</td></tr><tr><td> Pregnancy with one or more major complications</td><td>87 (31)</td><td>6 (9)</td><td>0.001</td></tr><tr><td> Delivery with one or more intrapartum complications</td><td>60 (21)</td><td>9 (13)</td><td>0.132</td></tr><tr><td> Delivery with one or more postpartum complications</td><td>27 (10)</td><td>4 (6)</td><td>0.477</td></tr><tr><td><strong>Neonatal complications</strong></td><td></td><td></td><td></td></tr><tr><td> NICU stay</td><td>17 (6)</td><td>3 (4)</td><td rowspan="2">0.741</td></tr><tr><td> Delivery <38 weeks</td><td>35 (12)</td><td>7 (10)</td></tr></tbody></table></div><div class="table-wrap-foot"><span id="fn-znad204-tblfn2"></span><div content-id="znad204-tblfn2" class="footnote"><span class="fn"><p class="chapter-para">Values are <em>n</em> (%) unless otherwise stated. *Pregnancy loss rates as reported in ages 25–29, 30–34, 35–39, and 40–44 years in Magnus <em>et al</em>.<sup><span class="xrefLink" id="jumplink-znad204-B12"></span><a href="javascript:;" reveal-id="znad204-B12" data-open="znad204-B12" class="link link-ref link-reveal xref-bibr">12</a></sup> †Participant age at time of survey completion. ‡Data not available. §Total number of pregnancies in childbearing surgeons in this age group. NICU, neonatal intensive care unit.</p></span></div></div></div></div><p class="chapter-para">The psychological impact of early pregnancy loss is well recognized<sup><span class="xrefLink" id="jumplink-znad204-B14 znad204-B15 znad204-B16"></span><a href="javascript:;" reveal-id="znad204-B14 znad204-B15 znad204-B16" data-open="znad204-B14 znad204-B15 znad204-B16" class="link link-ref link-reveal xref-bibr">14–16</a></sup>. Surgical training programmes should consider offering bereavement support and mandated leave after pregnancy loss to reduce the burden of guilt associated with taking time off work. Appointment of a lead clinician for pregnancy support may help trainees navigate this difficult area, providing a single point of contact to facilitate changes to working schedules in early pregnancy and acting to offer guidance after loss.</p><p class="chapter-para">Childbearing surgical trainees experienced minor and major pregnancy-associated complications in 62 and 31 per cent of pregnancies, respectively (<em><span class="xrefLink" id="jumplink-znad204-T2"></span><a href="javascript:;" reveal-id="znad204-T2" data-open="znad204-T2" class="link link-reveal link-table xref-fig">Table 2</a></em>). Major pregnancy complications were more likely in childbearing surgical trainees than the partners of non-childbearing surgical trainees (<em><span class="xrefLink" id="jumplink-znad204-T2"></span><a href="javascript:;" reveal-id="znad204-T2" data-open="znad204-T2" class="link link-reveal link-table xref-fig">Table 2</a></em>). Approximately 60 per cent of trainees who required time away from work due to pregnancy-associated complications felt their colleagues and training programme were supportive. Twelve childbearing surgical trainees reported a financial loss, ranging from £3000 to £50 000 (median £7500), due to work restriction during pregnancy. Rates of neonatal, intrapartum, and postpartum complications were higher in childbearing surgical trainees than in the partners of surgical trainees; however, statistical significance was not reached, this may be due to the small sample size (<em><span class="xrefLink" id="jumplink-znad204-T2"></span><a href="javascript:;" reveal-id="znad204-T2" data-open="znad204-T2" class="link link-reveal link-table xref-fig">Table 2</a></em>). Children of childbearing trainees were of similar weight to those of non-childbearing trainees (<em><span class="link link-data-supplement" data-supplement-target="sup1"></span><span class="content-section supplementary-material"><a path-from-xml="sup1" href="https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/bjs/110/12/10.1093_bjs_znad204/1/znad204_supplementary_data.docx?Expires=1734694910&Signature=4oCcsx0lD5dXP6sN-1U8-f69xFEM3u~X~CYGC6HN-bgPOh58IhFVzgX0J-GG0IHSDGm9WEMNaNLnu7kMeJvuxrysUhgKjkan8mnG~JEja68qHHLXtddxe~ZoOf1pVnDFM-WNtJLM7frfE3RrVun3YkSdC5wU1jPaxJSETmGYdxW3DMp7WCEONNfDtCDnsc-9tUVI0KmyValkxvxtToYgjEbXZl7HiX1q93cpxpqT2SuD~MU-AaRUSF06NKFkZn7eu3zZhgK6dpVZTiIDdVDFrLhreGBgq6sTDpFdH4yAqfPRUeUXkGloVIPiphpPIQ40SEhss~PCnhTiJRkVvMLKmA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA">Table S2</a></span></em>).</p><p class="chapter-para">Over 70 per cent of childbearing surgical trainees worked for 40 h or more each week during pregnancy, and 4 per cent worked more than 60 h per week. Most trainees continued to work at night throughout their pregnancy, and half continued to operate for more than 9 h each week up until maternity leave (<em><span class="link link-data-supplement" data-supplement-target="sup1"></span><span class="content-section supplementary-material"><a path-from-xml="sup1" href="https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/bjs/110/12/10.1093_bjs_znad204/1/znad204_supplementary_data.docx?Expires=1734694910&Signature=4oCcsx0lD5dXP6sN-1U8-f69xFEM3u~X~CYGC6HN-bgPOh58IhFVzgX0J-GG0IHSDGm9WEMNaNLnu7kMeJvuxrysUhgKjkan8mnG~JEja68qHHLXtddxe~ZoOf1pVnDFM-WNtJLM7frfE3RrVun3YkSdC5wU1jPaxJSETmGYdxW3DMp7WCEONNfDtCDnsc-9tUVI0KmyValkxvxtToYgjEbXZl7HiX1q93cpxpqT2SuD~MU-AaRUSF06NKFkZn7eu3zZhgK6dpVZTiIDdVDFrLhreGBgq6sTDpFdH4yAqfPRUeUXkGloVIPiphpPIQ40SEhss~PCnhTiJRkVvMLKmA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA">Table S3</a></span></em>). The majority (70 per cent) of childbearing surgical trainees altered their work schedule during pregnancy; 77 per cent felt guilty for burdening their colleagues by reducing their workload. Of those trainees who did not alter their work schedule in pregnancy, 40 per cent made this decision to avoid being ‘considered weak’ and 35 per cent because of concerns surrounding burdening colleagues.</p><p class="chapter-para">Night shifts and working more than 40 h a week are associated with higher risks of miscarriage and adverse pregnancy outcomes; additionally, adverse pregnancy outcomes are associated with prolonged standing and high fatigue scores<sup><span class="xrefLink" id="jumplink-znad204-B12"></span><a href="javascript:;" reveal-id="znad204-B12" data-open="znad204-B12" class="link link-ref link-reveal xref-bibr">12</a>,<span class="xrefLink" id="jumplink-znad204-B17 znad204-B18 znad204-B19 znad204-B20"></span><a href="javascript:;" reveal-id="znad204-B17 znad204-B18 znad204-B19 znad204-B20" data-open="znad204-B17 znad204-B18 znad204-B19 znad204-B20" class="link link-ref link-reveal xref-bibr">17–20</a></sup>. This study suggests that, even in combination with statutory maternity leave policies, the rest and working time requirements of the European Working Time Directive (EWTD) afford insufficient protection to pregnant surgical trainees. The outcomes from this study mirror findings reported in North America<sup><span class="xrefLink" id="jumplink-znad204-B7"></span><a href="javascript:;" reveal-id="znad204-B7" data-open="znad204-B7" class="link link-ref link-reveal xref-bibr">7</a>,<span class="xrefLink" id="jumplink-znad204-B21 znad204-B22 znad204-B23"></span><a href="javascript:;" reveal-id="znad204-B21 znad204-B22 znad204-B23" data-open="znad204-B21 znad204-B22 znad204-B23" class="link link-ref link-reveal xref-bibr">21–23</a></sup>. Employers should, as a matter of priority, offer altered working schedules to pregnant surgical trainees to protect obstetric health. Furthermore, these data support childbearing surgeons being considered a high-risk obstetric group<sup><span class="xrefLink" id="jumplink-znad204-B8"></span><a href="javascript:;" reveal-id="znad204-B8" data-open="znad204-B8" class="link link-ref link-reveal xref-bibr">8</a>,<span class="xrefLink" id="jumplink-znad204-B24"></span><a href="javascript:;" reveal-id="znad204-B24" data-open="znad204-B24" class="link link-ref link-reveal xref-bibr">24</a></sup>.</p><p class="chapter-para">The majority (98 per cent) of childbearing surgical trainees wanted to breastfeed their child, and 85 per cent achieved this for over 6 months. The most common reason for surgical trainees stopping breastfeeding early was inadequate work provision; steps should be taken to enable mothers to continue breastfeeding for as long as desired. Other barriers to breastfeeding included insufficient milk supply, conflict with work schedules, and fatigue or illness.</p><p class="chapter-para">Childbearing surgical trainees took a mean of 10.2 months of parental leave; 73 per cent of non-childbearing surgical trainees took 2 weeks of parental leave. Two thirds of non-childbearing surgical trainees felt that the amount of leave taken was insufficient (27), but cited concerns that longer times would be viewed negatively by colleagues and a reluctance to prolong training. Only a third of non-childbearing surgical trainees found they were able to organize their parental leave without any difficulties (<em><span class="link link-data-supplement" data-supplement-target="sup1"></span><span class="content-section supplementary-material"><a path-from-xml="sup1" href="https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/bjs/110/12/10.1093_bjs_znad204/1/znad204_supplementary_data.docx?Expires=1734694910&Signature=4oCcsx0lD5dXP6sN-1U8-f69xFEM3u~X~CYGC6HN-bgPOh58IhFVzgX0J-GG0IHSDGm9WEMNaNLnu7kMeJvuxrysUhgKjkan8mnG~JEja68qHHLXtddxe~ZoOf1pVnDFM-WNtJLM7frfE3RrVun3YkSdC5wU1jPaxJSETmGYdxW3DMp7WCEONNfDtCDnsc-9tUVI0KmyValkxvxtToYgjEbXZl7HiX1q93cpxpqT2SuD~MU-AaRUSF06NKFkZn7eu3zZhgK6dpVZTiIDdVDFrLhreGBgq6sTDpFdH4yAqfPRUeUXkGloVIPiphpPIQ40SEhss~PCnhTiJRkVvMLKmA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA">Table S4</a></span></em>).</p><p class="chapter-para">On return to work after parental leave, 61 per cent (104) of childbearing surgical trainees reduced their working hours to less than 40 h per week, compared with 15 per cent (6) of non-childbearing surgical trainees. Approximately 10 per cent of both childbearing and non-childbearing surgical trainees altered their work schedules after parental leave to accommodate family life, but continued to work more than 40 h per week. Nearly one in four non-childbearing trainees were unhappy with their work schedule on return to work; the majority did not change their work schedule due to concerns related to the views of their colleagues (<em><span class="link link-data-supplement" data-supplement-target="sup1"></span><span class="content-section supplementary-material"><a path-from-xml="sup1" href="https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/bjs/110/12/10.1093_bjs_znad204/1/znad204_supplementary_data.docx?Expires=1734694910&Signature=4oCcsx0lD5dXP6sN-1U8-f69xFEM3u~X~CYGC6HN-bgPOh58IhFVzgX0J-GG0IHSDGm9WEMNaNLnu7kMeJvuxrysUhgKjkan8mnG~JEja68qHHLXtddxe~ZoOf1pVnDFM-WNtJLM7frfE3RrVun3YkSdC5wU1jPaxJSETmGYdxW3DMp7WCEONNfDtCDnsc-9tUVI0KmyValkxvxtToYgjEbXZl7HiX1q93cpxpqT2SuD~MU-AaRUSF06NKFkZn7eu3zZhgK6dpVZTiIDdVDFrLhreGBgq6sTDpFdH4yAqfPRUeUXkGloVIPiphpPIQ40SEhss~PCnhTiJRkVvMLKmA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA">Table S5</a></span></em>). It may be that adopting a Scandinavian model of shared paid parental leave, with intervals ring-fenced for each parent, would lead to cultural change with respect to childcare in the medical workforce.</p><p class="chapter-para">It is likely that selection bias was present in this study; indeed, most survey responses were from female trainees. In addition, this study could have collated views of surgical trainees and trainers on the impact of providing support and cover to pregnant colleagues. Furthermore, these findings are limited to the experiences of surgical trainees in the UK, so caution should be exercised before initiating changes outside of this setting.</p><p class="chapter-para">This study highlights the need for urgent action to reduce rates of miscarriage and major pregnancy complications in surgical trainees in EWTD-compliant settings. Altering working schedules and limiting physical exertion may mitigate these risks; however, consideration will need to be taken of the impact of such changes on the surgical workforce as a whole and on the training opportunities and income of pregnant surgeons. Furthermore, cultural change is required to empower pregnant surgical trainees to access modifications to their working schedule and practice, as well as to enable non-childbearing surgical parents to take longer intervals of parental leave and alter work schedules after becoming a parent. Training programmes and national surgical associations must evolve to progress diversity in the surgical workforce and protect the obstetric health of surgeons.</p> <h2 scrollto-destination=424826673 id="424826673" class="backsection-title js-splitscreen-backsection-title" data-legacy-id=znad204-s0>Funding</h2> <p class="chapter-para">S.A.H. is a Wellcome Trust Clinical Career Development Fellow, 220668/Z/20/Z.</p> <h2 scrollto-destination=424826675 id="424826675" class="backacknowledgements-title js-splitscreen-backacknowledgements-title" data-legacy-id=ack1>Acknowledgements</h2> <p class="chapter-para">The contribution of the surgeons in training who provided data for this study is acknowledged. Author contributions: J.W., S.M., and S.A.H designed this study; J.W. and S.A.H. analysed and interpreted data; J.W. and S.A.H. wrote the first draft of the manuscript; and J.W., S.M., and S.A.H participated in the preparation of the manuscript by reading and commenting on the draft before submission.</p> <h2 scrollto-destination=424826677 id="424826677" class="backsection-title js-splitscreen-backsection-title" data-legacy-id=znad204-s1>Disclosure</h2> <p class="chapter-para">The authors declare no conflict of interest.</p> <h2 scrollto-destination=424826679 id="424826679" class="backsection-title js-splitscreen-backsection-title" data-legacy-id=znad204-s2>Supplementary material</h2> <p class="chapter-para"><span class="link link-data-supplement" data-supplement-target="sup1"></span><span class="content-section supplementary-material"><a path-from-xml="sup1" href="https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/bjs/110/12/10.1093_bjs_znad204/1/znad204_supplementary_data.docx?Expires=1734694910&Signature=4oCcsx0lD5dXP6sN-1U8-f69xFEM3u~X~CYGC6HN-bgPOh58IhFVzgX0J-GG0IHSDGm9WEMNaNLnu7kMeJvuxrysUhgKjkan8mnG~JEja68qHHLXtddxe~ZoOf1pVnDFM-WNtJLM7frfE3RrVun3YkSdC5wU1jPaxJSETmGYdxW3DMp7WCEONNfDtCDnsc-9tUVI0KmyValkxvxtToYgjEbXZl7HiX1q93cpxpqT2SuD~MU-AaRUSF06NKFkZn7eu3zZhgK6dpVZTiIDdVDFrLhreGBgq6sTDpFdH4yAqfPRUeUXkGloVIPiphpPIQ40SEhss~PCnhTiJRkVvMLKmA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA">Supplementary material</a></span> is available at <em>BJS</em> online.</p> <h2 scrollto-destination=424826681 id="424826681" class="dataavailabilitystatement-title js-splitscreen-dataavailabilitystatement-title" data-legacy-id=znad204-s3>Data availability</h2> <p class="chapter-para">Data utilized in the preparation of this manuscript will be made available to researchers upon reasonable request to the corresponding author.</p> <h2 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Published by Oxford University Press on behalf of BJS Society Ltd.</div><div class="license"><div class="license-p">This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<a class="link link-uri openInAnotherWindow" href="https://creativecommons.org/licenses/by/4.0/" target="_blank">https://creativecommons.org/licenses/by/4.0/</a>), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.</div></div> <span id="UserHasAccess" data-userHasAccess="True"></span> </div> </div> </div> <div class="widget widget-RelatedTags widget-instance-OUP_Article_RelatedTags_Widget"> <div class="related-topic-tags"> <div class="related-topic-tag-label">Topic:</div> <ul class="related-topic-tag-list"> <li> <a class="js-qb-topic-keyword-search" href="javascript:;" data-topic="pregnancy"><span>pregnancy</span></a> </li> <li> <a class="js-qb-topic-keyword-search" href="javascript:;" data-topic="surgical procedures, operative"><span>surgical procedures, operative</span></a> </li> </ul> </div> </div> <div class="widget widget-SolrResourceMetadata widget-instance-OUP_Article_ResourceMetadata_Widget"> <div class="article-metadata-panel solr-resource-metadata js-metadata-panel at-ContentMetadata"> <div class="article-metadata-taxonomies"> <div class="article-metadata"> <div class="article-metadata-taxonomies-title">Subject</div> <a href="/bjs/search-results?page=1&tax=bjs/1">Breast Surgery</a> <a href="/bjs/search-results?page=1&tax=bjs/10">Orthopaedics</a> <a href="/bjs/search-results?page=1&tax=bjs/11">Education</a> <a href="/bjs/search-results?page=1&tax=bjs/12">Endocrine</a> <a href="/bjs/search-results?page=1&tax=bjs/14">Transplantation</a> <a href="/bjs/search-results?page=1&tax=bjs/15">Trauma</a> <a href="/bjs/search-results?page=1&tax=bjs/16">Urology</a> <a href="/bjs/search-results?page=1&tax=bjs/17">Cardiothoracic Surgery</a> <a 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Pregnancy and parenthood in surgical training: a cross-sectional survey in the UK | British Journal of Surgery | Oxford Academic