Plastic surgery training takes a toll on reproductive health

Plastic surgery training takes a toll on childbearing and reproductive health, including negative effects on fertility, complications during pregnancy, and breastfeeding practices, reports a study in the November issue of Plastic and Reconstructive Surgery^®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Especially at a time when more women are training to be plastic surgeons, training programs need more family-friendly policies, suggests the special Plastic Surgery Focus article by Debra A. Bourne, MD, of University of Pittsburgh Medical Center and colleagues. They write, "Exceptional women and men who wish to have a family may be discouraged from entering this field if changes are not instituted to accommodate healthy pregnancies, reasonable parental leave, and childcare options."

Delayed childbearing, increased obstetric complications for plastic surgeons in training

The researchers sent an electronic survey regarding family planning and reproductive health to all residents and fellows at US plastic surgery programs. Three hundred seven trainees completed the survey; women were nearly twice as likely to respond as men (39 versus 20 percent). The trainees' average age was about 32 years. Nearly 60 percent were married; about one-third reported that they or their spouse had at least one pregnancy.

Most trainees – including more than three-fourths of women – said they intentionally postponed having children due to their careers. Female trainees were more likely to report negative stigma due to pregnancy, and to say they were planning to delay childbearing until after training. About 20 percent of trainees reported using assisted reproductive technologies, implying difficulty conceiving.

Fifty-six percent of female trainees reported a complication during pregnancy: a rate nearly four times higher than in the general population. This increased risk may reflect factors like sleep deprivation, emotional and physical, and a range of healthcare-related exposures.

Average maternity leave was 5.5 weeks for female trainees, while paternity leave for male trainees was just 1.2 weeks. Thirty-nine percent of female trainees breastfed for less than six months. Less than one-third said they had ready access to facilities for pumping breast milk while they were breastfeeding.

The study is the first to focus on reproductive challenges and challenges to starting a family specifically for plastic surgery trainees. The findings are especially important given the rising proportion of women in plastic surgery programs: 38 percent, according to recent data.

Our results demonstrate that the plastic surgery training environment discourages women from becoming pregnant during residency or fellowship."

Dr. Debra A. Bourne and coauthors

They hope their paper will help in identifying potential solutions to help trainees balance their careers with the demands of pregnancy and parenting – for example, more flexible scheduling, paid parental leave policies, and other steps to "promote a culture of pregnancy, breastfeeding, and childcare." Dr. Bourne and colleagues conclude: "The effort will result in improved job satisfaction, lower rates of burnout, and help to recruit preeminent people into plastic surgery, ultimately improving the specialty."