Surgical Ergonomics for the Pregnant Surgeon: Musculoskeletal Discomfort and Occupational Challenges

INTRODUCTION: Work-related musculoskeletal (MSK) disorders are a recognized occupational hazard for surgeons, arising from repetitive movements, awkward postures, and the physical demands of the operating room. Pregnant surgeons are an overlooked population who face unique physiological and ergonomic challenges that have been minimally addressed in the literature. OBJECTIVE: To identify the ergonomic challenges and MSK symptoms experienced by pregnant and postpartum surgeons and to explore current practices that may inform interventions to reduce injury and promote career longevity. METHODS: A nationwide REDCap survey was distributed to surgeons who were either currently pregnant or within 5 years postpartum. Recruitment occurred via email, professional societies, and social media. Self-reported data included demographics, obstetric history, surgical specialty, work hours, ergonomic challenges, and MSK discomfort (0–10). Participants rated MSK discomfort at 5 stages: pre-pregnancy, first trimester, second trimester, third trimester, and postpartum. A linear mixed-effects model was used to assess changes in discomfort over time, and associations with surgical modality were analyzed for all respondents using a scaled average discomfort score. RESULTS: A total of 146 surgeons completed the survey. Most respondents specialized in OB/GYN (67.8%), followed by General Surgery (11.6%), and Urology (5.5%). The mean age during pregnancy was 34.40 years (SD 3.39). Nearly one-third were currently pregnant (29.5%), and the remainder were in the postpartum period (70.5%). Most surgeons (84.9%) reported working 41–80 hours per week during pregnancy. MSK discomfort scores increased significantly throughout pregnancy (P<0.001), rising from a pre-pregnancy mean of 2.39 (SD 1.92) to 6.07 (SD 1.99) in the third trimester. Discomfort remained elevated postpartum compared to baseline, with a mean of 3.34 (SD 2.12; P<0.001). Open abdominal surgery (P<0.001), open surgery in other areas (p=0.04), vaginal surgery (P=0.05), and laparoscopy (P=0.03) were all associated with higher discomfort, while surgeons who performed no surgery reported lower mean discomfort scores (1.64; P<0.001). The lower back/sacrum was the most common site of discomfort across modalities, affecting over 90% of surgeons performing vaginal surgery or open non-adnominal procedures. Upper extremity pain was reported by 59.4% of those performing vaginal surgery and 54.8% of those performing laparoscopy. Surgeons performing microsurgery reported high rates of discomfort in both the neck/upper back and upper extremities (66.7% each). The most common ergonomic adjustments included stretching (33.6%) and requesting assistance with tasks such as heavy lifting (32.2%). Surgeons requiring unplanned time off had the highest mean discomfort score (5.23). CONCLUSIONS: Pregnant surgeons experience a substantial and progressive increase in MSK discomfort that peaks late in pregnancy and persists postpartum. Surgical modality influences the distribution and severity of pain, with lower back and upper extremities most affected. This highlights an unmet need for targeted ergonomic support, education, and institutional interventions for this population. Surgeon longevity depends upon fostering an adaptable operating environment and ensuring all surgeons have accessible support. This includes the integration of ergonomic practices that can be modified to accommodate the physiologic changes of pregnancy.