The Pregnancy and Postpartum Experiences of Plastic Surgery Residents

INTRODUCTION: Plastic surgery trainees report delayed childbearing due to the perceived incompatibility of surgical training with early family planning. Surgeon infertility rates are higher than that of the lay population and surgical training occurs during peak reproductive years, which contribute to poorer fertility, perinatal, and maternal outcomes. The unique challenges in the postpartum period that residents face including lactation and pumping once returning to clinical roles have not been studied. This survey aims to better understand plastic surgery trainees' experiences with parenthood and advocate for the normalization of the many facets of family planning. METHODS: An electronic Qualtrics-based survey was adapted from previously validated surveys in the medical literature. This survey was distributed to the 113 plastic surgery resident members of the American Council of Educators Plastic Surgeons (ACEPS). Data on demographics, parenthood knowledge, experiences, and perceptions were collected and analyzed. RESULTS: A total of 39 responses were received and of those who reported their sex, 85.2% were female and 14.8% were male, for a total response rate of 34.5%. One-quarter of respondents (25.6%) were unsure about whether a parental leave policy existed in either their residency program or through the American Board of Plastic Surgery. Fourteen trainees, representing over one-third of the respondents (35.9%), had children during residency training. Of those who answered, eleven had children by birth, one had a child via adoption, and one had a child with their partner as the birthing parent. All took parental leave, with eight people taking leave in the form of family and medical leave (FMLA), four as vacation, and four as elective or research time. The mean amount of leave was eight weeks, with a range of 3 to 12 weeks. More than half (53.4%) experienced guilt during parental leave, of which 57.1% experienced guilt from themselves and 42.9% experienced guilt associated with their co-residents. Eleven trainees (28.2%) were the birthing parent during training. Of these, nine (72.7%) intended to pump. On average, respondents pumped for a total of 8.1 months during residency. Two respondents reported that faculty made them feel uncomfortable pumping at work. Complications related to inadequate pumping, including diminished milk supply and mastitis, affected half of trainees. Over half of trainees (55.6%) ceased pumping earlier than they would have liked due to insufficient time and diminished milk supply. 75% of trainees reported that residency limited their ability to pump due to reasons such as insufficient time, increased stress, and inability to adequately nourish themselves to produce milk. CONCLUSIONS: Plastic surgery trainees experience significant barriers during parenthood including inadequate parental leave, few resources for parental leave policies and lactation support, and insufficient time to allow for pumping. A more supportive culture, conscious colleagues and faculty, and informed policy change can improve parenthood for plastic surgeons.