Mixed-Methods Evaluation of Surgeon Workplace Support and Obstetric Complications

Obstetric complications affect many surgeons and their childbearing partners, yet workplace dynamics surrounding pregnancy remain underexplored.

To analyze the prevalence of obstetric complications among childbearing surgeons and childbearing partners of surgeons, identify the occupational risk factors associated with these complications, and explore the lived experiences related to obstetric complications.

This survey study used convergent mixed-methods analysis of data from a 2024 survey of US surgeons administered to select members of the American College of Surgeons. The survey, which was available online from March to May 2024 and included free-text responses, asked about experiences related to family building, including obstetric complications and workplace support during pregnancy.

Pregnancy or parenthood.

Lack of workplace support (LOWS) was defined as feeling unsupported when reducing workloads during pregnancy, being discouraged from having children, being worried about childbearing-related stigma, and perceiving that childbearing conflicted with contractual obligations. Multivariable logistic regression models examined occupational factors associated with major pregnancy complications, comparing partners of nonchildbearing surgeons with childbearing surgeons and including and excluding exposures to LOWS. Qualitative thematic network analysis of free-text answers identified themes related to obstetric complications and perceptions of related workplace culture.

Of 3125 respondents (9.5% response rate among 32 890 eligible surgeons), 1473 surgeon-parents were included; 949 (64.4%) were female, and 524 (35.6%) were male. Obstetric complications (eg, placental insufficiency, placenta previa, and intrauterine growth restriction) more often impacted female surgeons (295 [31.1%] female vs 120 [22.9%] males; P = .001) even after adjusting for demographics, multiple gestation, work hours, and time standing at work (odds ratio [OR], 1.34; 95% CI, 1.01-1.78). LOWS was more common among female than male surgeons (606 [64.4%] vs 167 [31.9%]; P < .001). Adjusting for LOWS eliminated the sex-based differences in obstetric complications (odds ratio, 1.19; 95% CI, 0.89-1.59). Qualitative analysis of 697 free-text responses revealed 3 major themes: (1) physical demands of surgical work negatively impact pregnancy outcomes, (2) cultural norms discourage workplace accommodations, and (3) limited parental leave policies exacerbate challenges after pregnancy complications.

Pregnancy-related LOWS is a modifiable mediator of increased obstetric risk that disproportionately affects female surgeons. Addressing flexibility stigma, improving institutional support, and implementing policies that align with contemporary family needs are essential to foster gender equity in family building among surgeons.