Pregnancy and Motherhood During Oral and Maxillofacial Surgery Residency

Despite increasing gender diversity across health care, disparities persist in surgical subspecialties. Women comprise 19% of surgeons in the United States, yet represent 11% of the nearly 8,000 active members of the American Association of Oral and Maxillofacial Surgeons (AAOMS), excluding retired or candidate fellows. One potential deterrent to pursuing a career in oral and maxillofacial surgery (OMS) and completing residency training is the perception that OMS demands are incompatible with pregnancy and early parenthood.

The purpose of this study was to estimate the prevalence of perceived pregnancy-related stigma during OMS residency among trainees who experienced pregnancy and to describe career choice and satisfaction. A secondary purpose was to explore associations between perceived stigma, institutional support, and workload indicators.

This prospective cross-sectional study was conducted in the United States from January to February 2024 using a closed, invitation-only online questionnaire distributed to current and former OMS residents affiliated with Commission on Dental Accreditation (CODA)-accredited US training programs. Participants were eligible if they experienced pregnancy or motherhood during OMS residency and completed sufficient survey content for analysis.

The primary predictor variables were institutional support indicators measured individually using hospital-provided childcare, in vitro fertilization insurance coverage, perceived program accommodation for maternity leave, and lactation access. The secondary predictor variables were workload measured individually using third-trimester schedule modification and ease of discussing maternity leave with the program director. All predictors were coded as binary (yes/no) variables.

The primary outcome was perceived pregnancy-related stigma, operationalized using dichotomized survey items (agree/strongly agree vs disagree/strongly disagree) capturing negative evaluation related to pregnancy during residency. Secondary outcomes included maternity leave duration and adequacy and career satisfaction indicators.

Covariates included maternal age at first birth, number of pregnancies during residency, marital status, work setting, presence of a female program director, and mentorship access.

Descriptive statistics, bivariate analyses, and regression models were conducted using Stata 18MP, with significance set at P < .05.

Of 99 initiated surveys, 60 respondents met inclusion criteria (60 of;99, 60.6%). Because of survey skip logic, denominators varied across items. Perceived pregnancy-related stigma was common; 39 of 48 (81.3%) respondents reported negative stigma associated with being pregnant as a resident. Institutional supports were inconsistent, including limited childcare availability (six of 50, 12.0%) and in vitro fertilization insurance coverage (14 of 44, 31.8%). Of 26 respondents, 14 (53.8%) reported taking less leave than desired because their program did not accommodate a longer leave, and nine of 23 (39.1%) reported early cessation of breastfeeding or pumping due to lack of accessible lactation areas. In bivariate analyses, lack of leave accommodation was associated with worry about negative perception or resentment by co-residents (14 of 14, 100.0% vs eight of 12, 66.7%; P = .033). Reporting that it was easy to discuss leave with program leadership was associated with lower reports of negative stigma (seven of 15, 46.7% vs 15 of 15, 100.0%; P = .002) and worry about resentment by co-residents (nine of 15, 60.0% vs 15 of 15, 100.0%; P = .017).

Perceived pregnancy-related stigma was highly prevalent among OMS trainees who experienced pregnancy during residency. Institutional support was inconsistently available, and many respondents reported barriers to adequate leave accommodation and lactation access, with maternity leave frequently shorter than the amount they considered sufficient. Despite these challenges, most respondents reported strong commitment to remaining in OMS. Aligning program policies and communication practices with trainee needs may help attract and retain women in the specialty and foster a more inclusive training environment.