The challenge of being a mother and a neurosurgeon is a topic that is rarely discussed, even in today’s society. It often feels like a taboo subject for women neurosurgeons and trainees, as if motherhood would somehow make one seem like a lesser neurosurgeon. With the extensive time dedicated to neurosurgical education, training and lifelong learning, it can be challenging to determine how motherhood fits into this life.
Perhaps one of the reasons this is not a widely discussed topic is that neurosurgery is still a male-dominated field. Women represent only 12% of neurosurgery residents and 5% of practicing neurosurgeons. In a recent survey of 126 women neurosurgeons and trainees, 49% of the respondents have children and 33% plan to have children. In addition to dealing with the challenges of achieving work-life balance, a startling barrier to become a neurosurgeon mom is that over 50% of survey respondents feel pressure or backlash from their colleagues for having children.
An unfortunate perception of neurosurgery is that one should delay having children if they wish to enter the field. Many female medical students report they decided to go into a different surgery specialty due to this belief. The average age for women neurosurgeons to become first-time mothers is 31.3 years versus 29.3 years for male neurosurgeons as first-time fathers. The delay in starting a family has consequences, as 25% of women neurosurgeons reported taking more than a year to get pregnant, and 18.9% required medical intervention such as in vitro fertilization. Moreover, 40.1% of female neurosurgeons reported serious perinatal complications in at least one pregnancy, which is higher than the national average of 14.5%. The more significant consequence not reflected in these statistics is losing out on highly qualified trainees and neurosurgeons because of these concerns.
There needs to be some adjustments in the field of neurosurgery to make being a mother less of a hindrance and more accepted. Change is necessary on both the policy front and in the culture of the field. Formal parental leave and return to work policies should be established at every institution to promote equitable, gender-neutral policies for women and men, including for adoption and other family structures. Family leave policies are highly variable across practice environments, and only 25% of female neurosurgeons reporting having access to program parental leave allowances. Accommodations must be made for those during pregnancy and the post-partum period to ensure the health of the mother and baby. Access to lactation facilities close to the operating room/clinic and childcare is also crucial to those returning to work after parental leave.
Even with such policies in place, it still will not be enough until the culture regarding motherhood changes within the field of neurosurgery. Many women neurosurgeons report backlash from their colleagues for being pregnant and taking parental leave — ranging from microaggressions to being passed for career advancement opportunities. To prove to others that they will not let motherhood interfere with their job, many women neurosurgeons who have children work until their due date or return early from maternity leave. We need to do a better job normalizing being a mother and a neurosurgeon, which means taking breaks in the operating room for the physical needs of pregnancy and lactation. We need to have our male colleagues normalize taking paternity leave as well. They also need to speak up when they witness discriminatory behaviors towards women neurosurgeons. Finally, we need to speak up and advocate for ourselves and support others in our field who choose to become mothers.
Being a good mother and a good neurosurgeon is not mutually exclusive. It is hard, and we are our own worst critics when juggling these demanding jobs. With support and change on institutional and cultural levels, it may just make these two jobs a little more manageable.
The Motherhood & Neurosurgery webinar offers candid reflections on pregnancy and starting a family as a neurosurgeon. Panelists — Lola B. Chambless, MD, FAANS, Catherine A. Miller, MD, Lauren Albert Sand, MD and Doris Wang, MD, PhD — share advice for working while pregnant or nursing, and discuss how medical institutions can better support women surgeons through pregnancy and parenthood.
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Catherine A. Miller, MD
UCSF Department of Neurological Surgery
San Francisco, Calif.
Doris Wang, MD, PhD
UCSF Department of Neurological Surgery
San Francisco, Calif.
