Monday, June 15, 2015

Pregnant in the OR: When to Tell


I was 5 weeks pregnant and working in the spine room. Just as I finished my intubation and secured the airway, I turned to set the ventilator and administer some important medications. The surgery fellow started to position the fluoroscope near the patient's cervical spine, about a foot away from where I was working. "Please don't use the Xray right now; I need to put on a lead shield first," I said. "Yeah, ok... whatever..." he said, as he continued to fine-tune its position. Thirty seconds later he sighed, then started pushing some buttons and eyeing the screen. I looked at him sternly and said, "I'm serious. Don't do it. I'm pregnant."

After coos and congratulations from the fellow, resident, nurse, and scrub tech, I felt a bit awkward. Of course, I myself had just learned of my pregnancy; I hadn't even seen a heartbeat on ultrasound yet! This wasn't the way I expected to tell people my good news, and I really wish I hadn't been forced to do so in that situation. That being said, I really didn't want the radiation exposure at that time. I suffered a miscarriage a few weeks later and then had to engage those same people in some very awkward conversations.

The decision of when disclose a pregnancy in any situation is a highly personal one. Unfortunately, there is a lot of misguided shame surrounding miscarriage in our culture, and thus many expectant moms often wait until their first trimester has passed in order to disclose the good news. But in my line of work, there are clear benefits to telling others earlier rather than later. First, anesthesiology (like surgery and many other specialties for that matter) is a relatively physical practice. Say you're feeling faint during a procedure, battling nausea, needing frequent snacks, or have a constant urge to urinate. People are going to think you're having issues and might worry about your work performance... unless of course they know you are pregnant, in which all of these situations are commonplace and understandable.

In terms of shift scheduling, call assignments and specific work days for any given week are often determined well ahead of time. Usually, requests for days off or vacations are done so about 1-2 months in advance; however, because I work in an academic hospital, the summer poses a major scheduling challenge due to new resident orientation/training. If a baby is due in the summer, special arrangements need to be made so as to not impact the delicate balance of staffing during the transition period for brand new residents. In a private practice situation, far advanced notice might be necessary if the due date is around a major holiday. Therefore, alerting the appropriate vacation/call schedulers to a pregnancy earlier rather than later may affect your entire practice group.

In addition, pregnancy status may impact daily work assignments. At my institution, the schedulers try to avoid giving pregnant women assignments that involve consistent or high doses of radiation, such as what is encountered in the interventional radiology suite or cath lab. (I hope to address this more in a future blog post.) It's difficult to avoid assigments in orthopedic rooms since these cases are so ubiquitous, but you might want to also alert the nurse and scrub of your status so that when they mix the methacrylate joint glue, you can step out to avoid the fumes. And you definitely want your protective lead suit if a fluoroscope is in sight!

Just like disclosing a disability at work, it's a "know when to hold 'em, know when to fold 'em" situation. The right point to fold will be different for each individual. Because my first pregnancy (the one in the story above) ended in miscarriage, I was initially keeping things much quieter with my current pregnancy. However, a similar situation with the fluoroscope still happened again at 7 weeks! I got zapped twice in one day despite my veiled warnings, and after the second time I frustratingly blurted out my news to everyone in the room. Of course they paused, congratulated, and then took things much more seriously in the radiation department. It shouldn't have to be that way, but unfortunately most people are very nonchalant about radiation exposure.

Aside from that incident, I waited until about 10 weeks before I was open about my pregnancy. After I had a couple of ultrasounds under my belt and my IVF docs told me that my miscarriage chance was very low, I notified our anesthesia scheduling partners of my status. They have respectfully given me lower-exposure, lower-stress assignments (like fewer, less physical cases per day with limited fluoro, etc.) As far as other pregnancy symptoms are concerned, I have had my days of nausea and moving slowly, but it hasn't seriously affected my performance at this point.

Has anyone - trainee or practitioner - experienced issues with disclosing a pregnancy? Share your thoughts with us!

15 comments:

  1. As an anesthesia resident, I totally get this. I developed an obsession with lead during the first trimester. And I refused to tell but I think a number of the nurses had me figured out!

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  2. I haven't dealt with this yet, but our program has a "system" where pregnant residents can be asked to be flagged as such in the slating system so the staff doing resident room assignments can avoid putting them in rooms with fluoro. It would only alert the slater, but they rotate on a 1-2 week basis so it's not going to help keep the secret, but at least would avoid having to announce it to the whole OR!

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  3. So sorry to hear about your miscarriage... I want to write about my own experience with miscarriage a couple of months ago in a separate post sometime (still haven't quite sorted out my feelings) but I too struggled with this issue. I was doing my autopsy rotation at that time and had concerns about infectious and formalin exposures... I did tell people I never would have told otherwise and of course had to explain later after the miscarriage. Part of me is glad I was forced to do this though because I think we should be a lot more open/comfortable about talking about it, and people need to get better about responding in sensitive ways...

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    1. I'm sorry for your experience, and I totally agree that people should be more open about this. I encourage you to write about what happened for sure! I will help you heal and it will help others at the same time.

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    2. I meant IT will help yo heal...

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  4. I was about 10 weeks pregnant at the start of my MS3 general surgery rotation. At first I tried to avoid telling people on my team by cryptically asking the attending if there would be any radiation used during the procedure, to which he immediately replied: "Why, are you pregnant?" Bluntness of that conversation aside, he turned out to be a great advocate for me during the rotation. He made sure that I was able to leave the OR during procedures with planned radiation use, while still keeping me involved with other cases. As awkward as I felt disclosing my pregnancy so early on, it turned out to be the best decision, since it allowed me to avoid potentially dangerous situations while maintaining professionalism (rather than dashing unannounced out of the OR every time a cholangiogram was about to start - which seemed tempting at first).

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  5. So happy that your pregnancy is proceeding nicely! Hope you are feeling well. As a preg 3rd yr student I had only positive experiences in the OR and on the medicine floors. I found that my work ethic and professionalism defined me much more so than my inability to be present during flouro procedures.

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    1. Thank you, I can't complain too much so far! I'm glad your experience has been positive.

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  6. PracticeBalance - courageous and common story. When I was a second year resident, I told my program director about my pregnancy at 7 weeks because schedules for third year were due and I wanted to work out maternity leave. I was lucky to have a smooth pregnancy and a delivery that coincided with my maternity leave but always found pressure to "come out" about my pregnancies because of schedule or radiation or some other issue. I don't know of many other careers with such issues.

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    1. I agree, I think it would be much easier to conceal a pregnancy in many other lines of work. At least ours is a field where people should be more knowledgeable about the physiological changes and risks associated with pregnancy.

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  7. Thank you for this post!! I am an anesthesia resident and also about to start trying to get pregnant. The whole last month I have done nothing but spine cases with constant fluoroscopy. It made me really think about how I would disclose this, if and when I get pregnant. The early weeks are the ones we all try to hide until that mystical 12 week scan, but it's also the most vulnerable to the embryo... I'm hoping to speak to our scheduler and tell him, and also hoping our hospital is big enough that it won't be an issue. But perhaps the better thing to do is just make it public?! Time will tell. Great post!

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  8. I found out I was pregnant in October of my third year of med school (this year). Most of my first trimester coincided with my OBGYN and Surgery rotations. Luckily I didn't have any issues with nausea, but I did have issues with fainting if I wasn't aggressive about eating and drinking. Prior to my pregnancy, I never had this issue. I really don't like being treated differently than other students because of my pregnancy but once I let my residents know, taking care of myself so I could perform well became much simpler. The residents were very good about making sure I was assigned to cases without radiation exposure- aside from the time I spent on vascular surgery, I didn't feel like my education was adversely affected. The area where I struggled was exposure to infections. A lot of times residents and attendings don't really think of that aspect. I'm probably a little more prickly because my IgM for CMV came up positive in my first trimester, after further testing we determined the exposure was likely well before we conceived, but it was a stressful 2 weeks. When I was noticibly pregnant, I was assigned a patient who was immunocomprimised and had confirmed CMV and TB. Luckily I read the note prior to examining the patient and was able to take a different patient. In another instance, on rounds I was about to enter the room of a baby who, unknown to me had congenital CMV and was stopped right before by a resident who knew the baby's history. As a med student, I felt these issues were easier to manage because most of the time, the only person affected by me taking a different patient is me. I just finished third year and have to say, aside from a few bumps, it has been much easier balancing the pregnancy than I anticipated. I just took Step 2 CS at 32 weeks pregnant and had no issues. The break schedule is more than adequate. I will take CK at 35 weeks and don't anticipate any problems. In terms of 4th year planning, my school's administration has been incredibly supportive and accommodating.

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    1. The timing of your birth will be perfect! Good luck to you-

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