From bones to bump: pregnancy insights from an unaccredited orthopaedic registrar – navigating the expectations, challenges, and surprises

Navigating pregnancy during early surgical training presents unique challenges with limited support resources. As a newly pregnant Unaccredited Orthopaedic Registrar, I faced a myriad of questions and uncertainties. Female orthopaedic surgeons undergoing training and pregnancy are still scarce, leading me to seek guidance from a handful of peers and extensive research. Heidi Markoff's ‘What to Expect When You're Expecting’ provided foundational insights and highlighted the need for a tailored pregnancy guide for surgeons.1 Addressing gaps in information and support is crucial to alleviate concerns and to ensure the well-being of both mother and child throughout the demanding journey of surgical training and pregnancy. As a dedicated medical professional, commitment to patient safety was engrained from the moment I took the Hippocratic oath. However, when faced with a decision to continue to work as a pregnant professional, I was confronted with a new level of responsibility. My foremost consideration was ensuring a balanced approach towards patient safety and personal well-being including the well-being of my unborn child. With meticulous planning and proactive strategies, I harmonized my professional duties with the demands of pregnancy, safeguarding both patients and my baby. As an Unaccredited Orthopaedic Registrar navigating pregnancy, I have experienced firsthand how it impacts performance. From adapting techniques to handle the shifting centre of gravity during emergency procedures to upsizing gloves due to fluid retention, every day brought new challenges. Innovative solutions, like using a double tubigrip for stability of a developing pubic diastasis kept me moving forward safely, but the most important lesson was knowing when to hit pause. I looked up several resources including ‘Pregnancy and Surgical Training: the practicalities of being a pregnant surgeon’ by Kellee Slater on the GSA website to gain insight for making informed decisions.2 There was consideration regarding the timing of announcing pregnancy, as detailed in the British Orthopaedic Association's guidelines.3 Balancing the advantages and drawbacks of early versus delayed disclosures is deeply personal and hinges on factors like maternal history, career stage, and available support network. The sobering reality of miscarriage, with its risk as high as 15% of all recognized pregnancies, underscores the emotional gravity and highlights the importance of thoughtful consideration and support during this delicate period.4 Undertaking pregnancy with my third child as a third-year Unaccredited Orthopaedic Registrar brought further invaluable insights. Experience from previous pregnancies melded seamlessly with my work, requiring less external support. Like performing a routine ankle reduction, the process felt instinctive. This integration underscores the natural harmony between pregnancy and professional life, enriching both spheres. Pregnancy poses unique challenges for orthopaedic surgeons, particularly regarding radiation exposure, bone cement hazards, blood-borne pathogens, physical stress, and anaesthetic gases. Understanding and mitigating these risks are vital for maternal and fetal well-being. While radiation exposure from procedures is significantly lower than anticipated, precautions like informing the hospital's radiation safety officer, shielding, and maintaining distance from the C-arm are crucial. Similarly, bone cement exposure risks can be mitigated through vacuum mixing, double gloving, and using hoods. Blood-borne pathogen risks, including HIV and Hep B transmission, can be minimized by double gloving, and wearing eye protection, along with prompt adherence to hospital protocols in case of exposure. Managing physical stress involves staying hydrated and knowing when to limit work hours, especially in the third trimester. Anaesthetic gases pose theoretical risks in the first trimester, but studies have not shown significant associations with adverse outcomes. Overall, proactive risk management is essential for ensuring a safe and healthy pregnancy for orthopaedic surgeons and their babies.5-10 Returning to work postpartum entails a multifaceted process, fraught with emotional and logistical challenges. Balancing the stress of leaving your baby for the first time with professional responsibilities requires meticulous planning akin to preparing for a complex operation. A comprehensive return-to-work plan, with contingencies for various scenarios, is essential to navigate the transition smoothly. Central to this plan is addressing lactation concerns. Preplanning feeding strategies, including exploring breastfeeding opportunities, understanding pumping techniques, and considering alternative options in the event of being unable to establish lactation.5, 8 Returning to work as a surgical trainee also include being aware of allowances at work including the lactation room. Interestingly the distance from theatres, clinic and emergency department are also important factors so you can plan your pumping schedule and change it around if anticipating prolonged operating times. Additionally, childcare arrangements pose a significant consideration. With no one-size-fits-all solution, mothers must assess their social structure and household values to find a suitable system. Whether relying on partners, family members, daycares, or nannies, the key lies in establishing reliability and trust, ensuring peace of mind during work hours. The pervasive phenomenon of mum-guilt compounds the challenges of balancing professional and maternal roles. Striking a balance between career aspirations and motherhood is highly individualized, with quality of time spent with the child prioritized over quantity.11 Building a robust support system is vital for navigating this journey. Identifying role models, seeking guidance from experienced parents, and connecting with medical mum groups offer invaluable emotional and practical support. Platforms like ‘Adelaide Medical Mums and Mum's to Be’ groups on Facebook provide insights into coping strategies and resource sharing. While there isn't a definitive solution to these questions, I offer insights into my decision-making process. My aim is to offer guidance for individuals facing similar circumstances, enabling them to explore options aligned with their lifestyle and decision-making approach. Drawing from my own experiences and the support of mentors, I advocate for the establishment of guidelines to support gender and diversity equality in orthopaedic settings. To ensure a supportive environment for both those experiencing pregnancy and their supporters, including partners, friends, and colleagues. Anum Awais: Conceptualization; data curation; investigation; methodology; project administration; resources; writing – original draft; writing – review and editing. Nicole Williams: Resources; supervision; writing – review and editing. Ruurd L. Jaarsma: Supervision; writing – review and editing. Bhavin Jadav: Supervision; writing – review and editing. Aaron W. Stevenson: Writing – review and editing. Angela Alder-price: Writing – review and editing.