The ergonomic and occupational challenges of pregnancy during surgical residency
Pregnancy during surgical residency is a demanding intersection of personal and professional identity. It challenges the limits of physical stamina, organizational culture, and institutional flexibility, none of which are traditionally optimized for pregnant bodies. Although the number of women in surgical training continues to rise, most residency programs still operate under a model that assumes trainees are not, and will not be, pregnant.
A growing body of literature reveals the serious health implications of this oversight. Pregnancy in surgical residency is associated with increased rates of musculoskeletal injuries, fatigue-related complications, and adverse pregnancy outcomes, including miscarriage and preterm labor. These risks are compounded by long hours, prolonged standing, and limited access to breaks. These conditions are not only physically demanding but also unsustainable for pregnant trainees.
The average surgical resident works more than 60+ hours per week, often including overnight shifts and extended time in the operating room. For pregnant trainees, these conditions pose significant health risks. The combination of fatigue, dehydration, poor posture, and repetitive movements has been linked to back pain, carpal tunnel syndrome, and joint instability. All of these conditions are exacerbated during pregnancy. Prolonged standing, which is commonly unavoidable in surgical procedures, is a particularly well-documented risk factor. According to the Canadian Orthopedic Association and several US-based guidelines, standing for more than three hours at a time is associated with higher rates of preterm labor and low birth weight.
Ergonomic interventions are a vital yet often overlooked component of pregnancy support in residency. They offer a proactive approach to reducing physical strain and preventing complications without compromising educational value or patient care.
1. Workstation and OR modifications
The physical setup of the operating room should be reevaluated for pregnant surgeons. Adjusting surgical table height, monitor placement, and instrument access can reduce strain on the neck, back, and wrists. Gillespie et al. (2023) emphasize that ergonomic redesign such as optimizing positioning during laparoscopic procedures and providing appropriate foot support can significantly improve comfort and performance of pregnant residents.
2. Scheduled breaks and hydration access
Many trainees report limited access to rest and hydration which contributes to fatigue and dizziness. Guidelines including those from the National Health Institute recommend that pregnant workers be given regular breaks and access to food, fluids, and appropriate seating.
3. Personal protective equipment and safety
Pregnant residents must also be protected from occupational exposures. Guidelines from the American College of Surgeons and Canadian Orthopedic Association call for the use of properly fitted lead aprons, dosimeter monitoring for radiation exposure, and ventilation protocols to reduce risks associated with anesthetic gases and surgical smoke.
Despite the clear evidence supporting these modifications, implementation remains inconsistent. Many residents hesitate to request accommodations due to stigma or fear of burdening colleagues. Champaloux et al. (2022) revealed that even in supportive environments, the act of disclosing pregnancy was often met with anxiety and concern over how it would affect scheduling, call coverage, and perceived commitment.
Several national organizations have stepped in to provide clearer guidance. The American College of Surgeons, for example, recommends cessation of overnight call and 24-hour shifts after 30 weeks of gestation, along with frequent breaks and individualized risk assessments throughout pregnancy. The Association of Women Surgeons further emphasizes the importance of not requiring residents to make up missed call shifts or use vacation time for medical leave.
As the profession evolves, so must the systems that train and support it. Institutions should move beyond adjustments on an as need basis and toward standardized policies that anticipate rather than react to the needs of pregnant residents. Sterbling et al. (2023) propose the development of a structured pregnancy curriculum within general surgery programs. Such curricula would incorporate ergonomic education, hazard awareness, and maternal health guidelines to ensure consistency across training environments. Likewise, Mann and Glazer (2024) advocate for national standards that limit OR hours, ensure access to protective gear, and promote a culture of inclusion rather than sacrifice.
Ultimately, the conversation about pregnancy in surgical training must expand from a discussion of accommodations to one of equity and sustainability. Supporting pregnant residents is not a matter of lowering expectations. It is a commitment to retaining exceptional talent, preventing avoidable harm, and modeling a more humane version of professional excellence. For institutions, that means normalizing pregnancy, creating transparent and proactive policies, and investing in ergonomic solutions that allow pregnant residents to thrive. In the end, a surgeon’s ability to care for others should never come at the expense of caring for herself.
References
1. Supporting pregnancy and parental responsibility in the orthopaedic profession and throughout orthopaedic training—a position statement from the Canadian Orthopaedic Association. Canadian Orthopaedic Association. 2024.
2. AWS maternity leave policy for surgical residents. Association of Women Surgeons. 2023.
3. Revised Statement on the Importance of Workplace Support for Pregnancy, Parental Leave, and Lactation for Surgical Trainees. American College of Surgeons. 2024.
4. Guidance on Working as a Trainee during Pregnancy. National Institute of Health. 2013.
5. Gillespie AM, Wang C, Movassaghi M. Ergonomic considerations in urologic surgery. Current urology reports. 2023 Mar;24(3):143-55.
6. Champaloux EP, Acosta AS, Gray ST, Meyer TK, Bergmark RW. Otolaryngology residents’ experiences of pregnancy and return to work: A multisite qualitative study. Laryngoscope Investigative Otolaryngology. 2022 Oct;7(5):1322-8.
7. Sterbling HM, Kelly CH, Stafford A, Willey S, Dort J. Pregnancy curriculum: advocating for a healthier pregnancy in general surgery residency. Journal of Surgical Education. 2023 Dec 1;80(12):1799-805.
8. Mann H, Glazer T. Current state of safe pregnancy policies for the US surgical trainee. OTO open. 2024 Jul;8(3):e172.
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