How to Survive and Thrive as a Pregnant Neurosurgeon

Congratulations if you are pregnant, or considering pregnancy and parenthood! First and foremost, you are not alone - many of your neurosurgical colleagues have been through this beautiful but undoubtedly tumultuous phase of your life and career.

Working in neurosurgery is hard - long hours, long cases, little time for rest. Pregnancy can also be hard - poor sleep, nausea, discomfort. Combining the two is a challenge and shouldn’t be underestimated. Being prepared for it can make a difference and give you the best chance to enjoy this unique time in your life and make the most of the last few months of operating before you take time off. We have put together this guide with all the information we wished we had known earlier. It includes: 

The early days

Managing symptoms while at work 

Occupational hazards

Admin and Paperwork

Planning for time off and return to work 

Useful resources

Nausea/fainting - very common in the first trimester but can continue for longer. It’s important to eat regularly and stay hydrated. When you’re operating, eat something before starting and bring biscuits and a drink with a straw into theatre so that someone can offer it to you at intervals during the case. Especially important for any longer cases. 

Avoid prolonged standing (>3 hours) - known to be associated with higher rates of miscarriage and preterm labour (2). Make sure you have a stool nearby and sit down regularly during long cases. If you’re operating alone, do the whole case sitting if it suits you. Swap in and out with other trainees if possible to give yourself breaks.  

Rota considerations - Discuss it with your supervisor in your risk assessments how long you want to stay on the on call rota and whether you feel comfortable operating alone based on your symptoms. There is no rule for either, it depends on what you are comfortable with.

Moving and handling - found to be associated with low birth weight and preterm labour (2). Avoid transferring patients or moving heavy equipment. Consider taking the patients' feet or pumps/drains during transfers if you don't want to draw attention to your pregnancy.

Tips for general discomfort - If you can source some elasticated waisted scrubs, they can be more comfortable later in pregnancy. Compression stockings can be helpful for swollen feet/ankles. 

Mental health - Important to look after your mental health before, during, and of course after the pregnancy. Know that there is plenty of support available in the form of GP, Occupational health, wellbeing services offered via individual Trusts as well as Practitioner Health and the Deanery.

Admin and Paperwork

You must tell your employer in writing at least 15 weeks before your due date to be able to claim maternity pay. However, many people have this conversation much earlier to allow for any support or workplace adjustments. It is up to you when you decide to start this, but the earlier you inform them, the earlier you can receive support if needed.

Once you decide to share your news, you should undertake monthly risk assessments with your supervisor/line manager. The form should be available on your trust intranet. Things to discuss include:

On call rota - night shifts and long days. Consider how these duties affect your pregnancy symptoms eg. if you are very tired or not managing well, do not hesitate to request coming off the on-calls for a period of time.

Lone operating - ask for supervisor presence if you feel you need to take breaks and sit down. 

Altered clinical duties - consider the occupational risks mentioned above and make a plan for what duties you are happy with going forwards. You may need to change firm or swap lists. 

Once you get your MATB1 form at your 20 week scan, you should send this to HR so they can start planning your maternity leave/pay. You can also use this to access free dental care and prescriptions. 

Healthcare appointments - you are entitled to have time off to attend any healthcare appointments. 

Maternity leave - you are entitled to take up to 12 months maternity leave plus annual leave accrued over this period, including bank holidays. (Usually works out to be around 14 months total). It is up to you how much time you take off. 

Maternity pay - made up of occupational maternity pay (OMP) and statutory maternity (SMP) pay. You are entitled to 8 weeks full pay and 18 weeks half pay. Then SMP alone for a further 13 weeks. Bear in mind that your OMP is calculated based on an average of your paychecks for the 2 months before the 15th week before the due date. If you're feeling up to it, doing the odd locum shift at this time can really boost your OMP, although working too many hours can have risks. See the NHS guide below for further info about maternity pay - it can get very confusing if you are changing hospitals midway through pregnancy. 

Pregnancy is a ‘protected characteristic’ under the Equality Act 2020. It is illegal to treat someone unfavourably because of their pregnancy or maternity. 

Most professional organisations give reduced fees whilst you are on maternity leave - this includes RCS, MDU, MPS, GMC (if your income falls below a certain threshold). 

Planning Time Off And Return To Work

You do not have to decide straight away how long you want to take off. An employer should assume you're taking the full amount unless you state otherwise.

Childcare - it is worth considering childcare arrangements while you are pregnant. Nurseries get booked up quickly and it is less stressful if you already have an idea in mind. Ask around locally if you will need a childminder or a nanny. Do consider how you will split childcare arrangements or pick-up/drop-off duties with your partner, as well as whether shared parental leave is an option.

SuppoRTT - a national scheme in England to allow trainees to return to work safely and with support. Provides funding for courses, online tutorials and a supernumerary period once you return. You are entitled to take up to 10 “Keep in Touch” days. It is tempting to save these up and take them at the end of your maternity leave, but you will not get paid if you try to use them in your accrued annual leave at the end, so try to spread them out. There will be more information about SuppoRTT on your local deanery website. 

Breastfeeding - if you expect to be breastfeeding when you return to work let HR know with 6 weeks notice. You should have a breastfeeding risk assessment and there should be facilities available to express and store milk. 

Less Than Full Time - consider whether returning to work less than full time would be suitable. Discuss it with your educational supervisor or TPD and make sure you apply with 6 weeks notice - form should be available on your deanery website. There is a Whatsapp support group for LTFT neurosurgery trainees which is open to anyone to join
(LTFT Whatsapp Chat).

As a parent/carer, you are entitled to days off for childcare purposes at the discretion of your employer.

Returning to work after having a baby can be really tough. You may still be sleep deprived, catching all the viruses from nursery and having separation anxiety from leaving your child. You won’t feel like the same surgeon you were before. Use the support available and reach out to your supervisor or a mentor if needed. There is also a UK based Facebook group ‘Mums in surgery’. 

From neurosurgical trainee to neurosurgical mother - Your surgical skill, confidence and time-management can be affected, but rest assured, and know that you will feel settled and embrace your new ‘normal’ with time. The time you took out of training has not hindered your progress, you have birthed and raised a child which is probably harder than anything you’ve done before.

Useful Resources

JCST guidance PDF

British Orthopaedic Association guidance (really helpful and comprehensive)

RCS website - parents in a surgical career 

 British Association of Spine Surgeons - Training as a Parent

NHS England - Supported Return to Training

NHS advice for maternity leave/pay

NHS Scotland - Returning to Training 

LTFT trainees forum - Facebook

Mums in Surgery Facebook group

If you would like any help or support relating to any of the topics above, please contact:

Anna Bjornson - LTFT BNTA rep

Both of whom can be contacted via the Contact Us section of the website or alternatively via the BNTA email address: (BNTAe1v1m1@outlook.com)

References:

1. https://www.nhs.uk/pregnancy/

2. NHS Plus, Royal College of Physicians, Faculty of Occupational Medicine. Physical and shift work in pregnancy: occupational aspects of management. A national guideline. 2009. Available from: https://www.nhshealthatwork.co.uk/images/library/files/Clinical%20excellence/Pregnancy-FullGuidelines.pdf

3. British Institute of Radiology (2009). Pregnancy and Work in Diagnostic Imaging Departments 2nd Edition. Available from: https://www.rcr.ac.uk/our-services/all-our-publications/clinical-radiology-publications/pregnancy-and-work-in-diagnostic-imaging-departments-second-edition/

4. Downes J, Bauk PN, Vanheest AE. Occupational hazards for pregnant or lactating women in the orthopaedic operating room. J Am Acad Ortho Surg. 2014;22(5):326-32.

5. National Institute Clinical Excellence. British National Formulary. Povodine-Iodine. Available from: https://bnf.nice.org.uk/drug/povidone-iodine.html