Cole Stephanie, Arnold Michelle, Sanderson Alicia, Cupp Craig
Department of Otolaryngology, Naval Medical Center San Diego, San Diego, California 92134, USA.
Am Surg. 2009 May;75(5):411-5.
Pregnancy during graduate medical training became a pertinent issue in the United States during the 10-year interval between 1992 and 2002 as the number of female residents trended steadily upward to over 25 per cent. Surgical training programs characteristically present unique challenges and stressors for all trainees, and pregnancy introduces additional physical, professional, and emotional demands for the pregnant woman and her coworkers. A qualitative study was performed using in-person interviews of female otolaryngology residents who had given birth within the previous 12 months. Items addressed included the pregnancy course and its complications, specific stressors during and after pregnancy, and solutions implemented by the resident and her program director. Reactions and level of support from coworkers were also discussed. Five pregnancies were reported among three residents interviewed. One resident experienced preterm delivery, which necessitated a week-long stay in the neonatal intensive care unit for her infant. Another had chorioamnionitis during delivery of two infants. One child had low birth weight. The third resident had a miscarriage during the first trimester of her first pregnancy and sustained a minor head injury after fainting in the operating room during her second pregnancy. Overall, long hours, unpredictable work demands, and guilt over colleagues' increased workloads and altered schedules were noted as significant sources of stress among these residents; the women also described high expectations of themselves, along with misgivings over their ability to balance pregnancy and parenthood with career demands. The most significant postpartum stress indicator was the matter of child care, especially as it related to finding adequate coverage for on-call periods ranging from 3 to 14 days per month. Maintaining breastfeeding was an additional concern in the postpartum period. Pregnancy during surgical residency is a significant source of conflict for the pregnant resident and her colleagues. Our study illustrates how program directors can pre-emptively address challenges this event presents. When policies on maternity leave, call issues during pregnancy, and flexible rotation schedules are in place before pregnancy occurs, the process may be smoother and more rewarding for all involved.
在1992年至2002年的十年间，随着女性住院医师数量稳步上升至超过25%，研究生医学培训期间的怀孕问题在美国成为一个相关议题。外科培训项目对所有学员来说都有独特的挑战和压力源，而怀孕给孕妇及其同事带来了额外的身体、职业和情感需求。一项定性研究通过对在过去12个月内分娩的女性耳鼻喉科住院医师进行面对面访谈来开展。涉及的项目包括怀孕过程及其并发症、孕期和产后的特定压力源，以及住院医师及其项目主任实施的解决方案。还讨论了同事的反应和支持程度。在接受访谈的三名住院医师中报告了五次怀孕情况。一名住院医师经历了早产，其婴儿在新生儿重症监护病房住了一周。另一名在分娩两个婴儿时患了绒毛膜羊膜炎。一个孩子出生时体重低。第三名住院医师在第一次怀孕的头三个月流产，第二次怀孕时在手术室晕倒后头部受了轻伤。总体而言，长时间工作、不可预测的工作需求，以及对同事工作量增加和日程安排改变的内疚感被认为是这些住院医师压力的重要来源；这些女性还表示对自己期望很高，同时对自己平衡怀孕、为人父母和职业需求的能力有所疑虑。产后最显著的压力指标是 childcare问题，特别是与每月3至14天的值班期找到足够替代人员相关的问题。产后维持母乳喂养是另一个令人担忧的问题。外科住院医师培训期间怀孕对怀孕的住院医师及其同事来说是冲突的一个重要来源。我们的研究说明了项目主任如何能够预先应对这一情况带来的挑战。当产假政策、孕期值班问题和灵活的轮转时间表在怀孕前就已到位时，这个过程对所有相关人员来说可能会更顺利且更有意义。
