One snowy morning in frigid upstate New York, my new patient was anxiously sitting across from me in my office, hoping for words of reassurance as I reviewed her history. She was covered in winter gear, her puffer jacket obscuring all but her noticeable pregnant bump from my view. I reassured her that I had worked with many depressed pregnant women who ultimately went on to have totally healthy babies. But this woman was different. She was a doc, one of our own, and she wanted to know whether her unique doctoring stressors might pose a greater risk for her pregnancy.
It’s well established that employment itself does not carry any extra risk for pregnancy outcomes. But what about the unique stresses of physician employment during pregnancy? We have jobs that often will require long hours on our feet, with high levels of emotional stress and often physical exertion. I think of examples in my own life – I marvel as I think of my own mother, an amazing OBGYN, petite and very pregnant with me during her training as she stood in the OR for prolonged periods. Myself, as I sat across from a psychotic patient during rounds, fearful that she might shove the table separating us into my very big pregnant belly. My sister, a radiologist, commuting back to her NYC apartment via subway at odd hours of the night after completing a long and exhausting call.
With the very best of support, pregnancy can still be overwhelming. But speaking of support, sometimes we simply don’t feel that we have it. Studies have shown that we often feel our colleagues of both genders have negative attitudes towards childbearing during residency training and especially during medical school.1 However, this is likely improving, as one study,2 which explored variations in perceptions and attitudes of physicians-in-training in 2008 compared to in 2015, found that program directors and division chiefs are perceived to be more supportive of resident pregnancy now than they had been in 2008. Despite the fears expressed by our colleagues that pregnancy might be disruptive in a medical training and work environment, the evidence suggests otherwise.3, 4
While few studies have investigated the relationship between work as a physician and the risk of adverse pregnancy outcomes, there doesn’t seem to be any consistent evidence of negative outcomes of pregnancy for physicians versus other women of similar socioeconomic status. Specifically, there is no evidence of increased risk of miscarriage, ectopic pregnancies, stillbirths, preterm births and small for gestational age pregnancies compared to the general population, even for physicians who work especially long hours or are proceduralists.5, 6, 7, 8, 9 Studies of our pregnant nursing colleagues have similarly shown no increased risk of negative outcomes of pregnancy despite their unique working stressors.10, 11
However, as I explained to the nervous young doctor patient sitting in front of me, we as physicians often carry the emotional burden of doctoring and of helping suffering patients. Simply put, it is okay to be sad, nervous or stressed at times during our pregnancies. Some stress and intermittent periods of sadness during pregnancy are to be expected because they are within the realm of the normal human experience. On the other hand, studies have recognized that if the levels of stress or sadness become extreme, chronic, and unrelenting, it can actually be harmful for the baby.
Being physicians, we often want to push through our struggles to continue working and providing the best for our patients, perhaps even thinking that we can reverse the grips of pregnancy depression if we think positively and just keep contributing to the greater good. Even being a psychiatrist who researches and treats the mental health of pregnant women, I found that I was not immune – my postpartum blues slowed me down and overwhelmed me. Pregnancy is not protective against mental health issues, and depression and anxiety can often show up for the first time during your pregnancy. Further, depression during pregnancy and postpartum periods can impact pregnant women of all ages, races and socioeconomic walks of life.
Many pregnant women who are struggling and show up in my office are invested in conservative and natural management of their ailments during their pregnancies. In many of these cases, we opt for regular therapy, which is often sufficient. In some cases, we might also add an antidepressant. Many patients, including those in the medical field, can be wary of taking antidepressants during pregnancy. However, when I present the data regarding the risk profile of antidepressants versus the risks of uncontrolled depression or anxiety during pregnancy, many of my patients feel more confident in opting to add an antidepressant as part of their treatment.
Pregnant doctor mama, you’re doing great! But if you find yourself less able to cope with the unique stressors of doctoring while pregnant, stop and check in with yourself. Lean on your supports. Reach out to others. And if it gets worse and the sadness or anxiety feels overwhelming, reach out to your mental health colleagues. We’re here for you!
1. Stentz NC1, Griffith KA1, Perkins E1, Jones RD1, Jagsi R1. (2016) Fertility and Childbearing Among American Female Physicians. E. J Womens Health (Larchmt). 25(10), pp. 1059-1065.
2. Mundschenk MB1, Krauss EM2, Poppler LH1, Hasak JM1, Klingensmith ME3, Mackinnon SE1, Tenenbaum MM1. (2016). Resident perceptions on pregnancy during training: 2008 to 2015. F. Am J Surg. 212(4), pp. 649-659.
3. Erin G. Brown, MD1; Joseph M. Galante, MD1; Benjamin A. Keller, MD1; et al Juanita Braxton, PhD1; Diana L. Farmer, MD1. (2014). Pregnancy-Related Attrition in General Surgery. JAMA Surg. 149(9), pp. 893-897.
4. Tamburrino MB1, Evans CL, Campbell NB, Franco KN, Jurs SG, Pentz JE. (1992). Physician pregnancy: male and female colleagues’ attitudes. J Am Med Womens Assoc. 47(3), pp. 82-4.
5. Klebanoff MA1, Shiono PH, Rhoads GG. (1990). Outcomes of pregnancy in a national sample of resident physicians. N Engl J Med. 323(15), pp. 1040-5.
6. Quansah R1, Gissler M, Jaakkola JJ. (2009). Work as a physician and adverse pregnancy outcomes: a Finnish nationwide population-based registry study. European Journal of Epidemiology. 24 (9), pp. 531–536.
7. Rebecca Scully MD1, Nelya Melnitchouk MD1, Jennifer S. Davids MD2. (2016). Fertility and Pregnancy Outcomes in Female Physicians in Procedural Specialties. Journal of the American College of Surgeons. 223 (4), pp. S109
8. Masumi Takeuchi, Mahbubur Rahman, Aya Ishiguro, Kyoko Nomura. (2014). Long working hours and pregnancy complications: women physicians survey in Japan. BMC Pregnancy and Childbirth. 14, pp. 245
9. Matteo Bonzini, David Coggon, Keith T Palmer. (2007). Risk of prematurity, low birthweight and pre‐eclampsia in relation to working hours and physical activities: a systematic review. Occup Environ Med. 64(4), pp. 228–243.
10. Lawson CC, Whelan EA, Hibert EN, Grajewski B, Spiegelman D, Rich-Edwards JR. (2009). Occupational factors and risk of preterm birth in nurses. Am J Obstet Gynecol. 200(1).
11. Bonzini M, Coggon D, Godfrey K, Inskip H, Crozier S, Palmer KT. (2009). Occupational physical activities, working hours and outcome of pregnancy: findings from the Southampton Women’s Survey. Occup Environ Med. 66 (10), pp. 685-690.