Pregnancy can be one of the most physically demanding times of a person’s life. For the pregnant emergency physician, these challenges are compounded by a job marked by high physical demands, disrupted circadian rhythms, and few breaks. For residents, this toll can be even higher with off-service rotations incorporating 24-hour call shifts and work weeks nearing the 80-hour limit. The physiological toll of these conditions is well-documented: chronic sleep deprivation and night work are associated with increased risk of hypertensive disorders, preterm birth, fetal growth restriction, and early pregnancy loss [1, 2]. Research focusing specifically on the physician workforce has established a clear correlation between high-strain work environments and adverse pregnancy outcomes [3].

Over the past decade, several key publications have informed best practices for scheduling and support policies for pregnant emergency physicians. In 2016 Academic Emergency Medicine published the first best practice framework for supporting women emergency physicians derived via a stakeholder consensus model [4]. This paper offered recommendations on physician health and wellness in the context of pregnancy and maternity leave, with guidance applicable to both academic and community settings. In 2020, Chernoby et al described a pilot program supporting EM residents who were pregnant or new parents with overwhelmingly positive feedback and no additional scheduling burden on the department. Other residency programs have instituted similar policies with success [5, 6].  In 2022, MacVane et al conducted a nationwide survey of EM residency programs found that 60% would support guidance from GME and academic societies regarding scheduling during pregnancy [7].  A 2024 consensus statement in Annals of Emergency Medicine provided a comprehensive evidence-based framework for addressing pregnancy, parental leave, and lactation support with recommendations designed to enable professional advancement without sacrificing personal wellbeing [8].  The authors developed a framework to help emergency departments nationwide implement family-friendly policies, addressing the significant paucity, variability, and dissatisfaction with current parental support policies in emergency medicine.  

Taken together, this evidence base supports a clear mandate for standardized, protective scheduling policies tailored to the realities of emergency medicine, and a path forward. The following recommendations are intended to provide departments with a practical framework for supporting pregnant physicians while respecting the needs of emergency department operations and staffing.