Pregnant in the OR: When to Tell

I was 5 weeks pregnant and working in the spine room. Just as I finished my intubation and secured the airway, I turned to set the ventilator and administer some important medications. The surgery fellow started to position the fluoroscope near the patient's cervical spine, about a foot away from where I was working. "Please don't use the Xray right now; I need to put on a lead shield first," I said. "Yeah, ok... whatever..." he said, as he continued to fine-tune its position. Thirty seconds later he sighed, then started pushing some buttons and eyeing the screen. I looked at him sternly and said, "I'm serious. Don't do it. I'm pregnant."

After coos and congratulations from the fellow, resident, nurse, and scrub tech, I felt a bit awkward. Of course, I myself had just learned of my pregnancy; I hadn't even seen a heartbeat on ultrasound yet! This wasn't the way I expected to tell people my good news, and I really wish I hadn't been forced to do so in that situation. That being said, I really didn't want the radiation exposure at that time. I suffered a miscarriage a few weeks later and then had to engage those same people in some very awkward conversations.

The decision of when disclose a pregnancy in any situation is a highly personal one. Unfortunately, there is a lot of misguided shame surrounding miscarriage in our culture, and thus many expectant moms often wait until their first trimester has passed in order to disclose the good news. But in my line of work, there are clear benefits to telling others earlier rather than later. First, anesthesiology (like surgery and many other specialties for that matter) is a relatively physical practice. Say you're feeling faint during a procedure, battling nausea, needing frequent snacks, or have a constant urge to urinate. People are going to think you're having issues and might worry about your work performance... unless of course they know you are pregnant, in which all of these situations are commonplace and understandable.

In terms of shift scheduling, call assignments and specific work days for any given week are often determined well ahead of time. Usually, requests for days off or vacations are done so about 1-2 months in advance; however, because I work in an academic hospital, the summer poses a major scheduling challenge due to new resident orientation/training. If a baby is due in the summer, special arrangements need to be made so as to not impact the delicate balance of staffing during the transition period for brand new residents. In a private practice situation, far advanced notice might be necessary if the due date is around a major holiday. Therefore, alerting the appropriate vacation/call schedulers to a pregnancy earlier rather than later may affect your entire practice group.

In addition, pregnancy status may impact daily work assignments. At my institution, the schedulers try to avoid giving pregnant women assignments that involve consistent or high doses of radiation, such as what is encountered in the interventional radiology suite or cath lab. (I hope to address this more in a future blog post.) It's difficult to avoid assigments in orthopedic rooms since these cases are so ubiquitous, but you might want to also alert the nurse and scrub of your status so that when they mix the methacrylate joint glue, you can step out to avoid the fumes. And you definitely want your protective lead suit if a fluoroscope is in sight!

Just like disclosing a disability at work, it's a "know when to hold 'em, know when to fold 'em" situation. The right point to fold will be different for each individual. Because my first pregnancy (the one in the story above) ended in miscarriage, I was initially keeping things much quieter with my current pregnancy. However, a similar situation with the fluoroscope still happened again at 7 weeks! I got zapped twice in one day despite my veiled warnings, and after the second time I frustratingly blurted out my news to everyone in the room. Of course they paused, congratulated, and then took things much more seriously in the radiation department. It shouldn't have to be that way, but unfortunately most people are very nonchalant about radiation exposure.

Aside from that incident, I waited until about 10 weeks before I was open about my pregnancy. After I had a couple of ultrasounds under my belt and my IVF docs told me that my miscarriage chance was very low, I notified our anesthesia scheduling partners of my status. They have respectfully given me lower-exposure, lower-stress assignments (like fewer, less physical cases per day with limited fluoro, etc.) As far as other pregnancy symptoms are concerned, I have had my days of nausea and moving slowly, but it hasn't seriously affected my performance at this point.

Has anyone - trainee or practitioner - experienced issues with disclosing a pregnancy? Share your thoughts with us!