As an increasing number of women enter the practice of urology during peak years of their fertility, it is vital that we as a urologic community take the time to evaluate the specific needs and challenges faced by women urologists. Women urologists comprise over 11% of the urologic workforce, and recent AUA Match data suggest that 30% of the medical students entering urology residency are female.¹

Accommodations during pregnancy and policies for leave associated with childbearing for urology faculty and residents often are not outlined by institutions or employers. These needs are varied and include minimization of radiation exposure, adaptations to long work hours, modifications to physical lifting or standing in the operating room, access to clean area to express breast milk, and planned or unplanned time off. While the Accreditation Council for Graduate Medical Education and the American Board of Urology have instituted a policy of 6 weeks of paid parental leave during training, the language in these policies is not direct and does not address specific work modifications during pregnancy or postpartum periods. Similarly, there are no standards currently set forth at an organizational level by the AUA to support the needs of pregnant urologists, putting them at risk for pregnancy loss and complications. A lack of clear, written policies guiding work restrictions and modifications during pregnancy, parental leave, and lactation support can lead to challenges in on-time graduation from training, job retention, career progression, burnout, and adverse effects on maternal and infant health.² In the current study we aim to understand the childbearing practices of women in urology, and further characterize the struggles of pregnancy as a urologist.

From February through May 2022, the Society of Women in Urology conducted a census of the female urologists in the US and its territories. This was disseminated electronically in an anonymized fashion. Variables of interest included demographics, career position, practice location, whether they chose to have children, timing of childbirth in their career, use of reproductive assistance, pregnancy complications and loss, maternity leave length, and accommodations granted during pregnancy.

Of 379 respondents, estimated to represent 27% of female urologists based on the 2020 AUA Census, 69% reported having children. The average age of respondents was 42.9 years (SD 18.6), and 75% were practicing urologists, 15% residents, and 10% fellows. Many of these individuals had multiple pregnancies, and the timing of childbirth is demonstrated in the Figure. Maternity leave ranged between 2 and 36 weeks, with 78% taking 6 weeks or less. A significant number of women (36%) reported complications during pregnancy, 29% reported pregnancy loss, and 24% required assisted reproductive technology. Fifty-nine percent of respondents who experienced pregnancy received at least 1 accommodation during pregnancy. These included redistribution of call (46%), partner coverage of operative cases (21%), coverage of overhead (5%), decreased productivity requirements (8%), or other (19%).

Women in urology, like other female surgeons, delay motherhood, require higher rates of reproductive assistance, take a short amount of time for maternity leave, and face high rates of pregnancy complications, including loss, especially when compared to the general population.³ Our work as surgeons includes long work hours, standing in the operating room, physical heavy lifting, radiation, and cytotoxic exposures, all of which make our occupation high risk for complications during pregnancy.⁴ Women fear the impact on their reputation by requesting adaptations during pregnancy, despite the health risk this may pose for them and their unborn child.⁵ Therefore, it is imperative that guidance at a national and organizational level is outlined for planned and unplanned time off, as well as work modifications during pregnancy, particularly in the third trimester.

Women in urology need infrastructure to support childbearing, including during medical school, residency, fellowship, and practice. A major culture shift in the surgical workplace is required to create a supportive workplace for women urologists to deliver healthy children and reduce pregnancy loss and complications. Clear policies from institutions and employers to support women who choose to have children would potentially decrease pregnancy loss, complications, and infertility while promoting health and well-being. Modifications during pregnancy such as reduction to hours worked, reduction of hours operating, flexibility of rotations or relative value unit requirements, and decreasing call during the third trimester could reduce the risks from surgeon work hazards on pregnant women. Furthermore, creating guidelines to support women after pregnancy (or pregnancy loss) would be beneficial and could include increased duration of maternity leave, postpartum mentorship to help transition back to work, improved access to lactation space and storage for breast milk, and using alternative measurements of competency in training, other than time based such as milestones or skill-based advancement. Flexible accommodations can allow women to overcome systemic barriers to family building, and ultimately, retain women in the urology workforce and promote career progression.