Trauma and Orthopaedic Surgery is the career choice of many female medics. Currently, 5% of the consultant body are female but approximately a quarter of all new trainees at ST3 level in orthopaedics are female. The following pages aim to inform current and future trainees about the details of training in orthopaedics as a woman.
Pregnancy & Maternity FAQ
What can I do about feeling faint during surgery?
Many of us will have fainted in theatre at some point particularly when younger. It certainly does not mean that you are not well suited to a career in surgery. Women are physiologically four times more likely to faint than men and if you are standing very still for long periods of time whilst assisting feeling light headed is certainly common. Most female trainees will tell you that their body has gradually got used to long periods of standing up over time and that they no longer have so much of a problem with it. However, there are other things you can do to combat it.
- Eat regular small meals and certainly never miss breakfast or lunch
- Stay hydrated
- If you feel yourself getting slightly light headed do some heal raises or move around a bit at the table to get the blood pumping back up from your legs.
- If you really feel faint step back away from the table and sit down, you will desterilise yourself but clearly that is highly preferable to fainting onto the patient’s open wound and jeopardising the sterility of the operation.
- Some people find DVT stockings or maternity compression stockings helpful.
Is it OK to work with the image intensifier during pregnancy?
Obviously, we routinely wear lead gowns to minimise the radiation dose to the internal organs during procedures involving x rays. During pregnancy, there is a potential risk of radiation to the foetus. Radiation exposure if wearing a lead gown is less than 1 milliSievert over nine months, to put this in perspective the dose for a patient receiving an X-ray of the spine is 1.5 milliSievert.
There are ways to further reduce your radiation dose whilst pregnant:
- Tell the radiographer you are pregnant so that they can collimate or focus the X-ray beam on the area of interest.
- Use the mini c arm if possible which has a smaller radiation dose.
- Get into the good habit of taking fewer X-rays
- Stand further away from the C arm, 2m away dramatically reduces the dose.
- Stand behind a portable screen in theatre.
- Wear a lead skirt and top rather than a tunic for extra protection and comfort.
Hospitals usually leave it up to the surgeon’s individual preference what they want to do. In most units, the other registrars and consultants can manage to accommodate you if you don’t want to do a particular case involving a lot of X-rays.
Is it OK to work with cement for joint replacements during pregnancy?
The vapours from PMMA cement are classified as irritant. The main problem they can cause is irritation to the conjunctiva or respiratory tract. Mixing using a vacuum and using a cement gun along with the laminar flow air system all help to reduce our exposure to the vapours. There is no known evidence of risk to the foetus from these fumes but the effects have not been studied. Most hospitals will leave it up to you if you want to do cases involving cement during pregnancy and most people choose to continue as normal. The alternative is to step outside while the cement is used, theatre staff are generally accommodating of this.
How do I cope with nausea and vomiting during pregnancy whilst trying to operate?
Nausea is a horrible symptom even at the best of times. The standard advice for nausea during the first trimester is to eat small meals often which are quite plain e.g. crackers/toast etc to help settle the stomach. Strong smells can trigger the nausea, which may be unavoidable in theatre. Staying hydrated and well rested is also thought to reduce the severity of the nausea. In some cases, it may be necessary to discuss anti-sickness medication with your doctor. If you feel really sick it can help to unscrub for a few minutes. Clearly, if you are actively vomiting it is unwise to operate.
When can I stop doing night shifts?
There is no specific time during your pregnancy when you are obliged to stop working nights. However due to the tiredness that accompanies pregnancy many people choose to negotiate with their employer to stop working nights in the final stages of pregnancy. There is some evidence that work-ing night shifts during pregnancy may increase the risk of premature labour.
How long is maternity or parental leave?
You are eligible to take up to 52 weeks off. You will accrue annual leave during this time, which you can also take off. How much time you take off will obviously depend on your health post pregnancy, your baby and your childcare arrangements at home. Some trainees say they have found it easier to get back into the swing of work when they have had 6 months off rather than a whole year, particularly if it is a second child. You are obliged to take the first 2 weeks off, post delivery.
When can I start my maternity leave?
You need to inform your training programme director and the deanery in advance of your due date, it will be helpful to them for rotation planning if you can tell them when exactly you intend to go off and how long you intend to take off. Maternity leave can start from 29 weeks gestation. Most people stop working at 36 weeks, but you might want to go on until 38 weeks. If you need to take sick leave be-cause you are unwell during your pregnancy that is not a problem however if you need to take sick leave in the last 4 weeks of pregnancy then you employer may ask you to start your maternity leave rather than take sick leave.
How does pay work during maternity leave?
Overall NHS maternity pay is excellent. You need to notify your employer in good time of your intention to take maternity leave, this should be as soon as you are comfortable to do so e.g. after the 12 or 20-week scan. The latest you can inform them is 15 weeks before you are due i.e. in the 24th week. You will need to notify the maternity advisor in HR at the deanery, your own consultant, the person in charge of organising the rota in your hospital and your programme director.
The system for calculating maternity pay is somewhat complex. However, the end result is essentially 16 weeks full pay, 8 weeks half pay and then statutory maternity pay (approx. £600) up until the 9-month mark, then the last 3 months are unpaid.
These links explain the complexities of maternity and parental leave in more detail:
What about Paternity / Partner Leave?
The biological father, adoptive parent or partner of the child’s mother (male or female) may take ‘maternity support (paternity) leave’ for 2 weeks within the first 8 weeks after birth or adoptive placement.
Shared parental leave which commenced in 2015 essentially allows the child’s parents to divide 50 out of a total of 52 weeks maternity leave between themselves. The blocks of leave may also be split up.
Will having a C-section make it more difficult to return to work?
No! We don’t think so. Most people will take at least 3 months maternity leave, most take a year so it really should not be an issue. At 6 weeks you are able to start heavy lifting and exercising again then at 3-4 months your core strength and stability should return to normal but of course, everyone is different.
Can I still breastfeed when I go back to work?
Yes, depending on their age you may want to express milk for them to take to nursery and feed them morning and night while at work and any time when you are off with them. Your supply should be fully established on your return to work so you should have no problems feeding them more or less and you should not become engorged.
What are the options for working part time?
As a trainee, the minimum you can work is 60%, which sessions or days of the week you work will be up to you to negotiate with your trainer depending upon both your respective timetables. The advantage of less than full-time training is that if you are off you cannot be allocated any additional unexpected sessions. Generally, your day off will be when your consultant has no commitments. The day off needs to be the same every week if your child goes to nursery as they will have fixed days. With travel time and late finishes, it is often easier to work one whole day instead of two half days.
As a consultant, it is also possible to negotiate your contract around your life so that you work fewer sessions, or cluster your sessions on certain days. Some hospitals have evening clinics and theatre lists which mean that you can have a day off instead.
What do I do if my child is sick?
If your child is sick and there are no other options for childcare then you can take compassionate leave to care for them. Additionally, your consultant could accommodate you if you had to leave early to pick them up due to sickness. There is also the capacity to take up to 18 weeks of parental leave per child up until their 18th birthday to care for them, this leave is usually unpaid.