Pregnancy, Birth, and Maternity Leave in Neurosurgery and Cardiothoracic Surgery: A Qualitative Study.

INTRODUCTION: This study aimed to explore how female surgeons manage the demands of pregnancy, childbirth, and maternity leave and how workplace cultures shape their reproductive experiences. METHODS: A qualitative study was conducted using semistructured, in-depth interviews with surgeons in the United States and Canada (N = 22). A majority of the participants reported having children. Interviews focused on experiences with pregnancy, birth, and return to work. Transcripts were analyzed using an inductive thematic approach. RESULTS: Three major findings emerged: (1) pregnancy in an unaccommodating workplace, (2) the health and personal costs of an unsupportive work environment, and (3) maternity leave as an individual burden. Surgeons described significant challenges in timing pregnancies, often delaying childbearing and experiencing infertility, miscarriage, and/or reliance on assisted reproductive technologies. Participants reported a lack of formal pregnancy policies and accommodations, resulting in continued full clinical duties, including operating and overnight call, until the start of labor. Many described concealing pregnancies due to stigma and fear of professional repercussions. Nearly half of the surgeons in the sample reported experiencing pregnancy complications, and nearly a quarter reported infant health complications. Maternity leave policies were frequently absent, leading to financial penalties and pressure to return to work early. Experiences with colleagues ranged from supportive advocacy to hostility and retaliation. CONCLUSIONS: Female neurosurgeons and cardiothoracic surgeons navigate pregnancy and maternity leave within professional environments that often lack formal supports. Structural policies and cultural change are needed to support reproductive health, promote equity, and improve retention of women in surgical specialties.