“For anesthesiologists who identify as mothers, the balance between motherhood and professional life poses a unique set of challenges given the long hours, unpredictable schedule, and emotional and physical stress involved in practice”1 -- So begins today’s PAAD. Women make up more than 50% of medical school graduates and at least 30-40% of the anesthesia workforce (probably more if you include CRNAs, AAs, anesthesia technicians etc). Among women physicians, the Covid-19 pandemic peeled away the band-aid and exposed major flaws in health care delivery and work-life balance. Covid-19 demonstrated very clearly that women still have primary parental responsibilities of child and, increasingly, elder care. Many women in academic medicine were particularly affected, fell off promotion tracks, burned out, and were essentially screwed. Covid-19 was incredibly disruptive to all of us in and out of medicine and further belied the myth that women “could have it all”. More on “having it all” below…
In today’s PAAD, Berical et al.1 provide a detailed and admirable framework for how “mothers practicing anesthesiology can be supported and empowered.” They founded a Mother’s Support Group at their large academic institution, “championing the working mother in academic practice as a key to encouraging and maintaining a diverse workforce.” Left out of today’s PAAD are the many, many women in anesthesia who work in non-academic settings. I’ll ask about this at the conclusion of today’s PAAD. I am wondering how our readers in private and group practices outside of academia are handling the issues raised in today’s PAAD. Myron Yaster MD
Original article
Berical KA, Vogel TS, Robinson JM, Ward AM, Wiener-Kronish J. Championing the Mom: The Role of a Mother's Support Group in Academic Anesthesia Practice. Anesth Analg. 2023 Oct 1;137(4):777-781. doi: 10.1213/ANE.0000000000006575. Epub 2023 Sep 5. PMID: 37712469.
It is widely recognized that childcare and early childhood education in America is an expensive mess, developmentally inadequate for children, and massively stressful if not impossible for working parents. It really is a disgrace. Virtually all working mothers have to balance work commitments and childcare which is often difficult to secure, unpredictable, and very expensive. In the perioperative work space, mothers, anesthesiologists (attendings, residents, fellows and medical students), CRNAs, AAs, anesthesia technicians and support staff have to struggle with not only these common problems but the complexities of “pregnancy in the perioperative environment and efficiently accessing lactation rooms.”1
The goals of this published Mother’s Support Group were to “create a visible and accessible support network for those who identify as mothers or are interested in becoming mothers in the department across service roles, provide guidance on how to navigate pregnancy and parental leave in the anesthesia field, educate new mothers who choose to breastfeed about the lactation resources available in the perioperative environment, ensure a safe perioperative and periprocedural environment for pregnant providers and a system by which to disclose pregnancy status discreetly, provide confidential intradepartmental mentorship regarding pregnancy loss, in vitro fertilization, oocyte cryopreservation, and family planning, and foster a community to share childcare recommendations and parenting resources and to organize social events.”1
Working together with all of the stakeholders, the anesthesia, surgery, interventional radiology, and perioperative nursing departments, the group focused on the physical challenges of pregnancy and lactation, the overnight call schedule and being able to opt out of procedures involving potential teratogens like radiation, cancer chemotherapeutics, methyl methacrylate, etc. In our profession, minimizing exposure to anesthetic waste gas is almost impossible (but could be put on a wishlist or future goals!). They also developed “an online forum and listserv for discussion, questions, and childcare references. In addition, they provided confidential peer mentorship and support for group members.”1
The 4 major issues they tackled: 1) department scheduling guidelines for the pregnant provider, 2) call policy revisions for pregnant anesthesia attendings, 3) lactation support, and 4) mentorship and support. It’s beyond the scope of the PAAD to discuss how this team dealt with all of these issues and we would encourage all of you to read this article and discuss internally in your faculty meetings. We would like to discuss latation support which was featured in a recent SPA annual meeting. “Studies show that organizational and managerial support of lactation improves job satisfaction and, in some cases, rate and duration of breastfeeding”1-4 Creation of convenient lactation rooms in the perioperative areas of the hospital were key and required the support of perioperative leadership and hospital funding.
The authors concluded: “Creating a formalized Mother’s Support Group is mutually beneficial to both the department and working mother. Departmental benefits include potentially increased recruitment and retention of female providers, increased staff satisfaction, and a diverse and inclusive workforce. The working mother benefits by having formalized support and mentorship, a pathway to request appropriate clinical assignments when pregnant, and lactation resources, which, in turn, could lead to higher work satisfaction. We acknowledge that some of our protocols and resources may be most generalizable to other academic medical centers; however, we believe that forming a group like this is beneficial to advocate for and promote the well-being of mothers within any department, regardless of practice model or group size.”1
To briefly address the topic of “having it all,” we commend these authors and institutions for making thoughtful and wise efforts to help Moms achieve this end. This experience of “Mom” is inclusive to single parents, Dads who carry the “Mom load,” and all of the important variations of family structure. There is one critical point of validation I (Melissa) would like to add to this discussion. I suspect we all suffer from continuous guilt while trying to “have it all.” When we set out to do “all the things”, what results happening is fulfilling each commitment, achieving each goal, or pursuing a work- or home-related challenge is performed at about 65-70% as well as we would expect. We end up failing at how well we would “normally” do something or see an outcome that is below our personal standards or previous performance. From personal experience, I know that this leaves a feeling of constant failure, as opposed to feeling accomplished for striving admirably and nearly “having it all.” This should not be the case!! To that end, having solidarity, camaraderie and support for and from other Moms and Mom-figures can make a huge difference in morale and, importantly normalization of “having it all” (but never really having it all, and suffering as a result….). Being able to share your big and small “Mom wins” and “Mom fails” can make all the difference in normalizing the experience we all share. In our current world, I recommend a couple of great resources out there for that support. Physician Anesthesia Moms Group (PAMG) on Facebook – accessible by joining the group to be vetted, and Instagram handles “Dad and Buried” and “scarymommy” (my preferences, take with a grain of salt!) I know of some other great things to follow depending on your needs, goals and sense of humor, so please reach out if I can help you find the supports that will work for you! [melissabrooks45@gmail.com].
We are sure that many of our readers have faced these issues, not only in academic departments but also in private and corporate community group practices. Please send your thoughts and comments to Myron, particularly those of you who are in private or group practices. He will post in a Friday Reader response.
References
1. Berical KA, Vogel TS, Robinson JM, Ward AM, Wiener-Kronish J. Championing the Mom: The Role of a Mother's Support Group in Academic Anesthesia Practice. Anesthesia and analgesia. Oct 1 2023;137(4):777-781. doi:10.1213/ane.0000000000006575
2. Waite WM, Christakis D. Relationship of maternal perceptions of workplace breastfeeding support and job satisfaction. Breastfeed Med. May 2015;10(4):222-7. doi:10.1089/bfm.2014.0151
3. Jantzer AM, Anderson J, Kuehl RA. Breastfeeding Support in the Workplace: The Relationships Among Breastfeeding Support, Work-Life Balance, and Job Satisfaction. J Hum Lact. May 2018;34(2):379-385. doi:10.1177/0890334417707956
4. Garcia-Marcinkiewicz AG, Titler SS. Lactation in Anesthesiology. Anesthesiology clinics. Jun 2022;40(2):235-243. doi:10.1016/j.anclin.2022.01.014