No Good Time: How Surgical Careers Reshape Women’s Family Planning and Pregnancy

For women in surgery, the question of when to have a baby is never simply a personal one. A new qualitative study published in Global Surgical Education, the Journal of the Association for Surgical Education, argues that the very structure of surgical training and practice actively shapes reproductive decision-making, often pushing childbearing later into life and placing the burden of accommodation squarely on the shoulders of women themselves. The research, led by Jillian Schneidman of McGill University’s Division of General Surgery together with colleagues across Canadian institutions, offers one of the most detailed portraits to date of how women surgeons actually navigate family planning and pregnancy, rather than merely documenting the outcomes of those decisions.

The stakes of this question are well established in the surgical literature. Previous studies have shown that women surgeons experience higher rates of delayed childbearing, infertility, and pregnancy complications compared with other physician groups. Research published in JAMA Surgery in 2021 found substantial rates of infertility and pregnancy complications among US female surgeons, and other work has documented high rates of assisted reproduction use among surgeons of both sexes. Yet, as the authors of the new study point out, most of this scholarship has measured the consequences of surgical careers on reproduction without exploring the lived process by which women weigh fertility against the demands of residency, fellowship, and early practice.

To fill that gap, the research team employed a constructivist grounded theory methodology, a qualitative approach in which data collection and analysis proceed together in an iterative loop, with each interview informing the next and emerging themes refined through constant comparison. The investigators conducted semi-structured virtual interviews with women surgeons and trainees across multiple surgical specialties, recruiting participants through social media using maximum variation sampling, a technique designed to capture as wide a range of experiences as possible rather than a statistically representative sample. The team continued recruiting and analyzing until they reached what qualitative methodologists call information power, the point at which the richness of the data is sufficient to answer the research question.

Sixteen women participated in the study: twelve staff surgeons, three residents, and one fellow, drawn from five surgical specialties. From these interviews, three interconnected themes emerged. The first the authors describe as training dominance over reproductive timing. Surgical training is long, rigid, and unforgiving: five years of residency at minimum, often followed by fellowship, with call schedules, case volume requirements, and high-stakes examinations dictating nearly every hour. Within this structure, participants described how both explicit messages and a subtler hidden curriculum, the unwritten norms absorbed through daily life in the operating room and on the wards, shaped their sense of when pregnancy was even feasible. The result, for many, was the postponement of childbearing into their thirties or beyond, precisely the window in which fertility begins to decline and the risks of pregnancy complications rise.

The second theme, strategic planning within institutional constraints, captures the extraordinary lengths to which women surgeons go to align pregnancy with the rigid milestones of training and career. Participants described what the researchers call hyper-planning: mapping out research years, elective rotations, and the timing of board examinations years in advance, consulting fertility specialists about egg freezing, and calculating the optimal window in which a pregnancy might least disrupt training. Yet this hyper-planning collided with a fundamental biological reality that the authors emphasize: fertility and pregnancy are inherently unpredictable. A woman can schedule her residency timeline, but she cannot schedule conception, a healthy pregnancy, or a safe delivery. The mismatch between institutional rigidity and reproductive uncertainty emerged as a central tension in the participants’ accounts.

The third theme, ongoing adaptation within an inflexible system, describes what happens after the planning meets reality. Women relied on self-advocacy, informal mentorship from other surgeon mothers, and individually negotiated accommodations to balance the operating room with parenting. Critically, the study found that these systems often framed the very need for flexibility as a form of weakness. In a culture that prizes stoicism, endurance, and the appearance of effortless commitment, asking for modified duties or parental leave could carry professional costs, from subtle exclusion from operative opportunities to doubts about a surgeon’s dedication. The authors note that institutions frequently failed to provide adequate structural support for family planning, leaving individual women to improvise solutions on their own.

These findings resonate with a growing body of work on surgical culture. Studies using Hofstede’s cultural framework have characterized surgical environments as strongly masculine, hierarchical, and task-oriented, and ethnographic work has documented how women in surgery must navigate a discursive space that was not built for them. Research on maternity leave has found that program directors cite cultural and fiscal barriers to supporting pregnant residents, and surveys of residents consistently reveal uncertainty and anxiety about parental leave policies. The new study extends this literature by connecting these structural features directly to reproductive behavior, showing that the decision of when, or whether, to have a child is not made in a vacuum but within a web of institutional constraints and implicit professional norms.

The methodological rigor of the study deserves attention as well. Constructivist grounded theory, as developed by Kathy Charmaz, treats knowledge as co-constructed between researcher and participant, and the authors’ iterative coding process allowed themes to emerge from the data rather than imposing pre-existing categories. The use of maximum variation sampling ensured that the sixteen participants represented a range of specialties, career stages, and family situations, strengthening the transferability of the findings. The authors also acknowledge the limitations inherent in qualitative work: the sample, while rich, cannot establish prevalence, and participants who volunteer for interviews about family planning may differ systematically from those who do not.

What makes the study’s conclusions particularly pointed is its reframing of the problem. The challenges surrounding family planning and pregnancy in surgery, the authors argue, stem not solely from individual choices but from broader cultural and structural conditions that place the burden of accommodation on women themselves. When a surgeon must single-handedly engineer her pregnancy timeline around call schedules and examination dates, when mentorship happens informally rather than institutionally, and when requesting flexibility is read as a lack of commitment, the system itself is the pathology. The personal and professional costs of this arrangement, including delayed childbearing, increased reliance on assisted reproduction, and pregnancy complications, are borne disproportionately by the women navigating it.

The authors call for structural and cultural reforms that recognize family planning and pregnancy as expected and accepted aspects of surgical careers, rather than exceptions to be managed case by case. That would mean transparent, guaranteed parental leave policies; normalized part-time or flexible pathways during training and early practice; formal mentorship structures for surgeon parents; and a cultural shift in which asking for accommodation is understood not as weakness but as a reasonable response to the biological realities of reproduction. As the study’s title suggests, drawn from a participant’s own words, there is no good time to have a baby in surgery, and the goal of reform should be to change that. Creating environments in which women surgeons can thrive rather than simply survive, the authors conclude, is not only a matter of equity but of sustaining the surgical workforce itself at a time when women make up a growing share of trainees and practicing surgeons.

Subject of Research: Family planning and pregnancy experiences among women surgeons during surgical training and practice

Article Title: “There is no good time to have a baby” – family planning and pregnancy as a surgeon

Article References: Schneidman, J., Dusick, M., Davidson, J., Wilson, C. A., De Luca, A., Shaw, J., Webster, F., Graham, M. E., & Seemann, N. M. (2026). “There is no good time to have a baby” – family planning and pregnancy as a surgeon. Global Surgical Education – Journal of the Association for Surgical Education, 5(1), Article 203. https://doi.org/10.1007/s44186-026-00606-3

Image Credits: AI Generated

DOI: 10.1007/s44186-026-00606-3

Keywords: women surgeons, family planning, pregnancy, surgical training, grounded theory, hidden curriculum, parental leave, infertility, qualitative research, surgical culture, delayed childbearing, workforce