Parental Leave and Neuroradiology Fellowships.

BACKGROUND AND PURPOSE: A uniform policy on parental leave in radiology training programs is lacking. Although previous publications have addressed the status of parental leave policy among radiology residency programs, the state of parental leave in radiology fellowships has not been addressed to date. Our aim was to determine the state of parental leave policies in American neuroradiology fellowship programs. MATERIALS AND METHODS: An Internet survey was sent to the directors of neuroradiology fellowship programs listed on the Accreditation Council for Graduate Medical Education Web site (n = 87) in January 2020. The questionnaire assessed the policies of the fellowship programs and Program Directors' attitudes toward maternal and paternal leave. Four reminders were sent during the 3 weeks before closing data collection. RESULTS: The response rate was 76% (66/87). Ninety-four percent (62/66) of program directors claimed to have a maternal leave policy, of which 51/62 (82%) were written and 53/62 (85%) were paid. Additionally, 77% (51/66) had a policy for paternal leave, of which 80% (41/51) were written and 76% (39/51) were paid. The average length of paid leave was 6.7 ± 3.25 weeks for new mothers and 2.9 ± 2 weeks for new fathers. Unpaid leave was mostly based on the Family and Medical Leave Act. Fellows were responsible for making up call duties during the parental leave in 47% of the programs. Radiation exposure was restricted in 89% of the programs during pregnancy. Policies addressed breast feeding and untraditional parenthood in just 41% of the responding programs. Most program directors supported the development of a unified national policy on maternal (83%) and paternal (79%) leave. CONCLUSIONS: Most neuroradiology fellowship programs have explicit maternal and paternal leave policies that grant paid leave to trainees. Some also offer unpaid leave, mostly through Family and Medical Leave Act guidelines. A uniform policy derived from the Accreditation Council for Graduate Medical Education and/or American Board of Radiology would be useful and overwhelmingly accepted.

The Impact of Plastic Surgery Training on Family Planning and Prenatal Health.

BACKGROUND: Plastic surgery trainees who wish to start a family face challenges. This is the first study to collect data directly from residents and fellows to understand issues surrounding childbearing and to propose solutions. METHODS: Following institutional review board approval, an anonymous survey was distributed to all current plastic surgery residents and fellows in the United States. Data regarding demographics, obstetrical complications, parental leave, breastfeeding, and use of assisted reproductive technology were collected. RESULTS: The survey was completed by 307 trainees, for a resident response rate of 27.0 percent. Mean age of the respondents was 31.7 ± 3.8 years, 58.6 percent were married, and 35.3 percent reported at least one pregnancy for themselves or for their partner. Both male (67.4 percent) and female (76.5 percent) respondents intentionally postponed having children because of career. Women were significantly more likely to report negative stigma attached to pregnancy (70.4 percent versus 51.1 percent; p = 0.003) and plan to delay childbearing until after training. Fifty-six percent of female trainees reported an obstetrical complication. Assisted reproductive technology was used by 19.6 percent of trainees. Mean maternity leave was 5.5 weeks, with 44.4 percent taking less than 6 weeks. Mean paternity leave was 1.2 weeks. Sixty-two percent of women and 51.4 percent of men reported dissatisfaction with leave. Sixty-one percent of female trainees breastfed for 6 months and 19.5 percent continued for 12 months. Lactation facilities were available near operating rooms for 29.4 percent of respondents. CONCLUSIONS: Plastic surgery training may negatively impact fertility, obstetrical health, and breastfeeding practices. The data presented in this article provide the groundwork for identifying areas of concern and potential solutions.

Time Off Work After Childbirth and Breastfeeding Supportive Workplaces: Associations with Near-Exclusive Breastfeeding Trajectory Membership.

OBJECTIVE: We aimed to determine whether the association between time off work and a near-exclusive breastfeeding trajectory is moderated by perceived employer support for breastfeeding. METHODS: We conducted a secondary analysis of working mothers (n = 1,468) from the Infant Feeding Practices Study II, a longitudinal observational (2005-2007) study of U.S. infant feeding behaviors. Previous studies have found four latent infant feeding subgroups in the Infant Feeding Practices Study II sample, each following a distinct breastfeeding intensity trajectory. Multivariate least-squares regression was conducted to estimate whether time off work after delivery predicted increased membership in the subgroup characterized by near-exclusive breastfeeding, and whether this association was moderated by perceived employer support for workplace breastfeeding. RESULTS: Both time off work and perception of more breastfeeding support were independently, positively related to probability of membership in the near-exclusive breastfeeding trajectory (ß = 0.16, p = .019, and ß = 0.14, p = .004, respectively). The interaction of these two factors suggests an attenuation effect. The addition of paid leave to the model did not change the estimates. CONCLUSION: The positive relationship between time off and trajectory membership was significant only for mothers who perceived their workplaces to be unsupportive of breastfeeding.

Parental Leave for Residents at Programs Affiliated With the Top 50 Medical Schools.

BACKGROUND: Of the top 15 medical schools with affiliated graduate medical education (GME) programs, 8 offer paid parental leave, with an average duration of 6.6 weeks. It is not known how other GME programs approach parental leave. OBJECTIVE: We searched for the parental leave policies for residents in programs affiliated with the top 50 medical schools. METHODS: In 2019, we identified the top 50 medical schools designated by US News & World Report in the research and primary care categories (totaling 59 schools), and identified the associated GME programs. For each school, we accessed its website and searched for "GME Policies and Procedures" to find language related to maternity, paternity, or parental leave, or the Family Medical Leave Act. If unavailable, we e-mailed the GME office to identify the policy. RESULTS: Of 59 schools, 25 (42%) described paid parental leave policies with an average of 5.1 weeks paid leave; 11 of those (44%) offer ≤ 4 weeks paid parental leave. Twenty-five of 59 (42%) programs did not have paid parental leave, but 13 of these specify that residents can use sick or vacation time to pay for part of their parental leave. Finally, 13 of 59 (22%) offered state mandated partial paid leave. One school did not have any description of parental leave. CONCLUSIONS: While paid parental leave for residents has been adopted by many of the GME programs affiliated with the top 50 medical schools, it is not yet a standard benefit offered to the majority of residents.

You Can't Have It All: The Experience of Academic Hospitalists During Pregnancy, Parental Leave, and Return to Work.

BACKGROUND: The United States lags behind most other countries regarding the support for working mothers and parental leave. Data are limited to describe the experience of female hospital medicine physicians during pregnancy, parental leave, and their return to work in academic hospital medicine. METHODS: We conducted a qualitative descriptive study including interviews with 10 female academic hospitalists chosen from institutions across the country that are represented in Society of Hospital Medicine (SHM) Committees. Interview guides were based on the following domains: experience in pregnancy, parental leave, and return to work. Interviews were recorded, transcribed verbatim, and analyzed using a general inductive approach to theme analysis using the ATLAS.ti software (Scientific Software Development GmbH, Berlin, Germany). PRIMARY OUTCOME: Women in hospital medicine experience the following six common challenges in their experience as new parents, each of which has the potential to impact their career trajectory, wellness, and are associated with areas for institutional improvement: (1) access to paid parental leave, (2) physical challenges, (3) breastfeeding, (4) career opportunities, (5) colleague responses, and (6) empathy in patient care.

Looking for the best of both worlds.

Research institutions could do more to support scientists who are pregnant or have young children.

A solution to gender inequity in surgery? Better caregiving policies.

SUMMARY: Attitudes toward women in surgery appear to be shifting in a positive direction. Why, then, do women still represent only 27% of surgeons in Canada? The answer may, at least in part, lie in the field's inability to adequately accommodate caregiving duties, which are still disproportionately "women's responsibilities" in our society. Although most Canadian academic centres now have paid maternity leave policies for trainees and faculty, these do not necessarily apply to surgeons working in the community, nor do they always reflect what occurs in practice. The perceived inability of the field to accommodate both personal and professional duties is often a significant deterrent to young women considering a career in surgery. In this commentary, we explore the need to address the "caregiver problem" as an important step toward achieving gender equity in surgery.

Parental Leave Policies and Pediatric Trainees in the United States.

BACKGROUND: The American Academy of Pediatrics (AAP) states that each residency program should have a clearly delineated, written policy for parental leave. Parental leave has important implications for trainees' ability to achieve their breastfeeding goals. OBJECTIVE: This study aimed to measure the knowledge and awareness among members of the AAP Section on Medical Students, Residents, and Fellowship Trainees (SOMSRFT) regarding parental leave. METHODS: An online survey was emailed to SOMSRFT members in June 2013. Quantitative data are presented as percentage of respondents. Awareness of leave policies was analyzed based on having children and the sex of respondents. RESULTS: Nine hundred twenty-seven members responded to the survey. Among those with children, 40% needed to extend the duration of their training in order to have longer maternity leave, 44% of whom did so in order to breastfeed longer. Thirty percent of respondents did not know if their program had a written, accessible policy for parental leave. Trainees without children and men were more unaware of specific aspects of parental leave such as eligibility for the Family Medical Leave Act as compared to women and those with children. CONCLUSION: Despite the fact that United States national policies support parental leave during pediatrics training, and a majority of programs comply, trainees' awareness regarding these policies needs improvement.

Could gender equality in parental leave harm off-springs' mental health? A registry study of the Swedish parental/child cohort of 1988/89.

INTRODUCTION: Mental ill-health among children and young adults is a growing public health problem and research into causes involves consideration of family life and gender practice. This study aimed at exploring the association between parents' degree of gender equality in childcare and children's mental ill-health. METHODS: The population consisted of Swedish parents and their firstborn child in 1988-1989 (N = 118 595 family units) and the statistical method was multiple logistic regression. Gender equality of childcare was indicated by the division of parental leave (1988-1990), and child mental ill-health was indicated by outpatient mental care (2001-2006) and drug prescription (2005-2008), for anxiety and depression. RESULTS: The overall finding was that boys with gender traditional parents (mother dominance in childcare) have lower risk of depression measured by outpatient mental care than boys with gender-equal parents, while girls with gender traditional and gender untraditional parents (father dominance in childcare) have lower risk of anxiety measured by drug prescription than girls with gender-equal parents. CONCLUSIONS: This study suggests that unequal parenting regarding early childcare, whether traditional or untraditional, is more beneficial for offspring's mental health than equal parenting. However, further research is required to confirm our findings and to explore the pathways through which increased gender equality may influence child health.

Maternity leave in normal pregnancy.

OBJECTIVE: To assist maternity care providers in recognizing and discussing health- and illness-related issues in pregnancy and their relationship to maternity benefits. EVIDENCE: Published literature was retrieved through searches of PubMed or Medline, CINAHL, and The Cochrane Library in 2009 using appropriate controlled vocabulary (e.g., maternity benefits) and key words (e.g., maternity, benefits, pregnancy). Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to December 2009. Grey (unpublished) literature was identified through searching the web sites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.

Improving return-to-work after childbirth: design of the Mom@Work study, a randomised controlled trial and cohort study.

BACKGROUND: Many women suffer from health problems after giving birth, which can lead to sick leave. About 30% of Dutch workers are on sick leave after maternity leave. Structural contact of supervisors with employees on maternity leave, supported by early medical advice of occupational physicians, may increase the chances of return-to-work after maternity leave. In addition, to understand the process of sick leave and return-to-work after childbirth it is important to gain insight into which factors hinder return-to-work after childbirth, as well, as which prognostic factors lead to the development of postpartum health complaints. In this paper, the design of the Mom@Work study is described. METHODS: The Mom@Work study is simultaneously a randomised controlled trial and a cohort study. Pregnant women working for at least 12 hours a week at one of the 15 participating companies are eligible to participate. The supervisors of these pregnant employees are randomised at 35 weeks pregnancy into the intervention group or control group. During maternity leave, supervisors in the intervention group contact their employee six weeks after delivery using a structured interview. When employees do not expect to return to their jobs at the end of their scheduled maternity leave due to health problems, the supervisor offers early support of the occupational physician. Supervisors in the control group have no structural contact with their employees during maternity leave. Measurements take place at 30 weeks pregnancy and at 6, 12, 24 and 52 weeks postpartum. In addition, cost data are collected. For the RCT, primary outcome measures are sick leave and return-to-work, and secondary outcome measures are costs, health, satisfaction with intervention and global feelings of recovery. Outcome measures for the cohort are pregnancy-related pelvic girdle pain, fatigue and depression. Finally, a number of prognostic factors for return-to-work and for the development of complaints will be measured. DISCUSSION: The Mom@Work study will provide important information about return-to-work of employees after giving birth. Results will give insight in prognosis of postpartum sick leave and complaints. Also, the role of supervisors and occupational physicians in successful return-to-work after childbirth will be clarified.

The 'retrait préventif': an evaluation.

Risks of adverse fetal outcome by occupational group and specific work demands were derived from a large survey of work in pregnancy in Montreal, 1982-84. Among 56,000 employed women in Quebec who were pregnant in 1985, the most recent year for which this figure could be estimated, approximately 11,300 fetal deaths and 3,400 preterm births would be expected. It was calculated that about 680 fetal deaths were attributable to occupational factors, almost all ergonomic in nature. Withdrawal from exposure by reassignment or paid leave at about the 10th week could conceivably prevent half of these fetal deaths, but less than one fifth if delayed until the 16th week. About 110 preterm births were possibly related to occupation and might also be prevented by withdrawal from exposure. These estimated levels of benefit are obtained at a cost which is both financially substantial and threatening to equality of employment opportunity for women of childbearing age.

Development of a pregnancy policy for air medical personnel: an administrative approach.

Pregnancy of air medical personnel poses a unique challenge for the administration of air medical services. Pregnant staff vary in their approach to individual pregnancy and their desire to continue flight duties. Administrators are limited to actions that ensure optimal care for the patient regardless of the caregivers' health or condition. Air medical programs must balance what is acceptable for patient care and safety with what are legally acceptable practice restrictions. The Staff For Life helicopter service uses experts in obstetric care to evaluate the pregnant staff members' abilities to perform pre-determined physical duties associated with air medical care. A signed consent form acknowledging risk factors associated with air medical care ensures that the flight staff member has had a frank and honest discussion with her physician. The obstetric evaluation and consent form confirm for program administration a pregnant flight staff member's ability to function within her role and removes all ambiguity from the process.

Maternity leave. Better for baby.

Women working in the NHS have won radically improved maternity pay and leave provision under a new general Whitley council (GWC) agreement. The agreement gives women up to a year's paid and unpaid leave and better options for flexible working arrangements on their return.