By: DR. Monica Uceda and Catherine Polito
‘The risks to a pregnant interventionalist are minimal and should not prompt a woman with plans for a future pregnancy from avoiding IR as a career.” – Dr. Meredith Englander
For the 8.8% of female interventional radiologists, exposure to radiation, productivity and colleague perceptions are important concerns throughout their careers, especially during pregnancy. Women in Interventional Radiology (IR) are significantly underrepresented as a whole, and may in part be due to misconceptions regarding the practicality of being an interventionalists and starting a family. Underrepresentation of women in IR gives rise to discussion and allows clarification of misconceptions that may be hindering female medical students from entering IR as a medical specialty.
One common misconception is that practicing IRs should avoid pregnancy because of the potential detrimental effects on the fetus. However, with appropriate safety precautions in place, interventionalists are only exposed to a small dose of radiation and can have a successful pregnancy without fear of harming the fetus. To put things into perspective, flight attendants are exposed to an annual radiation dose ranging from 1-5 mSy compared to 0.75 mSy for medical workers with recordable radiation exposure and 1.6 mSy for physicians who perform fluoroscopic procedures. Several studies have been performed on the risk of spontaneous abortion and congenital defects during pregnancy in those who work in a field with routine radiation exposure. None of these studies have shown a clinically significant increase in incidence of either outcome.
With careful planning and a thorough understanding of how to minimize occupational radiation dose, female interventionists can continue to safely perform procedures without incurring significant risks to the unborn child. In recent years, Occupational Safety and Health Administration (OSHA) released specific occupational radiation protection guidelines for pregnant or potentially pregnant females in careers with radiation exposure. It has been highly recommended that women carefully review these guidelines when contemplating pregnancy. These guidelines have been put in place to prevent unnecessary damage to the unborn child as well as provide a safe working environment for all employees. It is also recommended that the fetal dose of radiation be less than 0.5 mSy per month. Additional shielding devices should be used to further reduce occupational exposure. Wearing dosimeters for all procedures with monthly interrogations can help increase awareness of true occupational exposure as well as minimize radiation dose to the baby. An additional badge should be worn at waist level under a protective apron from the date of pregnancy declaration until delivery.
Another concern held by many female interventionalists is being perceived as a burden by colleagues. In a recent SIR member survey by Ghatan et al, concerns regarding occupational radiation exposure as the driving force behind reduction in work hours and/or modifying one’s scope of practice were evaluated. This study showed that during pregnancy many female interventionalists will modify their practice with minimal effect on their colleagues. The study also addressed perceptions regarding work distribution amongst two different groups of physicians by asking them the same hypothetical questions and comparing answers. One group of physicians had worked with a pregnant interventionalist whereas the second group had never worked with a pregnant interventionalist. Unfortunately, a significant number of men and women surveyed believed that pregnancy would substantially impact their work hours. However, this perception was the opposite for the physicians who had worked with a pregnant colleague as these physicians had a positive experience with minimal effect on their hours. Overall this study concluded that pregnancy in IR is viewed with unwarranted angst and opinions of those who have not worked with a pregnant colleague do not reflect the actual reality of the experience.
For female interventionalists, there is no such thing as perfect timing when it comes to having a child. Regardless of one’s specialty, pregnancy as a physician can be overwhelming. While statistical analysis is important, personal insight and experiences are just as important. Dr. Sarah White, a 5th year attending IR at the Froedtert Hospital and Medical College of Wisconsin was paramount in sharing her personal experience. From radiation safety to call scheduling and maternity leave, Dr. White discusses some of the unique challenges and successes she experienced during her pregnancy as a practicing interventionalist.
- At what time during your career did you decide to have children?
I had my first child when I was a 3rd year attending, and am currently expecting my second child now as a 5th year attending.
- When did you tell your colleagues and how did they respond?
With both pregnancies, I told my partners at the beginning of my 2nd trimester. They were supportive and excited, and they allowed me to change my call schedule, so that I could do more call during my second trimester, and less call towards the end of my pregnancy. During the later stages of my pregnancy, my partners would take the longer cases, thus leaving the shorter cases for me.
My technologists and nurses were amazing too. They always had extra-shielding available without me having to ask and they provided stools in the room so I could sit down if I needed to. Also, they made time for me to eat between cases and would have cold water waiting for me when I was done with long cases. If we had a long day and I couldn’t get away, my clinic nurses would grab lunch for me to eat between patients. I could not have asked for a more supportive environment.
- Did you continue your same practice during your pregnancy?
Yes. I did not change my clinical practice at all. I continued to do cTACE, DEB-TACE, y-90, TIPS, EVARs, etc. I took full call, though it was front loaded, so I wouldn’t have to take call towards the end of my pregnancy.
- What kind of radiation protection did you have to use? Did it differ from your usual precautions?
I wore an additional belly skirt during both of my pregnancies, always used the ceiling mounted lead shield, and added a rolling shield during longer cases. During certain times of my pregnancies, I would have my partners infuse the y-90. Additionally, I used extra measures to decrease my overall radiation dose (last image hold, fluoro scene save instead of DSA, leaving the room if possible during DSA, low dose fluoro, etc.). In general, my pregnancy taught me how to limit my overall radiation dose, and I continue to put in to practice many of these techniques post pregnancy.
- What options are available for women interventionalists who may not be interested in or able to do interventions while pregnant?
Many interventions can be done with ultrasound. Women could negotiate time to do US guided cases only (e.g.: biopsies, paras, thoras, ablations, etc.). Alternatively, you could do diagnostic radiology or practice part time.
- How much time did you take for maternity leave?
I took 6 weeks for my first child; however, I have a very supportive family. My husband was able to take 3 months of paternity leave and my family was able to help out with my son until we transitioned him into daycare at 6 months of age.
- Were you able to get the amount of time you felt you needed?
My partners were amazingly flexible with me during this time. I unexpectedly delivered 1 month early, and all of my partners stepped up to help cover my call and take care of my patients. They kept me informed about what was going on, and when I returned to work, I easily transitioned back into my old routine.
- What was maternity leave like?
Maternity leave was wonderful. Being an interventionalist, we are used to being sleep deprived and up all night. With a new baby, you are up every two hours to feed and change the baby, but then you get to nap in between feeds. And… No one is bleeding to death, so it’s a nice change of pace.
- What was returning to work like?
The biggest challenge returning to work was allowing my body enough time to heal. As soon as I returned, it was business as usual. I had to wear my lead, which really puts a toll on your post-partum body. I was on my feet all day, between doing cases and rounding, etc., it was very difficult. My partners realized this, and without telling me, changed the call schedule, so I didn’t have to take any call my first month back.
In addition, I chose to breast feed, and finding the time to pump every 4 hours during the day was difficult. I showed up “late” to traumas and EVARs, because I knew I had to pump before going into long cases. Luckily, my staff was extremely patient, and it all worked itself out.
- Was it challenging to reintegrate with your team?
Not at all. When I returned, I was the same person. I didn’t talk about the baby all the time, so my transition back was easy.
- Is there anything you would have done differently?
I would have taken more time off for maternity leave. As a woman in an all-male practice, you fear being viewed as a burden but this was not the case. In fact, while I was on maternity leave, during my son’s naps, I was able to work on research projects, etc. from home. This time turned out to be extremely productive. I just think taking more time to allow your body to get back to normal before you have to get back to being in lead on your feet all day, would have made a big difference.
- Is there any advice or words of wisdom you have to offer aspiring female interventionalists?
There are many women interventionalists that are mothers. If you enter a practice where your staff are not supportive, then you are in the wrong practice. It is a lot of hard work, but if you have the fire in your belly, you will succeed at anything you set your mind to.