Going through pregnancy during residency training is an uphill climb. A mentor who has gone through it can give expectant mothers a much-needed guide.

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Having experienced pregnancy during residency training, Erika Rangel, MD, understands the unique challenges in balancing these two high-stakes life events. To ease the prospect for others, Dr. Rangel created a formal mentorship program for pregnant surgical residents at Brigham and Women’s Hospital, where she is a general surgeon and surgical intensivist.

“It’s empowering you to make the decisions that are best for you and not to make those based on stereotypes or pressures,” said Dr. Rangel, also an assistant professor at Harvard Medical School.

“There are so many ways to be a surgeon and so many ways to be happy being a surgeon, but it is important to make sure that you are making career decisions for the right reason and not because you are being influenced by what people believe a surgical parent should look like,” said Dr. Rangel, who highlights the value of mentorship for expectant mothers in a Viewpoint column in JAMA Surgery earlier this year.

The goal of the mentorship program for pregnant residents is to offer insight on how to confront many key decision points that trainees face. Those include how to work with your program on leave, finding flexible child care, navigating lactation while working and successfully returning from leave.

“If someone has a miscarriage and she needs to take time off, I have had residents say ‘I don’t want to say anything. I don’t want anyone to have to cover for me,’ and, ‘I can just do this myself,’” Dr. Rangel said. “It is important to encourage them that there is no taboo to needing support for a difficult life event and that we are a team. It’s normal to take time to grieve and physically recover. I try to encourage residents to not buy into this concept ‘presenteeism’ that so many of our residents and faculty fall victim to, where you feel you must be at work all the time even if it is unhealthy to do so.”

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In mentoring mothers-to-be, Dr. Rangel, a mother of two, has found that giving them a real-life example of the long-term picture can be helpful.

“I often have residents over at my house to show them: This is what it looks like when you are done,” she said. “It’s very important to build that camaraderie and support to show them it can be done.”

In her work with pregnant residents, Dr. Rangel tries to arrange three face-to-face meetings, usually over lunch. One of those meetings takes place after the resident returns to work to check in on how they are making the transition to working mother.

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Many pregnant surgical residents see their career trajectory altered and may change fellowship plans after giving birth. The point of the mentorship program is to give residents the encouragement to pursue their desired path and not bend to external pressure.

“Sometimes people may change fellowship training plans because they simply don’t know anyone who has balanced motherhood and a certain subspecialty,” Dr. Rangel said. “We can make introductions and give them insight on what it looks like at home, and that may change what they want to do.

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“We found looking at the data that more women than men are encouraged to pursue an ‘easier’ subspecialty because they are a parent. Having gender-based career counseling is going to impact our pipeline. We want to provide gender-neutral advice so these trainees can make objective decisions for their lives.” Beyond individual advice, Dr. Rangel said that another, longer-term aim of this type of program is to change the culture surrounding parenthood during residency.

“What programs like this do is slowly chip away at culture,” she said. “Culture change in medicine is demonstrating that organizations value the same thing that physicians value.”

Find out how residency program leave policies offer new parents some clarity.

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