Revised Statement on the Importance of Workplace Accommodations for Pregnancy, Parental Leave, and Lactation Support for Practicing Surgeons

Updated June 2021

The following statement represents an update of one originally developed by the American College of Surgeons (ACS) Women in Surgery Committee (WiSC) and approved by the ACS Board of Regents in February 2016. This revised statement was developed collaboratively by the ACS WiSC, the Association of Women Surgeons (AWS), and the ACS Board of Regents. It was approved at the ACS Board of Regents meeting June 11-12 in Chicago, IL. A separate statement, also approved by the Board of Regents in 2020, addresses the importance of parental leave policies for surgical trainees.

The ACS recognizes that a successful surgical career should not preclude a surgeon’s choice to be a parent. Surgeons who choose to have children (whether through a pregnancy of the surgeon or the surgeon’s partner, surrogacy, fostering, or adoption) have made an equivalent investment in their surgical careers as those individuals who choose not to have children. Choosing to become a parent does not detract from one’s full professional commitment to being a surgeon. The ACS is supportive of healthy pregnancy outcomes and emphatically condemns imposition of punitive repercussions or bias toward those surgeons who choose to have children.

Parental leave terms should be explicitly included in all employment contracts. The following guidelines provide a framework for parental leave policies:

• Parental leave, including childbearing and non-childbearing parents, should be provided equally for individuals who are new parents through pregnancy, surrogacy, fostering, or adoption.
• The surgeon should inform appropriate colleagues and supervisors of the pregnancy or anticipated adoption in a timely fashion to allow for accommodation of anticipated absence from professional duties. The surgeon’s team has a responsibility to support the medical needs of the surgeon and to keep health care information confidential. The surgeon will work together with the team to create a schedule that is flexible and equitable for the surgeon taking leave and those team members who will be affected by the absence. Surgeons should not be expected to make up for call missed during leave. The Family Medical Leave Act (FMLA) of 1993 allows employees to take up to 12 weeks of unpaid leave for the birth or adoption of a child, presuming the surgeon is employed by an organization meeting the criteria of the law, and the surgeon meets the eligibility criteria for FMLA, and has FMLA time available. The ACS supports parental leave of no less than six weeks (vaginal delivery), eight weeks (cesarean section), and domestic partner leave of not less than six weeks.
• Payment for parental leave should be negotiated between the surgeon and the employer. The surgeon should not be responsible for costs to the practice during the period of leave. If the surgeon’s compensation is based in part or entirely on work RVUs (relative value units), the surgeon should not be penalized for the decrease in RVUs directly related to the period of parental leave.
• The ACS encourages institutions and practices that are exempt from the FMLA law to voluntarily allow new parents the opportunity to take unpaid leave consistent with what is provided by the FMLA, if requested.
• Parental leave should not be a factor in decisions regarding surgeon career progression, assessment and evaluation, access to leadership or research positions, or academic promotion.

The following guidelines offer a framework for workplace accommodations and support of a pregnant surgeon:

• The ACS encourages individualized assessment of requests for reasonable accommodations of pregnancy-related conditions in accordance with applicable federal and state laws.
• It is appropriate to consider accommodations to call schedule, duty hours, and operative schedule late in the third trimester.
• A complicated pregnancy may require additional accommodations and modifications of schedule as determined by the surgeon and the treating physician.
• Surgeons who intend to breastfeed should be allowed flexibility to support expressing breast milk. Guidelines on breastfeeding by physicians in the workplace are available from several sources, including the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the American Academy of Family Physicians. For most individuals, expressing milk for 20−30 minutes every two to three hours provides sufficient milk for the infant. This accommodation also reduces the risk of developing engorgement, pain, or mastitis.^1-5 Covered employers are required to provide eligible employees with reasonable breaktime in a private, safe, and convenient place (other than a bathroom) to express breast milk or breastfeed for one year following the birth of a child. These requirements were set forth by the Patient Protection and Affordable Care Act of 2010, which amended Section 7 of the Fair Labor Standards Act.⁶ Access to a safe, hygienic, and convenient place for the secure storage of expressed milk should also be provided. Individuals should have protected time to express breast milk and have clinic and operating schedule adjustments without bias or penalty.

References

1. American College of Obstetricians and Gynecologists. Optimizing support for breastfeeding as part of obstetric practice. ACOG Committee Opinion No. 756. Obstet Gynecol.2018;132:e187–196. Available at: https://www.acog.org/-/media/project/acog/acogorg/clinical/files/committee-opinion/articles/2018/10/optimizing-support-for-breastfeeding-as-part-of-obstetric-practice.pdf. Accessed July 11, 2021.
2. American Academy of Pediatrics. Breastfeeding and the Use of Human Milk. Pediatrics. 2012;129(3):e827-e841. Available at: https://doi.org/10.1542/peds.2011-3552. Accessed July 11, 2021.
3. American Academy of Family Physicians (AAFP). Breastfeeding and Lactation for Medical Trainees. Available at: https://www.aafp.org/about/policies/all/breastfeeding-accommodations-trainees.html. Accessed July 11, 2021.
4. Livingston-Rosanoff, D, Shubeck, SP, Kanters, AE, et al. Got Milk? Design and implementation of a lactation support program for surgeons. Ann Surg. 2019 Jul;270(1):31-32.
5. Grinberg C. Pumped. JAMA. 2018;320(10):977-978.
6. Office on Women’s Health. What employers need to know. Available at: https://www.womenshealth.gov/supporting-nursing-moms-work/what-law-says-about-breastfeeding-and-work/what-employers-need-know/#1. Accessed July 11, 2021.

This revised statement will appear in the Bulletin of the American College of Surgeons, September 2021.