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Even though Faculty of Health Professor Leeat Granek has spent more than 20 years researching the experiences of health care professionals and women in medicine, her study of how female neurosurgeons and cardiothoracic surgeons experience pregnancy, childbirth and maternity leave caught her off guard.

“A lot surprised me,” she says of her findings published in the . “I think this paper is actually very shocking.”

The idea for the study – part of a five-paper series – grew out of Granek's previous research on career satisfaction among pediatric surgeons. During that work, she noticed that women described experiences that differed significantly from their male colleagues. It inspired her to pursue a study focused exclusively on female surgeons, concentrating on two of the most male-dominated specialties: neurosurgery and cardiothoracic surgery.

“There’s just no information on this whatsoever,” says Granek, noting there is little research on the topic. “It’s not just filling a gap. It’s filling a chasm.”

Granek wanted to understand how women navigate pregnancy, parenthood and surgical careers in specialties where years of training often overlap with prime childbearing years. While previous research has documented higher rates of infertility, miscarriage and pregnancy complications among female surgeons, she wanted to explore the experiences behind those statistics and the role workplace culture may play in shaping them.

To do this, Granek adopted a qualitative approach centred on hearing directly from surgeons about their experiences.

“With qualitative, you’re really trying to understand people’s experiences from their own perspective,” she says. “It was very important to me.”

Through professional networks across North America, Granek recruited female neurosurgeons and cardiothoracic surgeons. Participants were required to be fully trained doctors rather than residents, making the study notable given the limited research focused on women surgeons after training.

Interviewees were asked about pregnancy, maternity leave, balancing family life and surgery, as well as experiences of discrimination and harassment connected to motherhood.

Similar themes surfaced across both specialties in Granek's findings, and she says many of the experiences reported were shocking.

What emerged was a common experience of a workplace culture that many participants found difficult to navigate while pregnant or raising children. One woman described feeling so concerned about how a pregnancy would be perceived that she hid it from colleagues for months, wearing oversized clothing and leaving patient rounds to vomit in private. Another recalled going into labour unexpectedly and being yelled at by a colleague when she called to arrange coverage for an emergency case. Even as contractions began, she still completed rounds before checking herself into hospital.

Other stories were equally troubling. One surgeon returned from leave to discover colleagues had voted to reduce her salary by five per cent. When she asked whether anyone else’s pay had been cut, she was told no. Another participant recalled learning that while she was away on leave, her department Chair had replaced her in a leadership role. When she objected, she recalled being told she needed to decide whether she wanted to be a neurosurgeon or a mom.

That sentiment surfaced repeatedly throughout the interviews, says Granek. Several participants reported feeling there was never a “right” time to have children, while others delayed pregnancy because they worried it would be perceived as less committed to their careers. Some said they felt pressure to hide pregnancies from colleagues or supervisors, fearing they would be treated differently if they disclosed them.

The consequences of these experiences affected more than their careers. Participants described infertility, miscarriage and complications, including preeclampsia, placental abruption and premature birth. Some believed long hours, overnight call schedules, physically demanding work and a lack of opportunities to rest during pregnancy contributed to those outcomes.

The interviews also revealed a less visible but recurring challenge: many women were expected to arrange their own coverage before taking maternity leave. Rather than being treated as an institutional responsibility, participants described the task as something they had to organize themselves, often while preparing for childbirth.

“There’s no kind of understanding within the job that a woman is going to go off to have a baby and that somebody needs to cover,” says Granek. “That’s very different than every other workplace.

“They just really don’t have any policies or procedures or any thought whatsoever to surgeons who become pregnant,” she says.

Instead, several women shared they felt responsible for ensuring their work was covered before they left. Granek says some described maternity leave as though it were viewed within their departments as a personal absence rather than an expected part of professional life.

Women also frequently described receiving few accommodations while pregnant, even as they continued working in highly demanding specialties. Some reported taking on extra on-call shifts before giving birth in anticipation of the time they would later spend away from work. Others recalled a lack of basic accommodations, such as opportunities to rest, eat, drink water or reduce physically demanding responsibilities late in pregnancy.

“This is probably part of the reason why there’s so many worse outcomes, because they’re just exhausted,” says Granek. “They don’t have any accommodations in the workplace to eat, to drink, to take breaks, to put their feet up, to cut down on-call [shifts].”

The stories of these women point to a need for both cultural and policy change, Granek argues. One of the study’s central recommendations is stronger support for pregnant surgeons and new mothers, beginning with formal accommodations during pregnancy and more consistent maternity leave policies.

It further argues that pregnant surgeons should not have to navigate accommodations on an ad hoc basis. Among other measures, the study recommends reducing physically demanding workloads in later stages of pregnancy, limiting overnight on-call responsibilities and ensuring access to basic supports such as breaks, parking and lactation facilities.

Granek and the study's collaborators call for stronger leave protections, including extended paid leave, phased return-to-work options and protections against professional penalties associated with having children. The authors also argue that responsibility for arranging leave coverage should rest with institutions rather than individual surgeons.

Granek believes many of the challenges participants described stem from a workplace culture that has not fully adapt to the realities of pregnancy and parenthood. She argues these experiences should be recognized as a normal part of a surgeon’s career.

The researchers call on institutions to better educate staff about pregnancy discrimination, hold leaders accountable for discriminatory behaviour and create mentorship networks that support surgeons throughout pregnancy and parenthood.

“When we have policies in place without a cultural change, people don’t adhere to them or feel comfortable taking those policies,” she says. “Culture and policy have to come hand-in-hand. They can’t be just one or the other.”

The issue is also tied to who enters, remains and advances within these specialties. Although more women are entering surgical training than in the past, they remain significantly underrepresented in many surgical fields and leadership roles.

“We see more women in residency than we did in the past for some of these surgical specialties, but it’s still very low,” she says. “The main reason for that is that the culture is so inhospitable to women.”

That is why Granek says the goal is not simply to improve maternity leave policies, but to create a surgical culture where having a child is viewed as compatible with a successful career. For her, supporting pregnancy and parenthood is not only a matter of physician well-being, but also an important step toward improving gender equity and ensuring women remain and advance within some of medicine’s most demanding specialties.

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