Feature | Cardiovascular Training and Pregnancy: A Call to Action
This article was authored by Ki Park, MD, MS, assistant professor of medicine at the University of Florida in Gainesville, FL.
As a junior fellow, the catheterization lab was always my “happy place,” where everything felt right and I could let my hands do the work. Unfortunately, this same place became a source of anxiety during my interventional fellowship year. A few weeks after the academic year began, I notified my program that I was expecting.
At 25 – 26 weeks into an uncomplicated pregnancy, I presented with spontaneous preterm labor. Until then, I thought I was invincible, as many women do in this field. I did not modify my rotation schedule and continued to take STEMI call two weeks out of the month, travel to off-site rotations and work 12- to 16-hour days. The potential for a complication never occurred to me until I laid in the delivery unit and was told I was in labor. Despite all efforts, our son was born within 24 hours on Christmas Day, weighing 2 pounds, 2 ounces – a far cry from his expected due date closer to Easter. I was fortunate to train at a center with the highest level of neonatal intensive care unit (NICU) attention available, which also happened to be one floor above the catheterization lab.
One week after delivery, I returned to my rotation while our son struggled to breathe on his own. Since the interventional fellowship is traditionally 12 months, options for extending maternity leave past one month did not seem feasible based on my understanding of guidelines and regulations. Thus, I opted to “save” this time for when our son could leave the hospital in lieu of immediately after his birth.
As is often the case with very premature babies, our son’s course was prolonged by a multitude of complications such as severe apnea requiring multiple intubations, necrotizing colitis, retinopathy of prematurity and oral feeding intolerance. For better or worse, my proximity to the NICU was fortuitous and also torture as I continued to take STEMI call and work daily in the lab. As I struggled to deal with the typical challenges an interventional fellow may face, I also tried to maintain my role as a new mother with a child in the NICU. I would come in to breastfeed at 5 a.m. every day before procedures and visit whenever I came in for a STEMI. This life continued for 127 days. Finally, our son came home, and I took my one-month leave. I was fortunate to have obtained a faculty position at my training institution, which enable me to take a longer leave period after my fellowship before starting my full-time position.
When speaking to those who knew of my experience, I was always told I was “strong” and “super woman.” As much as I appreciated the sentiment behind these words, what people often do not understand and what challenges many women in our field is the feeling that we do not always have a choice. I felt like I could not quit my program and leave the field I loved so dearly. But under the circumstances I did not consider other options such as extending fellowship for an additional few months. I had this feeling even though my extremely supportive interventional program director and division chief, both of whom were women, presented other options to me. In retrospect, my thoughts may have been muddied by a matter of perception vs. reality, a feeling that I had to “do it all” as many women do when balancing work and family. In reality, treating such a situation as “medical leave” would have been the most ideal solution. It would have allowed me time to focus on our son and not feel as though I had to walk a fine line between being a new mother and a physician in training. However, this solution was not without its drawbacks. Although more advantageous on a personal level, such a move would have left a void in the rotation schedule, which my co-fellows may have had to fill. I also felt like any additional time making up work in the lab would detract from the experience of the incoming class of interventional fellows. Thus, there was no obvious solution to my dilemma.
My situation highlights the need for a more modern approach toward cardiovascular training, particularly as we prioritize recruitment of women into our field. Unfortunately, circumstances like mine are not uncommon. According to a 2017 article in the Journal of the American College of Cardiology, nearly half of all pregnancies among female cardiologists occur during fellowship and 40 percent of female cardiologists experience some type of pregnancy complication. As such, the field must adapt, just as women have adapted to balancing the needs of work and family. Instead of nebulous guidelines, which sometimes do not clearly agree between accreditation and training societies, general and interventional cardiology fellowship programs should have more flexibility in accommodating the training needs of pregnant fellows.
Today, our son is a happy, healthy and precocious three-year-old, who bears no trace of his lengthy hospitalization, other than the tiny scars on his hands from the many IVs he had. I was extremely fortunate to have had the unlimited support of my husband, family, friends and cardiology program; specifically, my interventional co-fellows who shouldered much of the clinical burden during this time. I know that these circumstances are not unique, and many women in cardiology have struggled in similar situations without the type of support I had. But if we want to have more women in our field, particularly women interventionalists, then we need to have more flexibility in accommodating pregnancy and potential pregnancy complications.
Ongoing efforts through ACC’s Diversity and Inclusion Task Force and Women in Cardiology Section to advocate for pregnancy issues are a significant step in the right direction. However, if such advocacy efforts are to be put into action, accreditation and training governing bodies must join the ACC in a collaborative effort to change the culture within cardiovascular training. Only then can our field make progress in providing an appropriate and supportive environment for pregnant trainees.