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A summary of the #BJSConnect tweetchat on pregnancy and parenthood for surgeons

An interview with past BJS Editorial Assistant Claire Donohoe on the paper she co-authored entitled “Pregnancy, parenthood and second-generation bias: women in surgery

Thank you for joining us @ClaireDonohoe6. Here is the first question. Can you summarise in one sentence the take-home message from the paper?


Second-generation bias results in perceptions that surgeons fit a certain stereotype & pregnancy is highly disruptive to the prevailing culture …so… until we change the culture we can’t make pregnancy more ”acceptable”.

Current policy can be seen to amplify female difference and may even be viewed as “benevolent sexism”.

Changing the culture may make working as a surgeon more enjoyable and sustainable for all surgeons, not just parents.

Thank you @ClaireDonohoe6! Now for Question 2: What is second generation bias?


This is bias that is often unintended and unconscious, whereby people who don’t meet the stereotypical norms of the profession, fail to thrive in the environment despite “mitigating” strategies.

For example, mothers may not achieve leadership roles and this is attributed to their parenting roles. The “solution”? Women should be encouraged to accept policies aiming to mitigate work-family conflicts BUT this may actually impede their advancement.

To an extent we all play the role that is expected of us – we act a certain way because that is how it “should” be – e.g. “my male colleagues take 3 weeks annual leave so I should take 3 weeks leave post-partum” so as not be disruptive.

You mentioned that there is a difference in perception between male and female surgeons. Can you explain this a little more?


Studies show that other professionals & patients have different perceptions of communication and personalities of male & female surgeons. “Warm” males are seen as competent, but “warm” females are not. In reality gender shouldn’t influence perception of competence (but it does).

What are some of the challenges facing surgeons who are parents?


What is a normal life event is seen as disruptive because of the work culture of surgery. Combining family life with attentive patient care means that the traits maintaining the status quo: perfectionism, compulsion, denigration of vulnerability & martyrdom are questioned. Also my personal privilege protects me from lots of the issues facing others of lower income, less secure employment and other biases.

Thank you. And finally: What do you think the solutions might be?


Policy to support diverse lives outside of work will be required, at a minimum, to enable culture change.

@RCSI_Irl have PROGRESS fellowships for senior female trainees AND have done a lot of work on underlying issues (see here). Thanks to work from @dmcsurg and others.

Research tells us that focusing on “equipping women” has not lead to increased leadership participation for women – culture needs to change (see @sinead_lydon‘s systematic review).

IMHO, the bare minimum should be: reasonable limits on working during the third trimester, adequate parental leave, on-site childcare, support and mentorship.

For example… from a consultant surgeon job advert: “There is… access to a Childcare Co-ordinator to help staff with their childcare arrangements”.

We should aim for diversity – families exist in multiple forms, females are not the default primary caregiver. Many men would prefer accommodations to allow them participate more fully in family life. Some people choose not to become parents AND also have commitments

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