Maternal Matters: Neurosurgery During Pregnancy—A German Nationwide Survey

Abstract

Background

In Germany, pregnancy often results in a ban from the operating theater for surgeons, reflecting legislation prioritizing maternal and fetal protection over individual autonomy. Due to limited data for German neurosurgeons, we aimed to assess the attitudes of German women neurosurgeons toward continuing surgical work during pregnancy and lactation to provide appropriate recommendations.

Methods

We conducted an online SurveyMonkey survey among all female members of the German Society for Neurosurgery (Deutsche Gesellschaft für Neurochirurgie) and the Professional Association of German Neurosurgeons (Berufsverband Deutsche Neurochirurgie).

Results

Of 286 invited women neurosurgeons, 122 responded (42.6%), with 65 (53.3%) having children or being currently pregnant with their first child. The majority (98.5%) desired to continue surgery during pregnancy, yet 80% expressed concerns about announcing their pregnancy due to potential job-related disadvantages. However, 35.4% (23 out of 65) ceased surgery due to an immediate ban imposed by the company physician and only a minority due to health-related issues (n = 2). Of the remaining 42 women who initially continued operating, 73.2% reported good departmental support during pregnancy. However, 18.5% (12/65) faced a subsequent surgery ban after announcing their pregnancy. Overall, there were no successful appeals (n = 13). Nearly a third eventually resumed surgery, implementing additional protective measures such as extended disease testing. However, self-estimation revealed a reduced surgical performance of approximately 35% compared with the year before pregnancy. Five women (7.7%) informed the company physician only at the end of pregnancy to circumvent the ban. Approximately a quarter (27%) experienced surgery-free periods of 1 to 1.5 years, whereas 21% reported 1.5 to 2 years per pregnancy. Forty-four percent reported discrimination in surgery allocation upon return, whereas 48% reported none.

Conclusion

Most women neurosurgeons aspire to continue surgery during pregnancy, yet face involuntary bans. Despite permission to operate, procedural volumes decrease significantly, compounded by surgery-free periods during lactation and parental leave, and reported discrimination upon return. We hypothesize that pregnancy-related bans exacerbate a glass ceiling effect, impeding women neurosurgeons' career progression, and propose removing bureaucratic obstacles to enable continued surgical practice.

Keywords

women neurosurgeons - pregnancy - surgical ban - Germany - pregnant surgeon - Maternity Protection Act

Publication History

Received: 22 April 2024

Accepted: 21 March 2025

Article published online:
26 June 2025

• References

• 1 Bennett CL, Baker O, Rangel EL, Marsh RH. The gender gap in surgical residencies. JAMA Surg 2020; 155 (09) 893-894
• 2 Odell T, Toor H, Takayanagi A. et al. Gender disparity in academic neurosurgery. Cureus 2019; 11 (05) e4628
• 3 Anon. Act on the Protection of Mothers at Work, in Training and at University (Maternity Protection Act - MuSchG). https://www.gesetze-im-internet.de/englisch_muschg/index.html . Accessed July 9, 2023.
• 4 Knieper C, Ramsauer B, Hancke K. et al. “Pregnant and operating”: evaluation of a Germany-wide survey among female gynaecologists and surgeons. Geburtshilfe Frauenheilkd 2014; 74 (09) 875-880
• 5 Kirk RM. Surgical skills and lessons from other vocations: a personal view. Ann R Coll Surg Engl 2006; 88 (02) 95-98
• 6 Burke CR, Mokadam NA. Repetition is the mother of skill. J Thorac Cardiovasc Surg 2018; 155 (04) 1694-1695
• 7 Anon. Physicians with specialty and subspecialty qualifications (as recognized by the German Medical Association - BÄK)Ärztinnen und Ärzte mit Gebiets- und Facharztbezeichnung BÄK. Accessed November 7, 2023 at: https://www.gbe-bund.de/gbe/!pkg_olap_tables.prc_set_orientation?p_uid=gast&p_aid=56592488&p_sprache=D&p_help=2&p_indnr=665&p_ansnr=66066406&p_version=6&D.000=1&D.001=3&D.002=3&D.003=3&D.395=2&D.928=3&D.100=3
• 8 Anon. Career setback due to pregnancy: young female doctors under pressure -Karriereknick durch Schwangerschaft: Junge Ärztinnen unter Druck. Marburger Bund. Accessed February 26, 2023 at: https://www.marburger-bund.de/hamburg/pressemitteilung/karriereknick-durch-schwangerschaft-junge-aerztinnen-unter-druck
• 9 Cicalese KV, Kruszewski KL, Krishnakumar A, Holloway KL. Experiences with pregnancy and child-rearing, advice for future mothers, and suggestions for improving the system: a qualitative study of women in neurosurgery. J Neurosurg 2024; 141 (03) 793-803
• 10 Maehara T, Kamiya K, Fujimaki T. et al; Gender Equality Committee of the Japan Neurosurgical Society. A questionnaire to assess the challenges faced by women who quit working as full-time neurosurgeons. World Neurosurg 2020; 133: 331-342
• 11 Karagianni M, Mihaylova S, Tzerefos C. et al. What to expect, when you expect. The neurosurgical perspective. J Clin Neurosci 2024; 129: 110880
• 12 Anon. Katja Nebe on the History of Maternity Protection in Germany: Dialogue with Women Is Missing-mdr.de. Katja Nebe zur Geschichte des Mutterschutzes in Deutschland: Dialog mit den Frauen fehlt. MDR. March 8, 2021. https://www.mdr.de/geschichte/zeitgeschichte-gegenwart/politik-gesellschaft/mutterschutz-dialog-interview-katja-nebe-100.html . Accessed November 10, 2023.
• 13 Fritze-Büttner F, Toth B, Bühren A. et al. Surgery during pregnancy - results of a German questionnaire. Innov Surg Sci 2020; 5 (1–2): 21-26
• 14 Vayssiere P, Broekman M, Cavallo C. et al. Parenthood and neurosurgery in Europe a white paper from the European Association of Neurosurgical Societies' Diversity in Neurosurgery Committee Part I - family planning and practice during pregnancy. Brain Spine 2023; 3: 102690
• 15 Janz C, Hadelsberg UP, Broekman M. et al. Parenthood and neurosurgery in Europe, a white paper from the European Association of Neurosurgical Societies' Diversity in Neurosurgery Committee, part II - practice with children. Brain Spine 2023; 4: 102717
• 16 Anon. Federal Ministry for Family Affairs, Senior Citizens, Women and Youth. Evaluation of the Maternity Protection Act: Report-Bundesministerium für Familie, Senioren, Frauen und Jugend. Eval Mutterschutzgesetz; 2023
• 17 Anon. German Medical Women's Association e.V.: Discrimination-Free Maternity Protection: Courage and Knowledge-Based Research for Responsible Design.-Deutscher Ärztinnenbund e.V.: Diskriminierungsfreier Mutterschutz: Mut und Erkenntnisforschung zur verantwortungsvollen Gestaltung. Accessed November 10, 2023 at: https://www.aerztinnenbund.de/Diskriminierungsfreier_Mutterschutz_Mut.3708.0.2.html
• 18 Szczesna A, Grzelak K, Bieniasz M. et al. Pregnant surgeon - assessment of potential harm to the woman and her unborn child. Ginekol Pol 2019; 90 (08) 470-474
• 19 Delva F, Carcasset P, Mouton P. et al. Greater risk of pregnancy complications for female surgeons: a cross-sectional electronic survey. Int J Environ Res Public Health 2022; 20 (01) 125
• 20 Malcolm RJ, Pilkington M, Merchant SJ, Velez MP, Brogly SB. Work-related factors and pregnancy outcomes in female surgeons. Ann Surg Open 2021; 2 (02) e069-e069
• 21 Anderson M, Goldman RH. Occupational reproductive hazards for female surgeons in the operating room: a review. JAMA Surg 2020; 155 (03) 243-249
• 22 Roubaud MS. The pregnant surgeon: what we are doing right. Plast Reconstr Surg Glob Open 2019; 7 (04) e2104
• 23 Anon. In the Trade Union Federation (FD): Experiences with Maternity Protection in the Workplace. Im Gewerkschaftsbund FD. Erfahrungen mit dem Mutterschutz am Arbeitsplatz. Accessed November 18, 2023 at: https://frauen.dgb.de/++co++d02fec6c-e640-11ec-b17e-001a4a160123
• 24 Anon. In the Trade Union Federation (FD): maternity protection – a significant gap between expectations and reality. Im Gewerkschaftsbund FD. Mutterschutz – Zwischen Anspruch und Wirklichkeit klafft erhebliche Lücke. Accessed November 18, 2023 at: https://frauen.dgb.de/themen/++co++f6ace5fe-e639-11ec-a8a0-001a4a160123
• 25 Adesoye T, Mangurian C, Choo EK, Girgis C, Sabry-Elnaggar H, Linos E. Physician Moms Group Study Group. Perceived discrimination experienced by physician mothers and desired workplace changes: a cross-sectional survey. JAMA Intern Med 2017; 177 (07) 1033-1036
• 26 Simpson AN, Cusimano MC, Baxter NN. The inconvenience of motherhood during a medical career. CMAJ 2021; 193 (37) E1465-E1466
• 27 Dowgiałło-Gornowicz N, Zięty JJ, Gornowicz M, Sztaba K, Osowiecka K, Lech P. To be a pregnant surgeon-is there anything to be afraid of?. Int J Environ Res Public Health 2023; 20 (03) 2265
• 28 Anon. Available at: https://dgnc.de/fileadmin/user_upload/Positivliste_DGNC_BDNC_final_unterz.pdf