Maternal Matters: Neurosurgery During Pregnancy-A German Nationwide Survey.

Abstract

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.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).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.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.