Pregnancy for female surgeons: an eternal challenge.

Medical career in Brazil has experienced the phenomenon of feminization. However, surgical specialties have not proportionally accompanied this growth. Among the factors supposedly responsible for the preference of young doctors for clinical specialties in detriment to surgical ones are the concern about having children, starting a family, and the need to reconcile the responsibilities and professional obligations imposed by the practice of surgery. This article brings an analysis of the problems involving pregnancy and the professional career of female surgeons, including their main occupational risks. Female participation in surgical practice dates back to ancient history when the art of healing was closely linked to divine powers. Archeological records suggest practices equivalent to medicine practiced by Egyptian queens and Greek deities. In the Middle Ages, under strong religious influence, the practice of medicine by women, and in particular the surgical practice, was strongly discouraged and even prohibited, being viable only in exceptional cases, for example, when the profession was inherited from a deceased spouse. Women practicing acts of “healing” were at risk of being accused of witchcraft and sentenced to death1. With the arrival of the modern era, women still had less social participation. Perhaps, the first woman to practice surgery on the European continent was Margareth Bulkley. Records suggest that Bulkley was forced to assume a male identity (Sir James Barry, British army surgeon) as a way to graduate in medicine in 1809 in Scotland and to work in surgery without discrimination. Her true identity was discovered only after her death in 18651. The title of first woman graduate in medical school in the world is credited to Elizabeth Blackwell, and it was in 1849 in the USA2. In Brazil, women were allowed only to attend regular university careers after the enactment of the Leôncio de Carvalho law in 1879. Before this date, wealthier families with avantgarde thoughts in relation to their daughters needed to send them abroad, as they did with Maria Augusta Generoso Estrela and Josefa Águeda de Oliveira. They were considered the first Brazilian female medical doctors, both having graduated from medical school in the USA in 1881 and 1882, respectively. The first doctor formally graduated as a medical doctor in Brazil was Rita Lobato Lopes in 1887. The first female surgeon to join the Brazilian College of Surgeons, the biggest and oldest association of surgeons in the country, was Mariza Garrido in 1959, only 30 years after its foundation3. Fortunately, the current scenario is very different from the past. Currently, in the United States of America, 37.1% of physicians registered at the American Medical Association are women4. In the United Kingdom, the percentage of women in medicine is even higher, which is 47.5% of the total number of registered professionals. However, when analyzing the percentage of medical specialists by gender, only 37% are women5. In the East, the number of women in medicine also continues to rise, but in a more discreet way. In the 2020 Japanese medical statistics, 23% of the country’s medical force was represented by women6. Following the trend of developed countries, the medical career in Brazil has already experienced feminization. According to the data from the last Brazilian medical statistics, the female presence in medicine has increased by 50% in the last 20 years. Today, women represent 46.6% of the Brazilian medical force, which is mainly due to the younger generations, represented mostly by medical doctors under 34 years old7. Despite the increase of female representation in the medical field, surgical specialties have not been attractive to women. According to the data from the Brazilian Medical Association, only 23.4% of medical doctors registered as general surgeons are women4. Regarding the members of the Brazilian College of Surgeons, women correspond only to 17.5% of the total amount. However, most young female surgeons will be able to evoke in their memory some female exponent that inspired or encouraged their surgical career, from Brazilian female surgeons with international recognition to excellent anonymous professionals pulverized in remote hospitals in Brazil.