Best Practice and Recommendations for Pregnant Orthopedic Surgeons Part II: Early Career and Practice.

INTRODUCTION: Pregnancy during orthopedic surgery practice presents unique challenges related to family planning, workplace accommodations, occupational exposures, board certification requirements, and postpartum return to work. Despite increasing numbers of women entering orthopedic surgery, there remains a lack of centralized guidance addressing pregnancy-related considerations. The purpose of this review is to summarize current evidence, to provide practical recommendations for orthopedic surgeons navigating pregnancy during their career, and to guide practice partners and organizations on how to create a culture of support and belonging during this time frame.

METHODS: Available literature, professional society guidance, federal workplace regulations, and occupational safety data were reviewed. Key topics included advanced maternal age and fertility considerations, American Board of Orthopaedic Surgery (ABOS) certification accommodations, workplace disclosure and legal protections, occupational exposure to methyl methacrylate (MMA) and ionizing radiation, physical demands of orthopedic practice, postpartum support, parental leave, and breastfeeding accommodations.

RESULTS: Delayed childbearing associated with orthopedic training and career progression may contribute to increased rates of infertility and obstetric complications among female orthopedic surgeons. Federal protections, including the Pregnant Workers Fairness Act, Family and Medical Leave Act, and Equal Employment Opportunity Commission regulations, provide important frameworks for workplace accommodations. Contemporary evidence demonstrates that occupational exposure to MMA and radiation during orthopedic procedures remains below established safety thresholds when appropriate precautions are employed. Physical demands such as prolonged standing, heavy lifting, and extended work hours may warrant workplace modifications during pregnancy. Postpartum support, equitable parental leave policies, and access to lactation accommodations may improve surgeon well-being and facilitate successful return to clinical practice.

CONCLUSION: Pregnancy should be recognized as a normal life event rather than a barrier to success in orthopedic surgery. Evidence-based accommodations, occupational safety measures, supportive workplace policies, and equitable parental leave practices can promote maternal and infant health while supporting professional development. Normalizing pregnancy and postpartum support within orthopedic surgery is essential to fostering a more inclusive and sustainable workforce.