Birth Trends and Complications Among Women Urologists

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Background: As the number of women entering urology grows, so should discussions and awareness regarding pregnancy. In order to understand if urology training and practice potentially put women and their pregnancies at risk, we set out to assess the childbearing differences between the average American woman and the female urologist. This study was submitted to the Internal Review Board.
Methods: A 114 item anonymous survey was sent to all 365 American Board Certified female urologists in May and July of 2007. Data concerning birth trends, pregnancy, assisted reproduction (ART) and complications was analyzed. Findings were compared to the most current Centers for Disease Control (CDC) data.
Results: Two mailings yielded a 69% response rate, with an average age of 43 years. 67.1% had biologic children. Ages, ART, pregnancy complications, bed-rest, induction, and Caesarian rates are listed below. There was a 10 fold increase of ART babies as compared to CDC data from 2004. Women who attempted ART and were unsuccessful were not assessed. Pregnancy complications were high. At age matched comparisons, women urologists had prevalence higher than the lowest income brackets in the United States. The induction rate was higher than average, while the Caesarian rate was lower, with only 19 elective surgeries performed secondary to residency/job demands or to decrease the risk of incontinence. 92% of women urologists would choose to have the same number of children, 66% would have children at the same point in their career, 16% earlier, 4% later, and 15% were uncertain.
Conclusions: Not surprisingly, women urologists were older by 7-8 years for all births, which could account for the higher number conceived by ART. Women urologists had fewer children, but were satisfied with the number they had. The induction rate was higher, which is likely related to the older age of pregnancy and the high rate of pregnancy complications. This high rate of pregnancy complications is concerning, particularly given that it is higher than mothers of lower income, presumably a population that is in contrast to ours. Unfortunately, causes cannot be determined by this study and are likely multifactorial. Interestingly, Caesarian rates were lower, which was not expected. As more women enter the field of urology, the issues of delayed childbearing and pregnancy will have a greater impact on residency programs and practice dynamics, and most significantly, on the women urologist herself. Understanding these issues is crucial for the woman urologist when planning her family, and to residency programs and practice partners when supporting their female colleagues.

	Women Urologists	CDC National Norms
Children per mother	2.0 (n=163)	2.7
Maternal Age (yrs):
First child	32.6 (n=153)	24.6
Second child	35.1 (n=119)	27.9
Third child	36.5 (n=33)	29.2
Fourth child	37.4 (n=74)	30.5
Conceived via ART	10.84% (n=17)	1%
Pregnancy complications	33.7% (n=109)	4.9-19%
Bedrest during pregnancy	21.2% (n=32)	No comparison identified
Early delivery induction	35.2% (n=50)	21.2%
Cesarian sections	18.7% (n=58)	22.9%

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