Case Study: A Pregnant Fellow

Abstract

Jane Kenny was thirty-two years old, married for five years, and had just completed her first year of a fellowship in high-risk obstetrics when she became pregnant for the first time. She and her husband John, a third-year graduate student in molecular genetics, looked forward to parents. In the third trimester of her pregnancy, Jane began to have premature labor. Her doctor advised bed rest and prescribed a medication intended to prevent further contractions. Four weeks later, when tests showed adequate fetal lung maturity, the medication was discontinued. Within a few days Jane delivered a healthy baby boy. During the time that Jane was bed rest, the other two fellows in the program split the on time between them. One who had been married for seven years did not have children; the other had two small children at home. Jane indicated to her colleagues that she felt guilty for not being there to do the work. As a rule the department allowed six weeks' maternity leave for house staff and fellows. Although Jane asked to have her four weeks of vacation time added to this, her request was denied. She was advised to postpone her vacation until the summer, when an additional fellow would join the program. Her mentor told her: You've already missed too much time in the fellowship. Pregnancy, after all, is elective. Was this a fair way to respond to Jane's request? Would it be unfair to consider her experience of a high-risk pregnancy relevant to the training in a high-risk specialty? What are the moral implications of considering pregnancy elective? As a woman in medicine who has had one child during her residency and is expecting another soon, I cannot help but feel emotionally drawn to criticize Jane's mentor for his seeming hardness of heart. But a closer, more rational analysis I believe that Jane's mentor made the right call in denying her additional time off for maternity leave. However, the manner and tone in which the mentor communicated this decision were suboptimal. In denied the extra leave, is Jane's identity as a woman shoehorned into a masculine norm? Is she a victim of a gender equality? Jane entered her fellowship and signed a contract that assured her a six-week maternity leave. When her male colleagues signed their contracts the maternity clause simply did not apply. If standard operating procedure at Jane's hospital is anything like the hospital where I practice, her male colleagues would be given minimal time off to bond with a new child. They would be back to the grind in a matter of days. Women parents get approximately ten times more leave to be with their newborn children than men parents do. This vastly unidentical treatment may or may not be appropriate (the question of extended paternity leave is not at issue in the case study) but it does demonstrate this point: women in medicine are not expected to act identically to their male counterparts. Still, one might argue that Jane's needs as a woman and a new mother transcend contractual obligations. This contract-be-dammed attitude imposes what I would like to call a false gender inequality. Instead of promoting the interests of women in the professions, such a devaluation of one of the most basic business institutions, the contract--and thereby one of the most basic ethical institutions, the promise--if promulgated generally would be devastating for women's long-term prospects in the professional community. Jane has professional responsibilities she entered into contractually, and the contract has been particularly formulated to take into account important gender differences. If Jane's contract specifies that she is to receive six weeks of maternity leave but she finds that ten weeks would make her happier, then Jane has made a mistake: she has signed the wrong contract. Jane desires extra time off because she values family. …