Breaking the glass ceiling in interventional endoscopy: Practical considerations for women

Maternity leave

Every institution and practice differ in the details of maternity leave policies. These details should be reviewed and negotiated in advance. At a minimum, they are guided by the federal Family and Medical Leave Act, which entitles employees to 12 weeks of unpaid, job-protected leave.⁴ Each pregnancy, delivery, and postpartum period is unique and unpredictable. While early planning and consideration of coverage are crucial, it is imperative to be realistic and fluid about the postpartum journey. The unpredictable need for an extended leave has the potential to lead to career stagnancy. It is important to remember that this is a small fraction of time in the context of an entire career.

Fluoroscopy exposure

The exposure to fluoroscopy and potential adverse effects on a pregnancy has been cited frequently by women as a barrier to pursuing advanced endoscopy.² Given the paucity of women in this field, there has yet to be definitive data on the management of fluoroscopy risk while pregnant. The ASGE Quality Assurance Endoscopy Committee has acknowledged the importance of such data and is currently preparing guidelines for radiation safety that will address the risks for pregnant endoscopists and strategies to minimize fetal exposure. The use of a fetal monitor and an early discussion with the institution’s radiation safety officer are essential to minimize fetal exposure.

Optimizing ergonomics

There have been several publications demonstrating the deleterious musculoskeletal impacts of poor ergonomics while performing endoscopy, with women being at greater risk.⁵The New Gastroenterologist has also published a primer on this topic. In addition to inadequate education on biomechanics and inconsistent implementation of preventative safeguards, poor endoscope design has been shown to contribute. This can be accentuated for women in advanced endoscopy who perform complex procedures with therapeutic endoscopes equipped with suboptimal handle size and dial placement.

The potential for musculoskeletal injury increases during pregnancy. The standard measures to optimize biomechanics include screen at eye level, bed at hip height, a cushioned mat, and an athletic stance.⁶ In addition, back injury during pregnancy in advanced endoscopy is not uncommon. Several considerations should be entertained including use of double lead versus standard two-piece 0.5-mm lead with shielding curtains and walls, sitting during procedures when possible, and incorporating short breaks in the endoscopy schedule. Furthermore, more focus and innovation are required from endoscope manufacturers to tailor toward female hand anatomy. Until then, these small but meaningful measures may help to ensure optimal biomechanics to prevent injury.

Breastfeeding/pumping

Breastfeeding in the field of advanced endoscopy has traditionally been challenging. Navigating the collection and storage of breast milk during a busy day of interventional cases can be overwhelming. The previously stagnant industry of electric breast pumps has recently been revolutionized by the innovation of wearable breast pumps. Women are no longer required to find private space to connect to a loud, wired, contraption at least 30 minutes at a time, several times a day. In the context of a busy endoscopy schedule, this antiquated ritual is nearly incompatible with the continuation of breast feeding after returning to work. With relatively silent, wearable breast pumps, it is now possible to continue patient care whether in the clinic or in the endoscopy suite with minimal disruption to a productive day.