The RCOG recognises that working during pregnancy is a significant consideration for all our workforce, with 63% of obstetricians and gynaecologists being women (GMC data 2025).
All pregnancies vary, with potential complications that can have impacts on areas of a person or family’s life. Even an uncomplicated pregnancy has marked physiological changes leading to biopsychosocial impacts for all of the workforce.
It is important when line managers and employers review the plans for a person’s pregnancy that they review both the person as an individual, the impacts of pregnancy and the environment that they work in. The workplace considerations may need to include the acuity of the unit, the number of doctors on shift at a given time and the ability for senior assistance to attend if required.
If pregnant, it is important that everyone reviews their local policies and documents. In the majority of cases women will need to discuss their plans for pregnancy with their line manager, for doctors in training this is usually their educational supervisor. It is an individual’s choice when to inform their employers or colleagues. Under employment law, a pregnant person will need to inform their employer by 15 weeks before the baby is due to qualify for maternity pay. Routine referral to occupational health is not normally warranted, if the pregnancy is uncomplicated, however procedures will vary between employers.
In addition, we should be mindful that we work within Women’s Health services and that this can cause additional stresses. The aim of this webpage is to provide an overview to existing national documents, considerations for individuals and employers and signpost to sources of further information.
Impacts of rotational shifts
An infographic produced by the Royal College of Physicians and the Faculty of Occupational Medicine outlines the impacts that shift working and night shift working can have on both the risk of miscarriage and preterm birth. A systematic review by Cai et al included 196,989 women. The evidence is of low certainty but concluded that ‘pregnant women who work rotating shifts, fixed night shifts, or longer hours have an increased risk of adverse pregnancy outcomes.’ The complications highlighted included preterm birth and altered placental function (small for gestational age, pre-eclampsia, and pregnancy-induced hypertension).
Cai C, Vandermeer B, Khurana R, Nerenberg K, Featherstone R, Sebastianski M, Davenport MH. The impact of occupational shift work and working hours during pregnancy on health outcomes: a systematic review and meta-analysis. American journal of obstetrics and gynecology. 2019 Dec 1;221(6):563-76.
Considerations for doctors in O&G working rotating shifts or resident night shifts while pregnant
- The gestational age that the doctor may consider coming off resident night shifts – for example, many doctors doing resident night shifts may decide to stop night shifts from 28 weeks if they work in a unit without sufficient clinical support (other doctors on call) or an acuity where regular breaks cannot be accommodated.
- The gestational age that the doctor may consider stopping shifts longer than 10 hours, or the need for fixed breaks on all shifts and facilitating these. Pregnancy and maternity are protected characteristics under the Equality Act 2010, therefore changes to hours do not affect pay.
- The gestation at which they plan to start their paid maternity leave.
- The need for any sick leave, attending antenatal clinic appointments, and any other reasonable adjustments that are required to continue to work safely.
- The impact of the daily duties on pregnancy, for example a manual handling assessment. This will often form part of a wider risk assessment in the workplace.
- Return to work resources available when coming back from maternity leave, including ‘keeping in touch’ days and the SuppoRTT programme from NHS England.
- During maternity leave to consider that where a doctor has a planned and expected move to a higher nodal pay point, and this was only prevented due to the doctor going on section 15 leave (which maternity leave falls into), the value of the higher nodal point should be reflected within the doctor’s pay for their section 15 leave, from the date this would have been expected to have been applied.
- Breastfeeding doctors should have an individualised assessment when returning to work, this should include the facilities and space to pump and store breast milk and a review of shifts to facilitate breastfeeding.
Each pregnancy should be treated in an individualised way, involving an open dialogue between the doctor and their line manager. Many pregnant people may choose to keep their work schedule unchanged, especially in environments such as theatres, but this may not be appropriate for all, and therefore regular and personalised risk assessments utilising local employer guidelines are key.
Returning to work, after parental leave, brings a complex set of decisions and factors to consider. The Royal College of Surgeons of England commissioned the Nuffield Trust to explore the impact of parental and caring responsibilities on participation, progression, and experience in surgical careers in order to understand the issues within that profession. This report can be accessed here.
The workforce in obstetrics and gynaecology require individual and holistic assessments to support safe working and the wellbeing of our staff and their families in the long term.