children and pain

[topwise]

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I don't know how many females there are on this board, but I'm wondering what women do if they have an interest in doing fluoroscopic injections, but they are also planning to have children in the future. I mean, aside from the nine months of pregnancy, if you're trying to get pregnant, you're still obligated to stay out of the fluoro suite. So theoretically, that could be up to two years of not being able to do your job just due to pregnancy. And that's if you're only having one child.

Is this something that deters a lot of women from doing Spine?

 

[lobelsteve]

I don't know how many females there are on this board, but I'm wondering what women do if they have an interest in doing fluoroscopic injections, but they are also planning to have children in the future. I mean, aside from the nine months of pregnancy, if you're trying to get pregnant, you're still obligated to stay out of the fluoro suite. So theoretically, that could be up to two years of not being able to do your job just due to pregnancy. And that's if you're only having one child.

Is this something that deters a lot of women from doing Spine?

Everyone wears lead gowns, they have lead gowns for pregnant women.

 

[topwise]

Gee, I don't think lead would be enough to make me feel totally comfortable. Especially if I were exposed to the radiation on a weekly basis.

 

[Ludicolo]

From what I remember from residency, it’s not that much of a problem. I would be more concerned about the weight of the lead apron, combined with the weight gain associated with pregnancy, causing low back pain.

For reassurance, a woman could wear one of those radiation dosimetry badges over her uterus/under her apron and have it checked more frequently. If it reaches a certain level (not sure what the recommended guidelines are) – stay out of the fluoro suite. But I believe the radiation exposure through the lead gown will be pretty minimal.

 

[PMR 4 MSK]

We get pregnant rad techs all the time - none of them have had deformed baby's, and given how many of them are pregnant at any given time, it's not really a problem making them. 2 of our nurses at the ASC had babies this year, both spent a lot of time with me in fluoro.

Seriously, with a full wrap-around lead shirt/skirt 2 piece or even a good 1-piece, with thyroid collar and lead glasses, you should not have anything to worry about. There are many ways to reduce your personal radiation exposure, and they all should be employed whenever possible -step away from the unit when you fluoro, point it in the right direction, press the button the minimal amount of time required, collimate, etc.

IMHO, X-ray is only dangerous if you let it be.

 

[topwise]

This is interesting to hear, because when I was called to hold a patient's neck for flex-ex films, I was told by the tech that I couldn't do it (even with lead) because I was pregnant. And that was just a one-time thing.

Plus the attending tells us not to go in the fluoro suite if there's a chance we could be pregnant. The pregnant residents sit out the injections.

 

[lobelsteve]

This is interesting to hear, because when I was called to hold a patient's neck for flex-ex films, I was told by the tech that I couldn't do it (even with lead) because I was pregnant. And that was just a one-time thing.

Plus the attending tells us not to go in the fluoro suite if there's a chance we could be pregnant. The pregnant residents sit out the injections.

Mostly because people are stupid, or just ignorant.
That same tech probably asks about seafood allergies.

Anyone care to google the terms radiation safety, pregnancy, seivert?

#1 http://www.kem.edu/dept/radiology/Info2.htm

Data from this link:

A total dose equivalent limit of 0.5 rem (5mSv) is recommended for the embryo or fetus. Once a pregnancy becomes known, exposure of the embryo or fetus shall be limited to less than 0.05 rem (0.5 mSv) in any month.

Female radiation workers who are pregnant should not exceed the dose limit to the surface of abdomen of 2mSv and a radionucliide intake of 1/20th of the annual limit.

All the means available for reducing doses should be used. These include :

In radiology : high voltages, short exposure times, diaphragm localizer, lead shielding of the abdomen, limitations on the number of films per examination, and number of examinations.
In nuclear medicine : Limitations of the administered activity, choice of radionucliides with short effective half life and pure X-ray emitters.


Also look at the chart below this data from the middle of that linked page.

 

[PMR 4 MSK]

This is interesting to hear, because when I was called to hold a patient's neck for flex-ex films, I was told by the tech that I couldn't do it (even with lead) because I was pregnant. And that was just a one-time thing.

Plus the attending tells us not to go in the fluoro suite if there's a chance we could be pregnant. The pregnant residents sit out the injections.

Perhaps they just want to avoid the 18-21 year statute of limitations on lawsuits you or your child might bring forth in years hence, should there be anything not perfect about them. I'm not saying you will, just that's the way most docs and institutions think today.

Say a resident has a kid who is later diagnosed with ADHD. Some crackpot lawyer finds a study showing that fetuses exposed to xrays have a higher incidence of ADHD. Lawsuit ensues for $1M+. Hospital, residency program, residency director, chairman, attending injectionist, chief of radiology, rad tech, nurse all get named. Wouldn't be surprised if things like this have already happened.

Also, liken it to iodine allergy. It's still a pervasive myth in radiology that someone with a shellfish allergy cannot be given contrast with iodine.

 

[Nico47]

There's a lot of evidence to suggest that, with standard precautions, both mother and child will be OK.

But it still comes down to what you're comfortable with doing. I personally decided to get pregnant and deliver BEFORE my pain months were scheduled so that this wouldn't be an issue (in addition to other good reasons) and I know an orthopod who did the same.

Ludicolo brings up a good point about thinking about other aspects of pregnancy and how they relate to your job. You can't plan everything, but if possible avoid long hours on your feet during your 3rd trimester. Also, you'll be most susceptible to smells during the first few months so rotations like SCI in which there are bed sores galore should be avoided!

I'm due in June (I guess this is my big SDN announcement 😀), if anyone has questions about how residency + pregnancy works feel free to PM me.

 

[topwise]

We still ask about shellfish allergy 🙂

Even with all the evidence that it's "probably okay", I wonder if something went wrong with the baby for whatever reason, if I would always blame it on the radiation.

Are there any women on here who did fluoro injections throughout their pregnancy who want to chime in?

P.S. Congrats, Nico47. I had my baby during residency too, and while it was kind of rough sometimes, it's a lot more doable in our field than some others.