Stephanie Pearson, MD, on ergonomics in ob-gyn: Beyond just standing straight

Stephanie Pearson, MD

A comprehensive approach to physical, visual, and emotional well-being in women's health care

As obstetricians and gynecologists, we spend our careers caring for others, yet we often neglect our own. The irony isn't lost on us; we counsel patients about posture during pregnancy while hunching over our desks or advise about stress management while burning the candle from both ends. It's time we apply the same attention to detail we give to our patients' well-being to our own professional health through comprehensive ergonomic practices.

The hidden epidemic: Work-related musculoskeletal disorders in ob-gyn

Work-related musculoskeletal disorders (WMSDs) have become an occupational hazard that's as common in operating rooms as surgical masks. Research indicates that WMSDs are prevalent among surgeons but have received little attention because of the under-reporting of injuries and the logistical constraints of studying surgical ergonomics.¹ Research also indicates that surgeons require mental acuity, physical dexterity, and situational awareness similar to high-performance athletes,but they are also manual laborers facing physically arduous work and long periods of ergonomic strain. In our specialty, the problem is compounded by the unique demands of gynecologic surgery, from the awkward positioning required for vaginal and laparoscopic procedures to the physical strain of lengthy cesarean sections.

The contributing factors are multifaceted and include increasing patient body mass index (BMI), smaller surgeon hand size, non-inclusive design of instruments and energy devices, and improper positioning of surgical equipment.² Each surgical approach, whether laparoscopic, robotic, or vaginal, brings its own ergonomic challenges that we must address proactively rather than reactively.

Musculoskeletal disorders are the number one reason physicians leave the practice of medicine. We can work to prevent these disabilities.

Physical ergonomics: The foundation of sustainable practice

Operating room positioning: Getting the basics right

The cornerstone of surgical ergonomics begins with proper positioning. Surgeons and OR staff should maintain a neutral body posture, which includes keeping the neck in a neutral position, the back straight, and avoiding rotation or tilt of the torso. Shoulders should be relaxed, and elbows kept close to the body. This may sound elementary, but watch any busy OR and you will see surgeons contorting themselves like yoga instructors attempting advanced poses, except these "poses" last for hours and lack the mindful breathing component.

For optimal positioning, consider these key recommendations:

• Chair and table height: Proper chair position allowing for 90-degree flexion at the knee, forearm placement parallel to the ground with elbows tucked at the side, and head flexion less than 20 degrees forms the foundation of ergonomic positioning.³ The operating table should be adjusted to allow the surgeon to work with minimal shoulder elevation and wrist deviation. The table should be adjusted to the tallest surgeon, with step stools for the other team members.
• Equipment positioning: Monitor placement is crucial in laparoscopic surgery. Screens should be positioned directly in front of the surgeon, at eye level, and at an appropriate distance to prevent neck strain. The days of craning our necks to see a monitor mounted high on the wall should be relegated to medical history alongside bloodletting.³
• Foot positioning: Often overlooked, proper foot positioning with both feet flat on the floor or a footrest helps maintain spinal alignment and reduces lower back strain. Anti-fatigue mats can provide additional support during lengthy procedures.

Instrument design and selection

The evolution of surgical instruments has been remarkable, yet many tools remain poorly designed for prolonged use. Many were not designed with women’s hands in mind. When selecting instruments, consider:

● Handle design: Ergonomic handles with appropriate diameter and texture reduce grip force requirements and hand fatigue.

● Weight distribution: Balanced instruments reduce wrist strain and allow for more precise movements.

● Activation force: Instruments requiring excessive force for activation contribute to hand and forearm fatigue.

Intraoperative breaks and stretching

Research supports the effectiveness of intraoperative breaks and stretching in reducing surgeon discomfort. Implementing structured micro-breaks during lengthy procedures isn't a sign of weakness; it's a sign of wisdom. Simple neck rolls, shoulder shrugs, and hand stretches can be performed between surgical steps, significantly reducing cumulative strain.⁴ The American College of Surgeons has an excellent resource for intraoperative breaks and stretches.²

Visual ergonomics: Seeing clearly without strain

Visual ergonomics in ob-gyn extends beyond having good lighting in the OR. Our specialty demands close, detailed work that puts significant strain on our visual system, from examining cervical biopsies under magnification to performing surgical procedures.

Lighting considerations

Proper lighting is essential for both surgical and clinical work. When your screen is much brighter than your surroundings, your eyes must work harder to see. Adjusting your environmental lighting can reduce eye strain.⁵ In clinical settings, this means:

● Balanced illumination: Avoid extreme contrasts between task lighting and ambient lighting

● Glare reduction: Position monitors and workstations to minimize glare from windows and overhead lights

● Color temperature: Use lighting that provides good color rendition for accurate tissue assessment

Digital eye strain in clinical practice

With the increasing digitization of medical records and imaging, we spend countless hours staring at screens. When people are exposed to glare or have uncorrected vision problems,

they tend to lean forward or backward in an attempt to compensate. An awkward body position leads to eye strain and accelerates postural fatigue. This creates a cascade effect where visual problems lead to postural issues, compounding our ergonomic challenges.

Solutions for visual comfort

Monitor positioning: Position screens at arm's length (approximately 20-26 inches) with the top of the screen at or slightly below eye level. This reduces neck flexion and allows for natural downward gaze.⁶

The 20-20-20 rule: Every 20 minutes, look at something 20 feet away for at least 20 seconds. This simple practice helps relax the focusing muscles and reduce eye strain.

Specialized eyewear: Computer lenses can be tinted to help reduce eyestrain from excessive glare from windows or fluorescent overhead lights. Antireflective coating or ultraviolet coatings, and amber tints can all help relieve eyestrain.

Emotional ergonomics: The often-overlooked component

While physical and visual ergonomics have gained recognition, emotional ergonomics, the psychological and emotional aspects of workplace design, remains underappreciated in healthcare settings. Poor workplace ergonomics can ultimately lead to extreme stress and burnout among employees. In our high-stress profession, addressing emotional ergonomics is beneficial and essential for sustainable practice. Ob-gyns are one of the top occupational classes that leave practice for mental health reasons.

The stress-ergonomics connection

When stressed, we tend to adopt poor postures—hunched shoulders, forward head posture, and tense muscles. This creates a vicious cycle in which poor ergonomics increases stress, which worsens our ergonomic habits. Breaking this cycle requires intentional intervention.

Creating emotionally ergonomic workspaces

Personalization: Allow for workspace customization that reflects individual preferences and needs. A family photo or a plant can provide psychological comfort and reduce stress.

Noise management: The constant beeping of monitors, overhead pages, and equipment alarms creates an acoustically challenging environment. Implement noise reduction strategies such as quiet zones in charting areas when possible.

Workflow optimization: Design workflows that minimize unnecessary movements and interruptions. Efficient workflows reduce frustration and allow for better focus on patient care.

Team communication: Establish clear communication protocols that reduce misunderstandings and promote collaborative problem-solving. A well-functioning team is an ergonomic tool in itself.

Managing emotional fatigue

Emotional fatigue from dealing with complex cases, patient losses, and administrative burdens can manifest physically. Regular debriefing sessions, peer support programs, and access to mental health resources are crucial components of emotional ergonomics.

Practical implementation strategies

Individual-level interventions

Ergonomic assessment: Conduct regular self-assessments of your workspace and surgical positioning. Many hospitals offer ergonomic evaluations, which you should take advantage of.

Education and training: Formal ergonomics training has not yet been widely implemented, but educational intervention shows promise; 88% of surgeons changed their practice after in-person training, and 74% reported decreased strain.⁸ Seek out ergonomic training opportunities and share knowledge with colleagues. Contact the Society of Surgical Ergonomics (https://www.societyofsurgicalergonomics.org/) for information and tool kits.

Personal protective equipment: Invest in high-quality, well-fitting surgical loupes, supportive shoes, and ergonomic instruments when possible.

Institutional level changes

Equipment investment: Advocate for ergonomic equipment such as adjustable operating tables, high-quality monitors, stools with backs, and ergonomic instruments.

Policy development: Develop policies that support ergonomic practices, including mandatory breaks during lengthy procedures and ergonomic training for all staff.

Cultural change: Foster a culture where ergonomic awareness is valued and discussing physical discomfort is normalized rather than stigmatized. Communication at every level of training is essential.

The economic case for ergonomics

Beyond the apparent benefits to physician well-being, proper ergonomics makes economic sense. Reduced injury rates lead to decreased workers' compensation claims, disability insurance claims, lower turnover rates, and improved productivity. In a profession already facing workforce shortages (disability is one of the contributing factors), keeping experienced physicians healthy and practicing longer is a strategic imperative.⁷

Special considerations for different practice settings

Robotic surgery

While robotic surgery was touted as an ergonomic solution, it brings its own challenges. The console position, hand and finger movements, and visual demands require specific ergonomic considerations. Regular breaks and proper console adjustment are essential for preventing new types of repetitive strain injuries.

Office-based procedures

The rise of office-based procedures means we perform more complex interventions in less-than-ideal ergonomic conditions. Portable equipment and space constraints require creative solutions to maintain ergonomic principles.

Labor and delivery

The unpredictable nature of obstetrics means we can't always control our positioning, but we can prepare. Proper stretching routines, maintaining physical fitness, and using ergonomic principles when possible can help manage the physical demands of obstetric practice.

Looking forward: The future of ergonomics in ob-gyn

As our understanding of ergonomics evolves, so does our approach to implementing these principles. Emerging technologies like exoskeletons for surgical support, AI-assisted positioning systems, and advanced wearable monitoring devices may revolutionize how we approach ergonomics in healthcare.

The integration of ergonomic principles into medical education is crucial. Teaching residents proper positioning and body mechanics from the beginning of their training will create a generation of physicians prioritizing their physical well-being alongside their professional development.

Conclusion: A prescription for professional longevity

Ergonomics in ob-gyn is not about perfection; it's about awareness, adaptation, and continuous improvement. By addressing physical, visual, and emotional ergonomics comprehensively, we can create more sustainable and enjoyable careers while maintaining the high standards of care our patients deserve.

The prescription is simple: stand straight, see clearly, and support each other. Our patients need us to be healthy, our families need us to be functional, and our profession requires us to be engaged for the long haul. After all, we can't pour from an empty cup, or in our case, we can't deliver babies with a bad back.

Remember, whenever you adjust your monitor, stretch between cases, or take a mindful breath during a difficult procedure, you're not just caring for yourself—you're modeling healthy behavior for the next generation of physicians. Now that's what I call preventive medicine.

References:

1. Restaino S, D’Indinosante M, Perelli F, et al. Ergonomics in the operating room and surgical training: a survey on the Italian scenario. Frontiers in Public Health. 2024;12. doi:https://doi.org/10.3389/fpubh.2024.1417250
2. Lin E, Young R, Shields J, Smith K, Chao L. Growing pains: strategies for improving ergonomics in minimally invasive gynecologic surgery. Curr Opin Obstet Gynecol. 2023;35(4):361-367. doi:10.1097/GCO.0000000000000875
3. Cleveland Clinic. Ergonomics Play Key Role in Well-Being of Surgeons. Cleveland Clinic. April 15, 2022. Accessed July 28, 2025. https://consultqd.clevelandclinic.org/ergonomics-play-key-role-in-well-being-of-surgeons
4. Luger T, Bonsch R, Seibt R, Krämer B, Rieger MA, Steinhilber B. Intraoperative active and passive breaks during minimally invasive surgery influence upper extremity physical strain and physical stress response-A controlled, randomized cross-over, laboratory trial. Surg Endosc. 2023;37(8):5975-5988. doi:10.1007/s00464-023-10042-9
5. Ergonomics for the Eyes: Simple Adjustments to Your Office Environment Can Help Reduce Visual Fatigue. American Academy of Ophthalmology. February 17, 2016. Accessed July 28, 2025. https://www.aao.org/newsroom/news-releases/detail/ergonomics-eyes-tips-avoid-computer-eye-strai
6. UCLA. Eye Discomfort. Ergonomics. April 3, 2019. Accessed July 28, 2025. https://ergonomics.ucla.edu/injuries-and-prevention/eye-strain
7. Sykes S. The Economic Case for Ergonomic Workspaces. Mega Force. June 5, 2024. Accessed July 28, 2025. https://www.megaforce.com/2024/06/05/the-economic-case-for-ergonomic-workspaces/