Both of them swore they would never do OB/GYN. Both of them ended up spending their careers caring for pregnant patients and their babies.
In this episode of The Fetal Frontline, recorded in honor of Women in Medicine Month, host Kris Rimbos brings together two fetal surgeons whose paths into the field are separated by about 30 years — and finds the same threads running through both.
Dr. Diana Farmer trained as a pediatric surgeon and landed in San Francisco in the 1980s, at what turned out to be the birthplace of fetal surgery. She describes an era when no one knew whether you could operate on a pregnant woman and keep her pregnant; when the discipline was to understand the natural history of a disorder in a fetus before you acted on it; and when the field's careful, slow, animal-model start is very likely what kept it from failing before it began. Her mentor was Dr. Michael Harrison — the father of fetal surgery, and the guest on Episode 4 of this podcast. She was the only woman in the field, and she says plainly that this is why the MOMS trial exists: she knew spina bifida repair would go worldwide, and she knew these were big operations carrying real risk to healthy pregnant women. Nobody wanted to run a trial — but it was so important to know whether it was beneficial. She wrote the grant anyway.
Dr. Kathy Bligard got interested in medicine watching her brother's doctors care for him after a diabetes diagnosis. She scheduled OB/GYN first among her clerkships specifically because she was certain she'd hate it — better to get the bad grade out of the way — and fell in love on day one on labor and delivery. Fetal surgery came later still, when her division director asked her a question she'd never considered: if you love diagnosing it this much, why don't you want to fix it? She has now inherited that fetal center, and is mentoring a junior partner into it.
The conversation moves from training and mentorship into the harder territory: what it costs, and what it doesn't. Dr. Farmer offers the advice she got at Wellesley — you can have a family, a career, and a social life, but only two at a time, so stage it rather than trying to hold all three at once. Dr. Bligard, who had one child in fellowship and spent her maternity leave in COVID lockdown, has landed somewhere similar: she doesn't get joy from chores, so she outsources them. "If you don't get joy from something, just don't do it. If it needs to get done, get someone else to do it for you."
And in the episode's most striking stretch, Dr. Farmer names something this podcast has circled before. Burnout, she argues, has nothing to do with long hours — people who do volunteer work overseas work 24/7 and come home full. It's the environment that won't let you do what you know is right; the moral injury; what she calls the medical industrial complex. What's genuinely hard is the responsibility itself: "That is the weight we carry. And we don't teach that very well." Medicine teaches anatomy, and how to deliver bad news. It doesn't teach how to survive your own bad outcome — the replaying, the "could I have done it better." Dr. Bligard picks it straight up, describing how long it took her to stop believing that a ruptured membrane after a TTTS laser was her personal failure.
They close on leadership and on the next generation: be persistent; get strength from colleagues, men and women both; don't let the slights define you. Dr. Farmer notes that most environments are improved by having women in the room. Dr. Bligard describes a fetal center staffed entirely by women. And asked what they'd tell a medical student thinking about this field, they don't hedge — have a blast, say yes to the thing you weren't looking for, and put yourself in a position to make a mistake and learn from it.
In this episode:
- Two routes into fetal surgery, 30 years apart — and why both guests were sure they'd never do OB/GYN
- The early days of the field: natural history before intervention, and the animal-model discovery that may have saved fetal surgery
- Why the MOMS trial happened — and why being the only woman in the room is the reason
- Mentorship, inheriting a fetal center, and the social worker as the unsung hero of the multidisciplinary team
- "You can have it all, but you kind of have to stage it" — career, family, and outsourcing what doesn't bring you joy
- Burnout as moral injury, not hours — and the weight of carrying a bad outcome
- Persistence, formal and informal leadership, and what to say to the next generation of women in surgery
Chapters:
- 0:00 — Welcome: Women in Medicine Month
- 1:41 — Meet Dr. Bligard and Dr. Farmer
- 3:52 — Dr. Farmer: from trauma surgery to San Francisco in the '80s
- 7:20 — Dr. Bligard: the clerkship she scheduled to get out of the way
- 10:52 — Mentors: Mike Harrison and the ethics of a brand-new field
- 14:40 — Mentors: Tony Odibo and "It's you now"
- 16:02 — Being a woman, and a parent, in the room with these families
- 17:55 — Collaboration, leadership, and why the MOMS trial exists
- 24:55 — Technical demands, emotional demands
- 29:25 — "I have no idea how I did it": career, family, and staging your life
- 33:02 — Rose-colored residency, COVID leave, and outsourcing the laundry
- 37:06 — The weight we carry: burnout, moral injury, and bad outcomes
- 45:55 — Leadership, persistence, and being heard in the room
- 52:07 — Keeping women in surgery — and what's really driving physicians out
- 56:27 — Advice to the next generation
- 58:55 — Closing: when women rise, they don't rise alone
Guests:
Dr. Diana Farmer, MD, FACS, FRCS, FAAP — fetal and neonatal surgeon, pediatric surgeon, and department chair; 30 years in fetal surgery, and principal investigator behind the MOMS trial grant.
Dr. Kathy Bligard, MA, MD — maternal-fetal medicine physician and fetal surgeon, Fetal Diagnosis & Therapy.
Host: Kris Rimbos — host of The Fetal Frontline and a long-standing member of the Fetal Therapy Nurse Network.
If this conversation resonated, share it with a colleague, a trainee, or a young woman deciding what to do with her career. As Kris puts it in the close: there's a place for you at the table — and if there isn't a seat, perhaps you're meant to build one.
Learn more about the Fetal Therapy Nurse Network at fetaltherapynursenetwork.org, and subscribe to The Fetal Frontline wherever you listen.
