We had been trying, but the moment you see the word on the test strip, reality hits differently. My career was on an upward trajectory—I had just been offered a major promotion. And all I could think was: Why now?

When I told my husband how nervous I felt, he assumed it was about my body changing, or how our family of two would soon become three. He was wrong—and visibly confused. My nerves stemmed from the timing. I was stepping into a new leadership role. I would need to take months off. Would I fall behind? Would they still take me seriously? Would they even keep me in the role once they knew?

I lived in quiet, constant stress. That stress hasn’t fully subsided, even now, after the birth of my beautiful daughter. The unique position women occupy when starting a family—especially in male-dominated fields—is often misunderstood or minimized. And yet, it’s one of the most defining realities of working womanhood.

I had spent over a decade in a male-dominated medical environment—working nights, holidays, and climbing each rung with persistence and grit. The promotion wasn’t handed to me; I had earned it through results, relationships, and resilience. But in moments of self-doubt, I still remind myself I deserve to be here.

Receiving a promotion felt like a turning point—not just for my career, but for my sense of identity as a leader. For once, I was being seen not just as dependable, but as someone with vision.

I recently led a busy emergency department through a major hospital acquisition. At the time, I already held a leadership position within the institution. Accepting the offer meant leaving a comfortable position to build a team and lay the foundation for an emergency department within our respected network.

If you’re in health care, you know its male-dominated nature. In 2023, only about 15 percent of health system CEOs in the U.S. were women. Medical school deans and department chairs are also predominantly male, with women holding approximately 27 percent of dean positions and about 25 percent of department chair roles, according to the AAMC’s State of Women in Academic Medicine 2023-2024 report. Yet women now make up over half of medical students. The leadership gap remains stark.

So why did I feel an immediate sense of panic after accepting the promotion? Why did I feel like I had to keep my pregnancy a secret to protect this hard-won opportunity? Maybe it was because in emergency medicine, women make up about 30–35 percent of physicians, but only about 10–15 percent of department chairs or chiefs.

I showed up to introduction meetings with executive leadership in baggy blouses and a secret pounding in my chest. Every time someone congratulated me, I smiled and swallowed both gratitude and morning sickness. I was making long-term decisions for the department while quietly tracking the due date on my phone, wondering how to onboard a new team of physicians, steer our quality mission, and deliver my first child—all while preparing to step away from work to savor those tender first moments of motherhood.

Part of it was impostor syndrome—I’m not afraid to name it. But when I spoke with other women, I wasn’t met with surprise. Instead, their nods validated a shared experience. It fueled the quiet fire inside me, whispering: This system wasn’t built for you, but you’re in it now. So what will you do?

I have navigated this new role with determination and care, now with a new perspective on all my female co-leaders and the junior faculty I mentor. I am here to share with readers that you can find allies in the workplace—sometimes male, sometimes your direct superior—but most importantly, you are validated.

The work to dismantle male-dominated structures continues, one seat at the table at a time. I look forward to women holding more than 30 percent of C-suite and CEO roles in health care. I look forward to women getting promoted without secrecy, apology, or fear.

I entered this journey seven weeks pregnant and terrified. I was building a team, a department, and a tiny human—all at the same time. I didn’t do it without fear, but I did it anyway.

Now, with a thriving daughter and a thriving department, I see it clearly: women don’t need to hide our pregnancies to be taken seriously. We need to be seen fully—as leaders, as mothers, as people capable of doing hard things.

I look forward to the day when promotions during pregnancy are celebrated, not questioned. Until then, I’ll keep building a system that’s finally built for us.

Join me in building a health care system that’s truly built for us—where women leaders don’t have to choose between career and family, but can thrive in both.

Christine DeSanno is an emergency physician.