Childbearing and lactation during surgical residency is becoming increasingly common as more women enter the surgical workforce. There is a growing need for policies that support residents in navigating the demands of surgical training while balancing the responsibilities of new parenthood. This chapter examines the complex challenges faced by childbearing residents over the course of residency, including issues related to pregnancy, parental leave, lactation, and return to clinical duties. Although many institutions have implemented policies to support childbearing residents and national organizations have taken steps toward broader advocacy, substantial work remains to create a supportive professional culture and inclusive environment for childbearing trainees.