Vol. 1 - Pages 9.1-9.30 (Printed Version)

Reproductive System

PREGNANCY AND US WORK RECOMMENDATIONS

Leon J. Warshaw

Changes in family life over recent decades have had dramatic effects on the relationship between work and pregnancy. These include the following:

·       Women, particularly those of childbearing age, continue to enter the labour force in considerable numbers.

·       A tendency has developed on the part of many of these women to defer starting their families until they are older, by which time they have often achieved positions of responsibility and become important members of the productive apparatus.

·       At the same time, there is an increasing number of teenage pregnancies, many of which are high-risk pregnancies.

·       Reflecting increasing rates of separation, of divorce and of choices of alternative lifestyles, as well as an increase in the number of families in which both parents must work, financial pressures are forcing many women to continue working for as long as possible during pregnancy.

The impact of pregnancy-related absences and lost or impaired productivity, as well as concern over the health and well-being of both the mothers and their infants, have led employers to become more proactive in dealing with the problem of pregnancy and work. Where employers pay all or part of health insurance premiums, the prospect of avoiding the sometimes staggering costs of complicated pregnancies and neonatal problems is a potent incentive. Certain responses are dictated by laws and government regulations, for example, guarding against potential occupational and environmental hazards and providing maternity leave and other benefits. Others are voluntary: prenatal education and care programmes, modified work arrangements such as flex-time and other work schedule arrangements, dependant care and other benefits.

Management of Pregnancy

Of primary importance to the pregnant woman—and to her employer—whether or not she continues working during her pregnancy, is access to a professional health management programme designed to identify and avert or minimize risks to the mother and her foetus, thus enabling her to remain on the job without concern. At each of the scheduled prenatal visits, the physician or midwife should evaluate medical information (childbearing and other medical history, current complaints, physical examinations and laboratory tests) and information about her job and work environment, and develop appropriate recommendations.

It is important that health professionals not rely on the simple job descriptions pertaining to their patients’ work, as these are often inaccurate and misleading. The job information should include details concerning physical activity, chemical and other exposures and emotional stress, most of which can be provided by the woman herself. In some instances, however, input from a supervisor, often relayed by the safety department or the employee health service (where there is one), may be needed to provide a more complete picture of hazardous or trying work activities and the possibility of controlling their potential for harm. This can also serve as a check on patients who inadvertently or deliberately mislead their physicians; they may exaggerate the risks or, if they feel it is important to continue working, may understate them.

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Recommendations for Work

Recommendations regarding work during pregnancy fall into three categories:

The woman may continue to work without changes in her activities or the environment. This is applicable in most instances. After extensive deliberation, the Task Force on the Disability of Pregnancy comprising obstetrical health professionals, occupational physicians and nurses, and women’s representatives assembled by ACOG (the American College of Obstetricians and Gynecologists) and NIOSH (the National Institute for Occupational Safety and Health) concluded that “the normal woman with an uncomplicated pregnancy who is in a job that presents no greater hazards than those encountered in normal daily life in the community, may continue to work without interruption until the onset of labor and may resume working several weeks after an uncomplicated delivery” (Isenman and Warshaw, 1977).

The woman may continue to work, but only with certain modifications in the work environment or her work activities. These modifications would be either “desirable” or “essential” (in the latter case, she should stop work if they cannot be made).

The woman should not work. It is the physician’s or midwife’s judgement that any work would probably be detrimental to her health or to that of the developing foetus.

The recommendations should not only detail the needed job modifications but should also stipulate the length of time they should be in effect and indicate the date for the next professional examination.

Non-medical Considerations

The recommendations suggested above are based entirely on considerations of the health of the mother and her foetus in relation to job requirements. They do not take into account the burden of such off-the-job activities as commuting to and from the workplace, housework and care of other children and family members; these may sometimes be even more demanding than those of the job. When modification or restriction of activities is called for, one should consider the question whether it should be implemented on the job, in the home or both.

In addition, recommendations for or against continuing work may form the basis of a variety of non-medical considerations, for example, eligibility for benefits, paid versus unpaid leave or guaranteed job retention. A critical issue is whether the woman is considered disabled. Some employers categorically consider all pregnant workers to be disabled and strive to eliminate them from the workforce, even though many are able to continue to work. Other employers assume that all pregnant employees tend to magnify any disability in order to be eligible for all available benefits. And some even challenge the notion that a pregnancy, whether or not it is disabling, is a matter for them to be concerned about at all. Thus, disability is a complex concept which, although fundamentally based on medical findings, involves legal and social considerations.

Pregnancy and Disability

In many jurisdictions, it is important to distinguish between the disability of pregnancy and pregnancy as a period in life that calls for special benefits and dispensations. The disability of pregnancy falls into three categories:

1. Disability following delivery. From a purely medical standpoint, recovery following the termination of pregnancy through an uncomplicated delivery lasts only a few weeks, but conventionally it extends to six or eight weeks because that is when most obstetricians customarily schedule their first postnatal check-up. However, from a practical and sociological point of view, a longer leave is considered by many to be desirable in order to enhance family bonding, to facilitate breast-feeding, and so on.

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2. Disability resulting from medical complications. Medical complications such as eclampsia, threatened abortion, cardiovascular or renal problems and so on, will dictate periods of reduced activity or even hospitalization that will last as long as the medical condition persists or until the woman has recovered from both the medical problem and the pregnancy.

3. Disability reflecting the necessity of avoiding exposure to toxicity hazards or abnormal physical stress. Because of the greater sensitivity of the foetus to many environmental hazards, the pregnant woman may be considered disabled even though her own health might not be in danger of being compromised.

Conclusion

The challenge of balancing family responsibilities and work outside the home is not new to women. What may be new is a modern society that values the health and well-being of women and their offspring while confronting women with the dual challenges of achieving personal fulfilment through employment and coping with the economic pressures of maintaining an acceptable standard of living. The increasing number of single parents and of married couples both of whom must work suggest that work-family issues cannot be ignored. Many employed women who become pregnant simply must continue to work.

Whose responsibility is it to meet the needs of these individuals? Some would argue that it is purely a personal problem to be dealt with entirely by the individual or the family. Others consider it a societal responsibility and would enact laws and provide financial and other benefits on a community-wide basis.

How much should be loaded on the employer? This depends largely on the nature, the location and often the size of the organization. The employer is driven by two sets of considerations: those imposed by laws and regulations (and sometimes by the need to meet demands won by organized labour) and those dictated by social responsibility and the practical necessity of maintaining optimal productivity. In the last analysis, it hinges on placing a high value on human resources and acknowledging the interdependence of work responsibilities and family commitments and their sometimes counterbalancing effects on health and productivity.

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