Curbside Consultation

Helping Pregnant Women Keep Their Jobs

 

Am Fam Physician. 2016 Sep 15;94(6):494-498.

Case Scenario

At 7.5 months pregnant, my patient found herself increasingly uncomfortable at work. Her varicose veins ached from standing on the job, where she was required to work a cash register and walk prescriptions from the pharmacy to the checkout area. I wrote a note to her boss explaining that she was pregnant and needed light-duty work for the duration of her pregnancy. Her employer's human resources department told her that there were no available alternative positions, and that she did not meet the eligibility criteria for leave as defined by the Family and Medical Leave Act. She would be allowed to reapply for any available openings after her baby was born, but human resources could not guarantee rehiring her. My patient is her family's primary breadwinner. Is there anything I could have done differently to avoid this outcome?

Commentary

Although many women can continue working during pregnancy without any adjustments, many other women require reasonable accommodations to allow them to continue working effectively and safely. Common pregnancy-related conditions and corresponding workplace adjustments are described in Table 1.

View/Print Table

Table 1.

Common Pregnancy-Related Conditions and Workplace Accommodations

ConditionPossible accommodation

Back pain

Alternate sitting and standing when possible; break for stretching twice daily, as well as during meal break

Breastfeeding

Two breaks of at least 30 minutes to pump; meal break where pumping may occur; private space for pumping

Carpal tunnel syndrome

Breaks from typing for at least 10 minutes every hour; wrist splints; padded roll in front of keyboard to prevent wrist extension

Gestational diabetes mellitus

Breaks for snack, bathroom, and blood sugar checks twice daily, in addition to meal break

Hyperemesis with dehydration

Have electrolyte drink available; schedule modifications as needed (e.g., late arrival, reduced hours, intermittent leave)

Postpartum depression

Schedule modification to accommodate therapy appointments

Varicose veins or hemorrhoids

Feet elevated when possible, support hose, extra water to drink, high-fiber snacks, sit (with cushion) instead of stand when possible

Table 1.

Common Pregnancy-Related Conditions and Workplace Accommodations

ConditionPossible accommodation

Back pain

Alternate sitting and standing when possible; break for stretching twice daily, as well as during meal break

Breastfeeding

Two breaks of at least 30 minutes to pump; meal break where pumping may occur; private space for pumping

Carpal tunnel syndrome

Breaks from typing for at least 10 minutes every hour; wrist splints; padded roll in front of keyboard to prevent wrist extension

Gestational diabetes mellitus

Breaks for snack, bathroom, and blood sugar checks twice daily, in addition to meal break

Hyperemesis with dehydration

Have electrolyte drink available; schedule modifications as needed (e.g., late arrival, reduced hours, intermittent leave)

Postpartum depression

Schedule modification to accommodate therapy appointments

Varicose veins or hemorrhoids

Feet elevated when possible, support hose, extra water to drink, high-fiber snacks, sit (with cushion) instead of stand when possible

Physicians should know the laws regarding employed pregnant women, and how to write a work accommodation note that will not jeopardize their patients' employment status.

Pregnant women are only partially protected at work by a patchwork of federal laws with several caveats. Some are left without a clear right to receive the accommodation they may need to continue working or to take job-protected leave.

  • The Pregnancy Discrimination Act prohibits discrimination on the

Address correspondence to Linda Prine, MD, FAAFP, at lindaprine@mac.com. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

REFERENCES

show all references

1. U.S. Equal Employment Opportunity Commission. Enforcement guidance: pregnancy discrimination and related issues. http://www.eeoc.gov/laws/guidance/pregnancy_guidance.cfm. Accessed December 14, 2015....

2. Jorgensen H, Appelbaum E. Expanding federal family and medical leave coverage: who benefits from changes in eligibility requirements? http://www.cepr.net/documents/fmla-eligibility-2014-01.pdf. Accessed December 14, 2015.

3. Childbirth Connection. Listening to mothers: the experiences of expecting and new mothers in the workplace. http://www.nationalpartnership.org/research-library/workplace-fairness/pregnancy-discrimination/listening-to-mothers-experiences-of-expecting-and-new-mothers.pdf. Accessed December 14, 2015.

4. Jackson RA, Gardner S, Torres LN, Huchko MJ, Zlatnik MG, Williams JC. My obstetrician got me fired: how work notes can harm pregnant patients and what to do about it. Obstet Gynecol. 2015;126(2):250–254.

5. Bonde JP, Jørgensen KT, Bonzini M, Palmer KT. Miscarriage and occupational activity: a systematic review and meta-analysis regarding shift work, working hours, lifting, standing, and physical workload. Scand J Work Environ Health. 2013;39(4):325–334.

6. Palmer KT, Bonzini M, Harris EC, Linaker C, Bonde JP. Work activities and risk of prematurity, low birth weight and pre-eclampsia: an updated review with meta-analysis. Occup Environ Med. 2013;70(4):213–222.

7. Palmer KT, Bonzini M, Bonde JP; Multidisciplinary Guideline Development Group; Health and Work Development Unit; Royal College of Physicians; Faculty of Occupational Medicine. Pregnancy: occupational aspects of management: concise guidance. Clin Med (Lond). 2013;13(1):75–79.

8. Grobman WA, Gilbert SA, Iams JD, et al.; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Activity restriction among women with a short cervix. Obstet Gynecol. 2013;121(6):1181–1186.

This series is coordinated by Caroline Wellbery, MD, Associate Deputy Editor.

A collection of Curbside Consultation published in AFP is available at http://www.aafp.org/afp/curbside.

Please send scenarios to Caroline Wellbery, MD, at afpjournal@aafp.org. Materials are edited to retain confidentiality.


 

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