Working when pregnant: what should I consider?
Authors: Abi Rimmer
Publication date: 05 Sep 2017
Abi Rimmer asks about risks and responsibilities among pregnant working doctors
“Know your rights”
Maddy Fogarty Hover, ST3 in paediatrics and the BMA’s “less than full time” representative for Yorkshire
“As a pregnant working doctor it’s important that you know your rights and responsibilities, and those of your employer, regarding time off for antenatal appointments and sickness during pregnancy.
“It’s the employer’s responsibility to carry out a risk assessment of an employee’s working conditions when she is pregnant, has recently given birth, or is breast feeding. Where an employee or her child would be at risk if she continued with her normal duties (including shift patterns), the employer should provide suitable alternative work, for which the employee will receive her normal rate of pay.
“All pregnant employees are entitled to time off for antenatal care. This is not restricted to medical examinations and can include relaxation classes and parent craft classes, as long as these are led by a registered medical practitioner, registered midwife, or registered health visitor. You should continue to receive your normal pay during your time off. You’re also entitled to ‘keep in touch’ days while on maternity leave.
“It’s also really important to keep a written record of everything you’ve agreed: NHS employers now have a greater responsibility for ensuring that everything is dealt with properly, including your entitlement to paid and unpaid leave, accrued annual leave, and bank holidays. After discussion with the employee they should confirm any paid and unpaid leave entitlements, an expected return date, the length of any accrued annual leave, and the need for the employee to give at least 28 days’ notice if she wishes to return before the expected return date.”
“Do your research”
Laura Hamilton, orthopaedic hand fellow at King’s College Hospital, London
“The main risks faced by pregnant surgeons occur because of long hours and fatigue, which are known to increase the risk of intrauterine growth restriction and fetal death. Transferring patients and heavy lifting should be avoided in pregnancy, owing to lax ligaments and an increased risk of miscarriage. We often hear concerns about using x rays, but a standard 0.5 mm lead apron will block 99% of radiation, and maternal tissues block a further 70%. It’s worth discussing your plans with the radiology department to reassure radiographers that it’s safe for them to use x rays in your presence.
“Surgeons come into contact with many potential teratogens, so it’s sensible to research any substances you use. Iodine scrub seems to be harmless, but lead and cytotoxic drugs can have teratogenic effects. Anaesthetic gases are thought to be teratogenic, but modern closed systems dramatically reduce the risk of inhaling these gases.
“A definite risk to patients arises, however, if a pregnant surgeon feels faint or ill while operating and drops sterile equipment or contaminates a surgical field. A pregnant surgeon must learn to put her own wellbeing first, for the benefit of patients as well as the fetus. Surgeons must each generate their own unique plan with occupational health, taking into account their specific job risks—but, with careful planning, there’s no reason why a surgeon should worry about pregnancy at work.”
“Prioritise your wellbeing”
Patrick O’Brien, consultant obstetrician and spokesman for the Royal College of Obstetricians and Gynaecologists
“The demands on a gynaecologist are similar to those on a general surgeon, with the physical and psychological pressure of theatre and busy clinics. It’s uncertain whether a heavy physical workload in pregnancy puts women at increased risk of either preterm delivery or miscarriage, according to the Royal College of Physicians. It’s possible that a heavy physical workload has no effect on either of these risks, but the balance of evidence suggests a slightly increased risk of both preterm delivery and miscarriage.
“It’s very important that pregnant clinicians prioritise their wellbeing, not only for the benefit of their baby and themselves but also for their patients. Fainting while operating in a warm theatre, for example, is clearly a risk to patients. Pregnant women may feel more tired than usual, particularly in the first and last few weeks of pregnancy, so they should try to rest when possible and not overdo things. Commuting is also likely to become more challenging in the final trimester.
“If women are struggling to carry out their normal duties they should speak to their supervisor and employer’s occupational health department to identify where changes can be made. It will probably be helpful, for example, to limit prolonged operating and night shifts whenever these become too difficult. A flexible approach to working can help women to feel more in control, but it’s important to remember that some of the difficulties experienced in early pregnancy may resolve later, allowing women to resume all or most of their normal duties.”
Abi Rimmer BMJ Careers