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August 25, 2001
By Deborah A. Raines, Ph.D., RNC
Congratulations you are pregnant! These are words that signal a lifetime of changes. Let’s begin with the story of Sherry. Sherry age 28 is pregnant with her second child. She works fulltime as a nurse to supplement the family income. Sherry sees nursing as a career and is anxious to continue working during this pregnancy. Sherry enjoys working float pool because of the challenges presented by caring for a variety of patients, being exposed to new experiences and using a multitude of skills and knowledge. During her first pregnancy, Sherry finished nursing school and passed the NCLEX. Thus she knows she can cope with being pregnant and having other responsibilities. She started her first nursing job when her son was just three months old and has worked fulltime since. She finds her career as a mother and a nurse complement each other. Now pregnant for the second time, Sherry must consider the implications of continuing to work during this pregnancy.
Can a woman work while pregnant?
If the pregnancy is low risk and normal, most women can continue to work into the third trimester. In fact, each year in the United States more than one million babies are born to women who work during their pregnancy. The woman with a job outside the home needs to consider environmental and occupational factors that may place her health and the well-being of her pregnancy or fetus at risk. The assessment of working conditions should include: potential exposure to teratogens, physical demands of employment and the work place environment.
Exposure to teratogens
A teratogen is a substance with the potential to alter the form or function of the fetus. Suspected teratogens include exposure to drugs, chemicals, infectious agents, heavy metals such as lead or mercury and radiation. The effect of a teratogen is greatest during fetal organogenesis or in the earliest weeks of pregnancy. Pregnant women should avoid exposure to anesthetic gases, infectious diseases - especially childhood rashes, toxic waste, or ionizing radiation, during the entire gestational period, but especially during the first trimester.
Physical Demands
Pregnancy results in muscular-skeletal changes that result in increased joint mobility, and a changing center of gravity. Consequently jobs that involve lifting, pushing or pulling require special attention to body mechanics to prevent injury. In general lifting during pregnancy should be limited to 25 pounds. If the work is strenuous, additional rest periods at home and increased caloric intake may be necessary to compensate for the additional physical exertion.
The physical requirements of the job also need to be evaluated. Studies have shown that standing for greater than four hours without a break is associated with an increased incidence of preterm labor. On the other hand, sedentary jobs with limited opportunities to get up and walk around are associated with a higher incidence of edema and thrombosis. In general, pregnant women should change activity every two hours. So if you are sitting, get up and walk, and if you are standing or walking, sit down and rest.
Work Environment
Studies have shown that stress, both physical and emotional, may play a part in maternal health and therefore in fetal well-being. Recently with more women in the work force, work places are becoming more “family friendly”. A safe workplace environment does not involve exposure to hazardous substances or organisms, provides for adequate breaks for rest and body movements, and accommodates the needs of the pregnant woman. In addition, there is legislation that protects a woman during pregnancy. The Pregnancy Discrimination Act of 1978 prohibits job discrimination on the basis of pregnancy or childbirth. Unfortunately this legislation classifies pregnancy as a disability as opposed to a healthy, developmental event. The second piece of legislation is the Family and Medical Leave Act (1993), which allow certain employees to take up to 12 weeks of unpaid leave for the birth of a baby.
Back to Sherry
Sherry continued to work throughout her pregnancy. She requests to not be scheduled for 12 hours shifts and not to be sent to the OR, PACU or Oncology unit because of potential exposure to gases and chemotherapeutic agents. Sherry enjoys orthopedics, and even though it can involve a lot of lifting, turning and moving of patients, she enlists the aid of her colleagues to complete these activity. When working Sherry brings a large bottle of spring water and nutritious snack for nibbling throughout the shift. Sherry plans her time so she can sit down and put her feet up about every two hours. She uses this time to rest as well as to check new orders, write nurses’ notes or review lab values.
Sherry is still working at 38 weeks gestation. She is scheduled to work the 3-11 shift on the post-partum unit. Sherry takes report and sets out to make rounds on her patients. About 6 p.m. Sherry approaches you and says she just called her husband and she needs to leave – NOW! She explains that she is in labor. You accompany Sherry to the labor and delivery unit where the physician determines that her cervix is dilated to 6 cm. Sherry is admitted to Labor and Delivery and you return to the unit to care for your patients. About 10 p.m. admitting calls for a bed for a new mother. At 10:30 p.m. the new patient arrives for room 3338, it is Sherry and her eight-pound, five-ounce baby daughter. Sherry started the shift as a nurse and ends the shift as a patient and new mother. Pregnancy really does change things!
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