[MVMA FAQs: Pregnancy and Veterinarians]
Pregnancy and the Veterinary Profession
The Legal Framework
Physical Changes and Limitations
Background and Disclaimer: In 2000, MVMA Member Dr. Aimee Dalrymple authored a three-part series of articles discussing different issues that arise when a practicing veterinarian is pregnant. That series is consolidated in this document. PLEASE NOTE: MVMA has not updated the material within or confirmed its continuing validity, so this information should be used for general purposes only. If you have specific questions about how the law applies in your workplace, please contact a competent attorney with experience in these matters. Both employers and employees may get information from the Massachusetts Commission Against Discrimination at www.mass.gov/mcad (or by phone from 8:45 am to 5:00 pm at 617-994-6000 (Boston) or 413-739-2145 (Springfield)) and about Massachusetts Maternity Leave at http://www.mass.gov/mcad/maternity1.html.
Pregnancy and the Veterinary Profession
Aimee M. Dalrymple, D.V.M.
Part 1: The Legal Framework
Due to the influx of women into the veterinary profession, pregnancy and motherhood are important issues to a large number of veterinarians, both employers and employees. This overview of employment law as it applies to pregnancy and maternity leave is intended as a guideline for veterinarians who are pregnant or for practice owners who have an employee who is pregnant. Additional resources are listed at the end, and you are encouraged to consult these references or an employment law attorney for any definitive explanation of the laws discussed.
Note: Massachusetts is an “employment-at-will” jurisdiction, meaning that – in the absence of a contract, agreement, or relevant law – both employers and employees may terminate their employment as they wish. This is not the case in all states, so if you are outside of Massachusetts or employed in a field where additional protections apply, please check for other restrictions or prohibitions. The laws described below are intended to restrict an employer’s ability to terminate an employee’s employment in certain circumstances for discriminatory reasons.
The Pregnancy Discrimination Act
This federal law, passed in 1978 as an amendment to the Civil Rights Act of 1964, is designed to protect pregnant women from discrimination in the workplace. This law applies to employers with at least 15 employees and states that pregnant women must be treated in the same manner as other applicants or employees with similar limitations or disabilities. An employer cannot refuse to hire a woman because of her pregnancy as long as she can perform the major functions of her job. A worker may not be fired or forced to leave because she is pregnant, and she must be allowed to keep working as long as she is able to do her job. Pregnancy and maternity leave should not affect seniority status or be the cause for denial of a promotion.
The Pregnancy and Medical Leave Act (FMLA)
Passed in 1993, this federal law applies to employers with fifty or more employees. As this requirement excludes most veterinary practices, this is a brief overview. The American Animal Hospital Association’s publication, Employment Law: Women in the Veterinary Workplace (now out of print), recommends that veterinary practices consider voluntarily implementing some of the FMLA procedures. Under the FMLA, an employee (who has worked for the employer at least 12 months or for at least 1250 hours during the last year) may take up to 12 weeks of unpaid leave per year if he or she is having or adopting a baby or if he or she has a serious health condition, including pregnancy. Spouses who work for the same employer are allowed a combined total of 12 weeks. Under certain circumstances, this leave may be taken intermittently. This law also entitles the employee to take leave to care for a son or daughter with a serious health condition. If possible, the employee must give 30 days notice. The employee must be restored to his or her original job on returning from leave. Certain key employees (those who are in the highest-paid 10%) may be excluded from FMLA protection. The employer must maintain and continue to pay for health benefits for the employee while on leave.
Massachusetts Maternity Leave Law
In Massachusetts, an employer with between 6 and 49 employees is required to provide an 8-week leave for female employees who give birth, adopt a child under the age of 18 years, or adopt a mentally or physically disabled person under the age of 23 years. The employee must work for 3 months prior to taking leave and must provide 2 weeks notice. The employer must maintain (though does not have to pay for) the employee’s health benefits while on leave.
Massachusetts Supplement to FMLA
Enacted in 1998 as a supplement to the FMLA, this law applies only to employers of more than 50 employees. Again, as this excludes most veterinary practices, it is offered here as a guideline only. Under this law, employers must allow employees to take up to 24 hours per year of family-related leave (for participating in educational activities or for accompanying child to routine medical, dental, or other professional medical appointments). The employee must give 7 days notice if possible.
Part 2: Occupational Hazards
Because of the increase in number of women now in the veterinary profession, most practices employ at least one woman of child-bearing age. In this profession, many occupational health hazards exist that are especially of concern for the pregnant woman or the woman trying to conceive. Some workplace hazards can potentially impact male veterinarians’ reproductive health.
Please Note: This overview of reproductive occupational hazards is intended as a guideline for pregnant veterinarians as well as veterinarians with pregnant employees. Because there are few studies regarding hazards to veterinary workers, much information has been extrapolated from studies on workers in related professions or from animal studies; therefore, the information on reproductive hazards is mainly suggestive, not definitive. Relevant sources are listed at the end of this article and are recommended for those seeking more complete and detailed information.
In general, scatter radiation poses a hazard to those who remain in the x-ray room as a radiograph is being taken. Radiation can affect egg cells and spermatogenesis, and is of particular concern to male and female veterinarians trying to conceive. The embryo is most susceptible to radiation-induced damage at 8-10 days post-conception (pre-implantation). Most women may not even know they are pregnant at this time, so it is important for women trying to conceive to be aware of this risk. Throughout gestation, the human embryo and fetus are very sensitive to radiation resulting in mutations and birth defects and can increase the risk of childhood leukemia.
Maximum admissible dosage for the fetus during gestation is 500 mrems (or 56 rems per month) as defined by The National Council on Radiation Protection and Measurements, but there is no established zero risk level of radiation. Each individual should keep track of personal exposures even before pregnancy, so that average exposure rate is known.
In order to minimize the reproductive hazards posed by scatter radiation, the following safety measures are recommended.
a) Decrease time of exposure: use properly-calibrated equipment and faster screen-type films.
b) Increase distance: use chemical and mechanical restraints.
c) Shield: use lead aprons, thyroid shields, gloves, and glasses.
d) Avoid exposure: when practical, pregnant employees or those trying to conceive should avoid performing radiography.
e) Monitor: use dosimetry badges including special ‘fetal” badges for pregnant women (worn at the mother’s waist under the apron.)
Veterinarians run the risk of physical trauma to their bodies each day due to lifting heavy objects (especially patients), operating machinery, and working with unpredictable animal patients. Reported injuries include kicks, bites, scratches, tramplings, and falls as wells as cuts, stabs, and self-injections. Pregnant veterinarians and employees may be more susceptible to physical injury due to fatigue and physical limitations (changing center of balance, for example). Also, traumatic injury can increase chance of miscarriage or injure the fetus.
In order to prevent physical trauma, the pregnant veterinarian might take these safety measures.
a) Decrease physical exertion in general.
b) Properly restrain patients by physical, mechanical, and/or chemical means.
c) Prepare for changes in weather.
d) Improve footing with proper footwear with good traction.
Zoonotic diseases with teratogenic and abortifacient effects include brucellosis, tuberculosis, cryptococcosis, listeriosis, lymphocytic choriomeningitis, Q fever, toxoplasmosis, and Venezuelan equine encephalitis. Of these infectious diseases, toxoplasmosis and listeriosis appear to be of main concern.
Cats are definitive hosts of this disease and humans can be intermediate hosts with subclinical infection. The oocysts are shed by the cat for two weeks after infection and then become infective after they sporulate in 1-5 days. Once sporulated, the oocysts can survive in dark shady soil for up to one year. Humans are infected by ingestion of oocysts in cat feces or by ingestion of tissue cysts in undercooked meat. Oocysts can also be inhaled in dusty environments contaminated with cat feces (indoor horse arenas, livestock barns, show rings, etc.) or when handling infected meat (meat inspection, necropsies of cats, sheep, horses, pigs).
If a mother is initially seronegative and then acquires an infection during her pregnancy, the fetus can be infected via the placenta. Treatment during pregnancy reduces the likelihood of transmission to the fetus. However, congenital infection can result in abortion or premature birth, blindness, deafness, retardation, encephalitis, and other defects. Preventive measures include the following.
a) Have a toxoplasmosis titer performed prior to pregnancy.
b) If seronegative prior to pregnancy, discuss the value of systematic follow-up assessments during gestation with your physician.
c) Avoid contact with cat feces, wash hands or wear gloves when working with cats or cat litter (and gardening), and cook meat until well done.
Listeria monocytogenes is widespread in the environment and most often causes disease by ingestion of infected milk or inhalation of contaminated dust (poor quality silage). This organism causes abortion or neonatal septicemia or meningitis. Large animal practitioners are more at risk due to preponderance of cases in ruminants (cases in dogs are rare). Recommendations include wearing protective clothing and washing hands, as well as use of surgical masks in potentially-contaminated environments.
In general, universal precautions should be practiced to prevent zoonotic infection. Centers for Disease Control guidelines advise that all blood and body fluids be treated as if potentially infectious. Refer to the OSHA Bloodborne Pathogens Standard (http://www.osha.gov/SLTC/bloodbornepathogens) for specific information on handling sharps, hand washing after patient contact, use of personal protective equipment, use of disinfectants, education and training, and labeling.
The Registry of Toxic Effects of Chemical Substances lists more than 900 chemicals that are teratogens, and many more mutagens and carcinogens. A pregnancy is most susceptible to teratogens and abortifacients from the third week to the third month, so this hazard is important to recognize for those trying to conceive as well as those already pregnant.
According to OSHA hazard communication standards, employers must list all chemical hazards encountered in the workplace and educate staff of their existence. All containers must be labeled, and information on the individual hazards must be maintained. Examples of common chemicals that pose reproductive hazards are formaldehyde (preservative); ethylene oxide (sterilizing agent); pesticides (e.g., flea dips, shampoos, sprays, spot-on products); dyes; and solvents. To prevent chemical exposure, provide adequate ventilation and use protective clothing when handling these substances.
Some drugs commonly used in veterinary practice pose a particular risk to pregnant women. Antineoplastic drugs target rapidly dividing cells and therefore pose a significant risk to the fetus if the mother is exposed (usually through the skin or by inhalation). These drugs include alkylating agents (chlorambucil, cisplatin, and cyclophosphamide), antibiotics (actinomycin D), antimetabolites (methotrexate), mitotic inhibitors (vincristine), and miscellaneous drugs (hydroxyurea, L-asparaginase).
Pregnant women should avoid handling these drugs, and all individuals should reduce exposure by employing these measures.
a) Preparing drugs in a Class II vertical laminar flow safety cabinet.
b) Using personal protective equipment such as specific chemotherapy gloves, disposable gowns with long-cuffed sleeves, and high-dust or respirator masks.
c) Using hydrophobic filters when drawing up injectable agents.
d) Breaking pills in a resealable plastic bag.
e) Washing hands.
f) Using above measures when handling urine and vomitus from patients as some drugs are excreted unchanged.
Prostaglandins cause smooth muscle contraction and can induce labor at any stage of pregnancy. These drugs can be absorbed through the skin, so one must wear protective gloves and clothing.
Anesthetic gas exposure poses a special risk to the pregnant veterinarian or employee, principally from leakage from anesthetic equipment. Studies have shown an increased risk of abortion and birth defects in anesthesiologists and nurse anesthetists. Defects included hemangiomas, heart defects, hypospadias, pyloric stenosis, pectus excavatum, inguinal hernias, congenital hip dislocations, microcephaly, and mental retardation. There can be increased frequency of these defects in children of males chronically exposed to anesthetic gasses. The first trimester of pregnancy appears to be the most critical time of exposure.
The National Institute for Occupational Safety and Health (NIOSH) recommends that exposure to halothane and methoxyflurane should be limited to 2 ppm and nitrous oxide to 25 ppm. There are no limits set currently for isoflurane levels. In order to minimize reproductive and other health hazards, an effective waste-gas management program is the best approach to keep the levels of waste gases down. Additional recommendations follow.
a) Use good work practices: start gas flow after induction, use snug-fitting endotracheal tubes and masks, inflate endotracheal tube cuff properly, occlude Y-piece if breathing circuit is disconnected, empty breathing bag into the scavenge system, administer oxygen alone to the patient before disconnecting, use the appropriate oxygen flow rate, and fill vaporizer using a funnel/bottle adapter when few other people are around.
b) Utilizing a scavenging system is essential
c) Maintain equipment: perform daily inspection of circuit including leak testing (usual source of leaks is soda lime canister), repair, and calibration as needed.
d) Provide adequate ventilation.
e) Undertake an air monitoring program that includes semi-annual air sampling with chemical dosimetry available via industrial hygiene laboratories (American Industrial Hygiene Association, http://www.aiha.org/Content.)
In order to minimize the reproductive hazards in veterinary practice, it is important to become knowledgeable about these hazards. Staff should be made aware of these risks in writing and educated on preventive measures as per the OSHA Hazard Communication Standard. Personal protective equipment (in different sizes to fit different workers) should be provided and its use enforced.
When an employee becomes pregnant or is trying to conceive, employers and employees should review job hazards and safety procedures. If the employee feels that the risk is too great (the employer may not make this decision for the employee), then they should discuss reassignment of duties or disability leave. The employee can consult with her physician for advice.
Most importantly, plan now for employee pregnancy through the employee handbook, policies on disability and maternity leave, and cross-training to allow change of duty assignments.
Part 3: Physical Changes & Limitations
When expecting a child, most working women expect to enjoy a healthy pregnancy, and rightly so. However, most women also expect to continue their present jobs with little change until the baby’s arrival. In reality, pregnancy involves a progression of physical changes that may directly affect a woman’s work abilities and temporary arrangements need to be considered to cope with these changes.
Some experts recommend that women working in strenuous jobs (which include daily lifting, pushing, pulling, and bending) should stop working by the 28th week of pregnancy. Others say that a pregnant woman should leave her job by the 24th week if it requires standing more than four hours per day. As veterinary practice falls into these categories, the pregnant woman and her co-workers should recognize that her day-to-day job will almost certainly have to be modified for her to continue working throughout her pregnancy.
Women working in the veterinary profession may not recognize the variety of tasks they perform in one day. The physical changes of pregnancy may temporarily limit the performance of some tasks and require adaptations of others. For example, authorities recommend that a pregnant woman not lift any more than 15 pounds at a time to avoid injury to the fetus and placenta. This section provides a trimester-by-trimester guide to the physical changes of pregnancy and suggests comfort measures to cope with these changes while working in a veterinary practice setting.
Working in veterinary practice is physically challenging. It is important for the pregnant woman and her co-workers to recognize that fact early on and make the day-to-day accommodations necessary from the beginning.
The first trimester of pregnancy includes the first twelve weeks following conception. During this time, women may experience nausea (often referred to as morning sickness), fatigue, and/or headaches and dizziness. These symptoms directly relate to the increase in pregnancy hormones and the increase in circulatory system function (i.e., pulse rate increases by 10-15 beats/min).
Morning sickness/nausea: Contrary to the name, morning sickness does not just occur in the morning, but can last all day or occur at any time of day. Up to 70% of women experience this nausea; a few may experience vomiting so severe as to require hospitalization. Most women find that nausea disappears by the fourth or fifth month of pregnancy, but in the meantime, women can employ many strategies to deal with this discomfort.
a) Eat small, frequent meals. Schedule small breaks every two to three hours during your workday. Recommended snacks – such as saltines, animal crackers, yogurt, Fig Newtons, dried fruit, dry toast, salted pretzels, and bananas – are low in fat and high in protein and/or carbohydrates. Do not skip meals such as breakfast and lunch because you are “too busy”!
b) Eat anything that appeals to you because adequate food intake is important. Junk food calories are better than no calories at all.
c) Avoid smells that cause nausea. This may be all but impossible in a veterinary practice (!), but you can post a warning list of odors at work (i.e., scorched coffee, cleaning solution) that trigger your nausea so that co-workers can help you avoid them. Also, try keeping cut lemons in the refrigerator at work. Some women find that sniffing the fresh citrus reduces nausea.
d) Eat a small, sweet bedtime snack.
e) Eat crackers or sip weak tea at least 30 minutes before getting out of bed. For women with marked morning nausea, scheduling a later morning arrival to work temporarily may be very helpful.
f) Get adequate rest (see fatigue section).
g) Your choice of beverage may help curb nausea. Try various tastes until you find what works: include salty fluids such as Gatorade, cola, or broth; herbal teas such as peppermint tea; drinks containing ginger (ginger ale or ginger tea); or tart drinks such as lemonade.