Aug. 28, 2000 -- Joan Bartlet of Clarksville, Tenn., a single mother expecting her second child, may have to work right through her pregnancy. She needs the money and the health benefits that her job as an aide at a nursing home brings. "This is a very stressful job," the 26-year-old says. "I'm studying to become an RN, but for now I've got to do this."
Concerned about Bartlet's health -- and the future health of her baby -- her obstetrician wants her to stop lifting patients from wheelchairs to beds and back during the third trimester of her pregnancy. Although the nursing home says this lifting is essential to her job, Bartlet is petitioning her employers to switch her to lighter duty for these crucial three months. Despite her doctor's advice to take a break if her employers won't budge, she doesn't have disability insurance to cover lost wages if she were to take time off.
Bartlet has reason for concern. A study published in the April 2000 issue of the journal Obstetrics and Gynecology gathered data from 29 recent studies -- published over the last four years -- that monitored the experiences of more than 160,000 pregnant working women. Researchers concluded that physically demanding work during the third trimester significantly increases a woman's risk of pregnancy-related problems. The study found a greater incidence of premature birth, hypertension, and preeclampsia (dangerously high blood pressure accompanied by swelling and toxemia) in the women with strenuous jobs, especially those involving prolonged standing and repetitive lifting.
What Jobs Are Strenuous?
"Our research shows an increased risk for women who work on assembly lines, who do heavy manual labor," says Ellen Mozurkewich, MD, principal author of the study and a professor in the department of obstetrics and gynecology at the University of Michigan Medical School in Ann Arbor. "This is not about people in good shape who exercise sensibly during pregnancy. It's not about women who work in offices."
In fact, all of the studies Mozurkewich and her colleagues analyzed were careful to include a control group of working women who didn't do physically demanding labor. One contrasted veterinarians working with cats and dogs to vets who work with and move large farm animals. Another compared the experiences of ward nurses who are constantly on their feet to nurses who sit in offices doing paperwork. "Women who work tend to be healthier than women who don't work," Mozurkewich says. "So the risk has to do with the kind of work you do, not with working."
Reducing the Risks
Mozurkewich believes that pregnant women in physically demanding jobs should ask to be switched to "light duty" work after the first trimester, but she knows that's not always realistic. "The problem is that these women can't afford not to work, and their employers can't honor their requests for a lighter load without losing money," she says.
Cindia Cameron, who supervises the hot-line staff for 9 to 5, the National Association of Working Women in Atlanta, Ga., gets a lot of calls asking about light duty. "The news isn't good," she says. "You'd think that since light duty is offered to people with bad backs and broken legs, it would also be offered to pregnant women. But it isn't." A Texas federal court recently upheld Continental Airlines' decision to restrict light-duty privileges to people with work-related injuries, Cameron says. Pregnant flight attendants and baggage handlers have to keep slinging suitcases or take unpaid maternity leave.
In the final analysis, the decision to work during pregnancy is yours. You can't hold an employer liable for medical problems that develop -- even when your doctor has advised you to quit work or change the kind of work you do during a problem pregnancy, Mozurkewich says. Worker's compensation covers clear-cut on-the-job injuries, but the issue becomes murkier with pregnancy complications, which cannot be linked to a specific work incident. Such claims are usually contested and may become caught up in court appeal after court appeal.
Instead of threatening legal action, negotiate for fair treatment clearly and respectfully and you may well get some kind of concession, Cameron says. There's also strength in numbers: Talk to other people in your company to find out who shares your concerns and will support your grievance.
If you can't get light duty, try to take days off as you need them, Mozurkewich says. A 1989 French study of female factory workers showed that those who took sick days periodically during their third trimesters had lower preterm birth rates than those who worked without breaks.
Protection During Pregnancy
Unfortunately, there aren't enough laws that protect working women during pregnancy. The Pregnancy Discrimination Act of 1978 requires companies employing 15 people or more to treat pregnancy just like any other disability and to cover it under short-term disability plans. But most companies don't offer short-term disability insurance anyway, Cameron says. She recommends that women investigate their company's policies before asking for assistance. "Then document any experience you've had with light-duty jobs and make a case that you are valuable to the company."
Some companies do offer disability leave, and Social Security also offers disability insurance to women with problem pregnancies. You may be eligible if your doctor determines that your pregnancy is particularly difficult or if medical conditions you had before are exacerbated by your pregnancy. Ask your doctor for a letter documenting your case to take to your company's human resources department or to the local Social Security Administration office.
Using Family Medical Leave
What if your doctor says no lifting and your boss won't budge? "You'll have to use family medical leave early," Cameron says. "The trouble is you'll lose time you could use after your child is born."
The Family and Medical Leave Act, passed in the United States in 1993, guarantees 12 weeks of job-protected family leave, but a recent Congressional study found that, because the leave is unpaid, some women who are eligible don't take it. Recently President Clinton announced a proposal to create a paid family leave program by using unemployment insurance funds. It needs Congressional approval to become law. Mozurkewich hopes that her study will alert public officials to the dangers of demanding physical work -- in particular during the final trimester of pregnancy -- and edge Congress a little closer to establishing a more enlightened family leave policy.
None of this will happen soon enough to help Joan Bartlet get through her pregnancy, however. She's had to help herself. When she couldn't get nursing administrators to budge on light duty, she found another way out. "A job opened up in the activities department," she says. "I'll still be working with patients, but I won't have to do the heavy lifting I do as an aide." This solution has some disadvantages. "I had to take a cut in pay," Bartlet says. "I'm making $6 an hour now. As an aide, I made $8." But it's the only alternative she sees to protect her health and her baby's.
Jean Callahan is a freelance writer based in Salem, Mass., who specializes in health and medical issue. Her work has appeared in many national magazines including Health, Self, and Parenting.