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Goodman JM, Crawford AM, Cottrell EK, Guise JM. "How Do I Prepare for This?" Patient Perspectives on Providers' Employment-related Support During Pregnancy. Womens Health Issues 2024; 34:291-302. [PMID: 38383227 PMCID: PMC11116059 DOI: 10.1016/j.whi.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 12/29/2023] [Accepted: 01/12/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Health care providers can offer employment-related support to pregnant patients by providing information about occupational risks and benefits, discussing adjustments, and/or completing paperwork to help patients obtain accommodations or benefits, but little research has examined whether and how this support is provided. METHODS We conducted interviews with 20 adults who had been employed while pregnant within the 5 years preceding data collection. Eligible participants had low incomes, were hourly wage earners, or were employed in service or retail occupations. Applied thematic analysis was used to identify emergent themes. RESULTS People who had been employed while pregnant described a range of experiences during that time, including physical and psychological demands from work, lack of access to appropriate accommodations, difficulties combining breastfeeding with work, and work-related challenges accessing health care. Participants described four primary roles that health care providers played: 1) completing paperwork needed to apply for benefits or receive work modification; 2) providing information about how to mitigate employment-related risks; 3) providing referrals to social or medical services; and 4) advocating for patients to ensure receipt of accommodations, resources, and information. Strategies identified by patients that could be enacted within health care to help them better navigate the work-pregnancy interface include increasing appointment flexibility, providing information about work-related risks and benefits programs and referrals to legal support, and helping providers to understand and support their patients' individual work-related concerns. CONCLUSIONS Health care providers have a critical role to play in supporting employed pregnant people to achieve flexibility in managing their work and to be active participants in discussions about recommended workplace accommodations.
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Affiliation(s)
| | | | - Erika K Cottrell
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon; OCHIN, Inc., Portland, Oregon
| | - Jeanne-Marie Guise
- Harvard Medical School, Boston, Massachusetts; Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Mehra R, Alspaugh A, Dunn JT, Franck LS, McLemore MR, Keene DE, Kershaw TS, Ickovics JR. "'Oh gosh, why go?' cause they are going to look at me and not hire": intersectional experiences of black women navigating employment during pregnancy and parenting. BMC Pregnancy Childbirth 2023; 23:17. [PMID: 36627577 PMCID: PMC9830615 DOI: 10.1186/s12884-022-05268-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/30/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Workplace legal protections are important for perinatal health outcomes. Black birthing people are disproportionally affected by pregnancy discrimination and bias in the employment context and lack of family-friendly workplace policies, which may hinder their participation in the labor force and lead to gender and racial inequities in income and health. We aimed to explore Black pregnant women's experiences of pregnancy discrimination and bias when looking for work, working while pregnant, and returning to work postpartum. Additionally, we explored Black pregnant women's perspectives on how these experiences may influence their health. METHODS Using an intersectional framework, where oppression is based on intersecting social identities such as race, gender, pregnancy, and socioeconomic status, we conducted an analysis of qualitative data collected for a study exploring the lived experience of pregnancy among Black pregnant women in New Haven, Connecticut, United States. Twenty-four women participated in semi-structured interviews (January 2017-August 2018). Interview transcripts were analyzed using grounded theory techniques. RESULTS Participants expressed their desire to provide a financially secure future for their family. However, many described how pregnancy discrimination and bias made it difficult to find or keep a job during pregnancy. The following three themes were identified: 1) "You're a liability"; difficulty seeking employment during pregnancy; 2) "This is not working"; experiences on the job and navigating leave and accommodations while pregnant and parenting; and 3) "It's really depressing. I wanna work"; the stressors of experiencing pregnancy discrimination and bias. CONCLUSION Black pregnant women in this study anticipated and experienced pregnancy discrimination and bias, which influenced financial burden and stress. We used an intersectional framework in this study which allowed us to more fully examine how racism and economic marginalization contribute to the lived experience of Black birthing people. Promoting health equity and gender parity means addressing pregnancy discrimination and bias and the lack of family-friendly workplace policies and the harm they cause to individuals, families, and communities, particularly those of color, throughout the United States.
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Affiliation(s)
- Renee Mehra
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College St, CT, 06520, New Haven, USA.
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, UCSF Box 0606, CA, 94143, San Francisco, USA.
| | - Amy Alspaugh
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, UCSF Box 0606, CA, 94143, San Francisco, USA.
- College of Nursing, University of Tennessee, 1200 Volunteer Blvd, Knoxville, 37916, USA.
| | - Jennifer T Dunn
- Department of Social and Behavioral Sciences, School of Nursing, University of California, 490 Illinois Street, CA, San Francisco, 94158, USA
| | - Linda S Franck
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, UCSF Box 0606, CA, 94143, San Francisco, USA
| | - Monica R McLemore
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, UCSF Box 0606, CA, 94143, San Francisco, USA
| | - Danya E Keene
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College St, CT, 06520, New Haven, USA
| | - Trace S Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College St, CT, 06520, New Haven, USA
| | - Jeannette R Ickovics
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College St, CT, 06520, New Haven, USA
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Luke S, Carrillo G, Demeritt H, Truong T, Baldwin M, Sullivan R, Avery K, Swamy G, Wheeler S. Improving Clinician's Knowledge and Comfort with Prenatal and Postpartum Employment Laws: A Pilot Intervention. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2022; 3:924-930. [PMID: 36479369 PMCID: PMC9712045 DOI: 10.1089/whr.2022.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/19/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND It is common for pregnant people in the United States to continue to work throughout their pregnancy. Pregnant people may need leave time or other accommodations to continue working safely. It is imperative that obstetric providers are knowledgeable regarding laws that govern the prenatal and postpartum period to provide appropriate counseling and medical documentation in support of requests for leave time and workplace accommodations. METHODS We created a virtual training for obstetric clinicians regarding employment considerations in the prenatal and postpartum period. The training details the federal laws that govern this period, when and how to request reasonable accommodations from an employer, and provides resources for clinicians to use when they believe pregnancy-related discrimination has occurred. We conducted pretest and post-test surveys to assess change in knowledge about employment laws and comfort with counseling patients. RESULTS There were 61 clinicians who completed the training (50.4% response rate). The majority (88%, n = 54) of respondents reported no prior formal training about employment laws in pregnancy. On the pretraining self-assessment, >93% (n = 57) of participants felt they had minimal or very minimal knowledge regarding lactation and pregnancy-related accommodations, compared with >91% (n = 55) feeling very or somewhat knowledgeable after the training. The mean percent correct on the knowledge assessment increased from 55% to 67% on the pre- and post-test knowledge questions, respectively. DISCUSSION Our findings suggest an on-demand virtual training can improve knowledge and comfort for obstetric clinicians about federal employment laws in pregnancy and postpartum.
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Affiliation(s)
- Shauntell Luke
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Gabriel Carrillo
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
- Health Justice Clinic, Duke Law School, Durham, North Carolina, USA
| | - Hannah Demeritt
- Health Justice Clinic, Duke Law School, Durham, North Carolina, USA
| | - Tracy Truong
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Melody Baldwin
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Richalle Sullivan
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Katrina Avery
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Geeta Swamy
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sarahn Wheeler
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
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Nurses' experiences of working while pregnant: A qualitative descriptive study. Int J Nurs Stud 2021; 124:104092. [PMID: 34689012 DOI: 10.1016/j.ijnurstu.2021.104092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Healthcare work environments are fraught with occupational hazards that can impact nurse health as well as patient care. However, little is known about how these hazards impact nurse health during pregnancy, and the experiences of nurses in the work environment during pregnancy and upon their return postpartum. OBJECTIVE To describe registered nurses' (RNs') experiences of working while pregnant and returning to work postpartum. Specifically, their experiences related to the work environment and work-related hazards. DESIGN A qualitative descriptive design was utilized to describe nurse experiences at work, occupational hazards during pregnancy, and experiences of returning to work after pregnancy. PARTICIPANTS AND SETTING A convenience sample of twenty nurses working in direct patient care roles across the United States were recruited for virtual semi-structured interviews. METHOD Participants were interviewed using a semi-structured question guide to explore nurse experiences, specifically occupational hazards at work during pregnancy and upon returning to work. Interview transcripts were analyzed using deductive and inductive content analysis. RESULTS Deductive findings for occupational hazards and risks during pregnancy and postpartum included exposure to infectious diseases, imaging, physical tasks (e.g., lifting and performing CPR), cleaning products, patient violence, and medication administration. Inductive thematic findings included: support needed avoid occupational hazards and make necessary modifications; desire to be 'supernurses' and put the patient first even when it meant taking risks for our health and that of their child; and fear of the consequences of occupational hazards and exposures. CONCLUSIONS Occupational hazards experienced by nurses during pregnancy that may impact their health and that of their baby were broader than previously studied. Pregnant nurses should receive education from their healthcare providers early in their pregnancies about the occupational hazards themselves and the potential modifications they should seek. Managers, occupational health and other health system leaders, and policymakers should be aware of occupational hazards for nurses, including pregnant nurses, and support workplace modifications. Future research should focus on assessing the prevalence of these hazards, the longitudinal impact of exposures that can lead to negative consequences for nurse and fetal health, and reducing the risk of exposure to these hazards for pregnant nurses. TWEETABLE ABSTRACT RNs described a variety of occupational hazards of working while pregnant and postpartum. Inconsistent ability to modify work to protect self and baby leads to completing work demands known to be hazardous.
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Sherin M, Gildner TE, Thayer ZM. COVID-19-Related Changes to Pregnant People's Work-Plans Increase Prenatal Depression. Front Glob Womens Health 2021; 2:639429. [PMID: 34816196 PMCID: PMC8594024 DOI: 10.3389/fgwh.2021.639429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/22/2021] [Indexed: 12/16/2022] Open
Abstract
The COVID-19 pandemic has caused unprecedented rates of unemployment in the United States. Pregnant workers may be especially affected as they are over-represented in low-wage service and hospitality industries impacted by the pandemic. We surveyed an online convenience sample of currently working pregnant people living in the U.S. (n = 1,417) to determine whether COVID-19-related changes to how long individuals planned to work during their pregnancy, and uncertainty about these changes, were associated with prenatal depression. As hypothesized, both COVID-19-related work-plan changes (OR = 1.81, 95% CI 1.36-2.42, p < 0.001) and uncertainty about the precise nature of these changes (OR = 2.62, 95% CI 1.14-6.0, p = 0.022) were associated with significantly higher odds of a clinically-significant depression score. These effects appeared to be even greater among individuals who continued working outside the home during the pandemic. Since the U.S. is one of the few countries in the world that does not guarantee paid parental leave, pregnant people may be forced to choose between keeping their jobs and risking infection during the COVID-19 pandemic. Our results demonstrate a need for immediate suspension of the eligibility requirements for the Family and Medical Leave Act and/or universal access to both paid family leave and prenatal depression screening. This would help to alleviate these concerns and provide pregnant people with more options while preserving their employment status and financial security.
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Affiliation(s)
- Margaret Sherin
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Theresa E. Gildner
- Department of Anthropology, Dartmouth College, Hanover, NH, United States
- Department of Anthropology, Washington University in St. Louis, St. Louis, MO, United States
| | - Zaneta M. Thayer
- Department of Anthropology, Dartmouth College, Hanover, NH, United States
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Franco J, Morris L, Lee J, Williams JC. The Health Care Provider's Role in Securing Work Accommodations for Pregnant and Postpartum Patients. J Midwifery Womens Health 2021; 65:474-486. [PMID: 32841486 DOI: 10.1111/jmwh.13131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/23/2020] [Accepted: 04/08/2020] [Indexed: 11/30/2022]
Abstract
Most women today are the primary, sole, or cobreadwinners for their families; their continued ability to work during and after pregnancy is crucial for their families' well-being. Midwives and other health care providers are regularly asked to provide work notes for patients who need adjustments to how, when, or where their job is done to continue working while maintaining a healthy pregnancy or breastfeeding. Whereas an improperly written work note can result in the patient being forced out on leave or losing their job, an effectively written work note from a health care provider can ensure the patient will receive the adjustments they need to stay safe and healthy on the job. Health care providers can also play an important role by incorporating discussions about workplace issues into care conversations. This article provides an overview of pregnancy-related employment rights, guidelines for writing effective work notes, and a discussion of common workplace issues patients face and how health care providers can respond.
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Affiliation(s)
- Juliana Franco
- Center for WorkLife Law, University of California, Hastings College of the Law, San Francisco, California
| | - Liz Morris
- Center for WorkLife Law, University of California, Hastings College of the Law, San Francisco, California
| | - Jessica Lee
- Center for WorkLife Law, University of California, Hastings College of the Law, San Francisco, California
| | - Joan C Williams
- Center for WorkLife Law, University of California, Hastings College of the Law, San Francisco, California
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Physical and Organizational Job Stressors in Pregnancy and Associations With Primary Cesarean Deliveries. J Occup Environ Med 2017; 59:571-577. [DOI: 10.1097/jom.0000000000001019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Karkowsky CE, Morris L. Pregnant at work: time for prenatal care providers to act. Am J Obstet Gynecol 2016; 215:306.e1-5. [PMID: 27255471 DOI: 10.1016/j.ajog.2016.05.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/20/2016] [Accepted: 05/24/2016] [Indexed: 11/25/2022]
Abstract
Fifty years ago, when a woman became pregnant, she was expected to stop working. Today, however, most women who work are the primary, sole, or co-breadwinner for their families, and their earnings during pregnancy are often essential to their families' economic well-being. Medical data about working during pregnancy are sparse but generally show that both low-risk and high-risk women can tolerate work-related duties well, although some work accommodations (eg, providing a chair for sitting, allowing snacks, or modifying the work schedule) may be necessary. However, some employers refuse to accommodate pregnant women who need adjustments. This can result in a woman being forced to make the choice between working without accommodations and losing her income and health insurance or even her job. Prenatal care providers can play an important role by implementing changes in their own practice, shaping public policy, and conducting research to increase protections for pregnant women and to ensure that they receive medically recommended accommodations while continuing to earn income for their growing families.
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9
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Grajewski B, Rocheleau CM, Lawson CC, Johnson CY. "Will my work affect my pregnancy?" Resources for anticipating and answering patients' questions. Am J Obstet Gynecol 2016; 214:597-602. [PMID: 26976559 DOI: 10.1016/j.ajog.2016.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 03/02/2016] [Accepted: 03/07/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Authoritative information on occupational reproductive hazards is scarce and complex because exposure levels vary, multiple exposures may be present, and the reproductive toxicity of many agents remains unknown. For these reasons, women's health providers may find it challenging to effectively address workplace reproductive health issues with their patients who are pregnant, breast-feeding, or considering pregnancy. Reproductive epidemiologists at the Centers for Disease Control and Prevention National Institute for Occupational Safety and Health answered >200 public requests for occupational reproductive health information during 2009 through 2013. The most frequent occupations represented were health care (41%) and laboratory work (18%). The most common requests for exposure information concerned solvents (14%), anesthetic gases (10%), formaldehyde (7%), infectious agents in laboratories (7%) or health care settings (7%), and physical agents (14%), including ionizing radiation (6%). Information for developing workplace policies or guidelines was sought by 12% of the requestors. Occupational exposure effects on breast-feeding were an increasing concern among working women. Based on information developed in response to these requestors, information is provided for discussing workplace exposures with patients, assessing potential workplace reproductive hazards, and helping patients determine the best options for safe work in pregnancy. Appendices provide resources to address specific occupational exposures, employee groups, personal protective equipment, breast-feeding, and workplace regulations regarding work and pregnancy. These tools can help identify those most at risk of occupational reproductive hazards and improve workers' reproductive health. The information can also be used to inform research priorities and assist the development of workplace reproductive health policies.
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Affiliation(s)
- Barbara Grajewski
- Industrywide Studies Branch, National Institute for Occupational Safety and Health, Cincinnati, OH.
| | - Carissa M Rocheleau
- Industrywide Studies Branch, National Institute for Occupational Safety and Health, Cincinnati, OH
| | - Christina C Lawson
- Industrywide Studies Branch, National Institute for Occupational Safety and Health, Cincinnati, OH
| | - Candice Y Johnson
- Industrywide Studies Branch, National Institute for Occupational Safety and Health, Cincinnati, OH; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA
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