Recommendations for Workplaces
1. Ensure that policies and guidelines regarding pregnancy and parental leave are in place and well communicated, in order to make the process of accommodation as open, smooth and rewarding as possible. Do so whether or not any pregnant physicians are present in the workplace, since existing mechanisms for accommodation send a positive signal to female employees and recruits whose futures include starting a family.
2. In workplaces where policies do not exist, develop well-written and well-defined guidelines on maternity, parental leave and postpartum accommodation.
3. Ensure that policies and guidelines are reflected in a supportive and open attitude to encourage female colleagues to discuss their needs as early as possible.
4. Implement ‘stop the clock’ tenure and earning tracks that allow for interruptions due to family needs.
5. Address preconception risks or threats to optimal fetal and maternal health in the work environment that could be prevented, mitigated or eliminated for female physicians.
Recommendations for Physicians Considering Pregnancy
1. Familiarize yourself with work conditions that present risks or can lead to complications in pregnancy. Consider the conditions that apply to pregnant women in general such as repetitive stooping and bending, high job strain, long hours and shift work. Consider conditions that affect pregnant physicians specifically, including exposure to radiation, violence, infectious and antineoplastic agents and solvents.
2. Analyze the specific employment conditions and leave policies when selecting a training program, residency programs or practice. Look for arrangements that offer flexible hours, part-time work or job sharing, on-site childcare services, emergency and sick-child care and facilities for breast feeding or the expression of milk.
3. Discuss the physical, professional and psychosocial demands of your work with your personal physician to understand your unique needs as dictated by your personal health status, age and reproductive history.
4. Obtain full information about the policies, procedures and guidelines regarding pregnancy and maternity, such as leave entitlement and shift variation where you work.
5. Obtain full information that will support decisions about your own and your family’s financial situation in the event of complications during pregnancy or after birth, including disability insurance, particularly considering education debt.
6. Understand your options regarding duration of leave after delivery, including paid or unpaid leave, continuation of insurance benefits, whether vacation and sick leave can be accrued from year to year or used in advance and whether schedule accommodations are allowed and supported.
7. Given the increased risks associated with pregnancy for older mothers, there is a possibility that you may require costly and timeconsuming fertility treatment. Early prenatal screening is also recommended.
During Pregnancy: Creating a Safe Maternal-Fetal Environment Maternal and fetal health are of paramount concern to everyone during pregnancy and a strong, shared understanding of risk factors should underpin efforts to ensure accommodation by providing safeguards.
Recommendations for Workplaces
1. Ensure that policies and programs are in place to reduce or eliminate risks to mother and fetus, including:
• Reduce or eliminate requirements for night shifts and on-call duties for pregnant physicians from 24 weeks gestation onwards.
• Provide pregnant physicians with opportunities to change work posture to avoid standing more than four hours at a stretch.
• Adjust work hours to allow for rest and proper nutrition.
• Provide flexible schedules for residents including flexibility in rotation and limits to on-call scheduling without penalizing non-pregnant colleagues.
• Ensure that pregnant residents and employees have at least two consecutive days off every week and work no more than five days in a row.
• Arrange back-up coverage of all clinical duties of pregnant physicians from 36 weeks of gestation onward in the event of an early delivery.
• Minimize physicians’ exposure to potentially violent patients who may endanger the pregnancy.
• Reduce work activities for pregnant physicians in situations of high job fatigue such as work weeks of 40 hours or more.
2. Modify work conditions and allow pregnant physicians to opt out of work when:
• Infectious disease prophylactic measures are not deemed by an occupational health specialist to provide sufficient protection.
• Exposure to infectious diseases and the potential impact of treatment or post-exposure prophylaxis is determined to be unsafe for the mother or fetus.
3. Provide flexible leaves during medical training and make an effort to allow the pregnant trainee to complete her education or residency in a timely fashion without having to repeat training.
4. Be prepared to provide for situations where bed rest or other activity modifications are needed in higher risk pregnancies.
Recommendations for Pregnant Physicians
1. Monitor changes in the physical, professional and psychosocial demands of your work with your personal physician to better understand the kinds of accommodation you may require, in keeping with your changing physiological and emotional needs.
2. Ensure that practice partners, employers and program leaders are made aware in a timely fashion of medical conditions or complications of your pregnancy that require accommodation or may lead to a premature delivery.
3. Ensure that you obtain appropriate support from your physician to document requirements for accommodation.
4. Comply with all infectious disease prophylactic measures recommended by occupational health, including opting out of work in circumstances where infectious disease prophylactic measures (e.g. personal protective equipment) are deemed by an occupational health specialist not to provide sufficient protection or exposure to infectious diseases and the potential related impact of treatment or post-exposure prophylaxis is determined to be unsafe for mother or fetus.
5. Eliminate physically strenuous work and heavy lifting, especially during the latter states of pregnancy.
6. Avoid continuous prolonged standing of greater than four hours at a time and, after 32 weeks of gestation, do not stand for more than 30 minutes at a stretch.
7. Do not work more than 5 consecutive days without at least 2 consecutive days off.
8. Well in advance of delivery, identify and secure arrangements for infant daycare or other domestic and childcare support that will be needed to return to work following birth.
After Birth: Creating a Supportive Environment for New Parents
For new mothers and fathers, the transition to life as a working parent is a demanding time and this is particularly the case for women who are also dealing with the physiological changes associated with the postpartum period. Recommendations for Workplaces
1. Provide health-related leave lasting six to 13 more weeks postpartum depending on the circumstances of the birth. For example, uncomplicated vaginal deliveries will require six to eight weeks health leave while more complicated deliveries will need nine to 13 weeks or longer.
2. Encourage and support female colleagues to take an adequate period of voluntary leave postpartum to breast feed and nurture their infants.
3. Create a workplace that is progressive in promoting benefits for women who combine medicine and motherhood such as facilitating part-time and shared practice models.
4. Provide support, include private space and equipment and time for breast feeding or the expression of milk by mothers.
5. Offer a comprehensive set of supports to parents such as flexible hours, part-time work or job sharing, on-site childcare services and backup in case of a sick child.
6. Provide support to colleagues when they return after giving birth. Sometimes, when a colleague is no longer visibly pregnant, they’re offered less support. Yet the demands of motherhood: sleep deprivation, hormonal changes and infant health concerns can be even more demanding than pregnancy.
7. Address postpartum risks or threats to maternal health that could be prevented, mitigated or eliminated by modification or reducing work hours.
Recommendations for Physicians as New Parents
1. Engage in discussions about return to work well in advance of the actual return.
2. Recognize that, for even the most committed women professionals, leaving a newborn to return to work is stressful. Seek support and accommodation to mitigate this stress and resist “toughing it out’.
3. Recognize that postpartum sleep disruption and deprivation may have a real and significant impact on thinking and memory and seek accommodation as required.
4. Consider a graduated return to work and “keeping in touch” mechanisms during work.
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