Guidelines for Work with Employees During Normal Pregnancies
04. 2007

OPM recently was hired by a large teaching hospital to develop guidelines for work for employees with a normal pregnancy. 

This guideline is copyright protected but provides you with an example of the type of work we provide for our clients across Canada related to the development of clear; concise; evidence based guidelines related to accommodation in the workplace.

Guidelines are becoming increasingly important for employers to have in place for two reasons:

• Guidelines developed in this manner will protect the employee from injury to the best of an employers capabilities.
• The use of evidence based guidelines derived in this manner will satisfy the increasing requirements on the part of the Federal and Provincial Human Rights Commissions and therefore, prevent your company from having to defend an accommodation plan in the courts.

It is safe for women with a normal pregnancy to continue to work and to exercise during pregnancy with the following provisos:

No exposure to warm/hot work environments & ensure adequate work to recovery ratios to allow for dissipation of heat associated with physical work during the first trimester of pregnancy; the ability to dissipate heat during work/exercise is a significant factor as an increase in maternal core temperature of more than 1.5 degrees C during embryogenesis increases the risk for major congenital malformations. Using the Borg Rating of Perceived Exertion, women should work/exercise in the range of 12-14 (the use of the Borg Visual scale in the workplace would be a recommended tool particularly in the first trimester of pregnancy)

1. Over 50% of pregnant women experience moderate to significant changes to the lower back which result in symptoms of low back pain. In the Joint Policy Statement with the Canadian Physiotherapy Association and the Society of Obstetrical and Gynecologists of Canada #159 May 2003 recommendations during pregnancy and shortly afterward recommend a. pelvic floor muscle training with a physiotherapist to prevent urinary incontinence during and after pregnancy  b. core stability training with a physiotherapist to prevent and treat back and pelvic pain during and following pregnancy; the Accommodation program at Sunnybrook should therefore refer pregnant employees with otherwise normal pregnancy's to the rehab department for exercise prescription in these two main areas which will allow the employees to continue to work safely in their jobs at Sunnybrook c. lifting/lowering/carrying of awkward objects should be limited during pregnancy.  Moving patients who are at risk of falling/losing balance should be limited during pregnancy as there is some evidence that sudden loss of balance with potential for falls may have an adverse effect on the fetus.
2. A large body of the literature clearly shows a relationship between jobs which require static standing (meaning work such as a cashier; lab with extensive static standing at a workstation; Operating room nurses and assistants); pre-term births as well as low birth weight which may have clinical significance. The jobs in the hospital which require true static standing should be limited to no more than 6 hours per day and should be modified to allow frequent alterations in posture to sitting; walking; standing on a frequent basis.
3. A large body of the literature shows a relationship between hours of work/shift & night work as resulting in a Cumulative Work Fatigue Score which in turn results in low birth weight babies which may have clinical significance. The guideline that show flow from this includes; the work week should be limited to no more than 42 hours per week; manual materials handling should be limited to no more than 30 min per day of a low weight, moderate repetition type demand; Borg Scale Exertion of 12-14; & consideration for placing someone on a more permanent shift during pregnancy to allow for adequate work/rest schedules is indicated in the literature as well.