Should I Keep Working While I’m Pregnant?

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This is one of the most common questions I receive at the first few pregnancy visits and during the last few weeks of pregnancy.

I want to offer some evidence with a mix of existing guidance and education as an answer to this question in hopes of giving a little more support or information than you might be getting in your pregnancy care.

It’s also important to remember that work during pregnancy looks different for everyone.

I broke this post into three parts: the facts, guidelines and evidence behind work and pregnancy; frequently asked questions; and resources that you may need in your back pocket.

I’ll share my personal opinion on working in pregnancy at the end and what I did for each of my pregnancies for total transparency!

Let’s get to it!

Guidelines, Evidence and Facts About Work During Pregnancy

Let’s start with the guidelines. The main guideline for work during pregnancy comes from the American College of Obstetricians and Gynecologists (ACOG, 2018) – it’s not a true guideline; the organization calls it “Employment Considerations.” Here are the main points:

Work during pregnancy is safe for most people.
Work becomes a point of concern for people that work in high risk jobs (working with pesticides, heavy metals, increased risk of falls or injury, physically demanding jobs) or people that have high risk pregnancies.
Work during pregnancy is further complicated by the wide variety of regulations, job benefits or lack thereof, pregnancy or postpartum leave, and pregnancy or postpartum wage coverage. These benefits vary from state to state.
Federal and state laws prohibit discrimination and harassment against people that are pregnant.
Although there are some states moving towards better pregnancy and postpartum leave, there is no federal law that guarantees coverage to people.
Your obstetric provider can write notes that recommend changes to your job requirements depending on your job or any high risk conditions to your pregnancy. (Note: These notes are merely recommendations and there is not a guarantee your employer will honor the recommendation.)
If you do receive leave, or time off, leave is only for a limited amount of time.
Your partner may be eligible for time off as well as part of their employee benefits.
Your obstetric provider plays a key role in talking about how much time your employer offers you as leave, when you are going to take leave, filling out necessary paperwork, and following up at recommended appointments to ensure additional leave is not indicated.
If you are experiencing true harassment, discrimination, or require extended medical leave, you may need to seek legal advice from a lawyer or expert (ACOG, 2018).

Moving to the evidence, there are a lot of cohort and observational studies that have been done. In 2019, a systematic review was published in the American Journal of Obstetrics and Gynecology. The review looked at 62 observational studies and found that:

Working rotating shifts versus a fixed shift during the day time was associated with a higher chance of preterm labor, that an infant was smaller for gestational age, preeclampsia and gestational hypertension.
Working fixed night shifts was also associated with higher chance of preterm delivery and miscarriage.
Working longer hours (>40 hours a week) increased the chance for miscarriage, preterm delivery, low birthweight infants, and small for gestational age infants.
Working more than 55.5 hours a week have a 10% increase in the odds of having a preterm birth (Cai et al., 2019).

And lastly, some facts about working during pregnancy before the FAQs.

In 2015, 70% of women with children less than 18 years of age worked.
About 56% of pregnant women work full time during pregnancy.
82% of women pregnant for the first time work into or through the last month of their pregnancy.
Most women (73%) return to work within 6 months after birth.
53% of pregnant women felt they should change the requirements of their jobs while pregnant but 37% did not request any changes; of those that did request changes, 9% were denied their any accommodations (ACOG, 2018).

Frequently Asked Questions

Should I keep working 40 hours a week?

This is a personal decision, but evidence shows that 40 hours a week is generally safe for most people.

What changes should I make at work while I’m pregnant?

Across the whole pregnancy, these changes are helpful:

Taking additional rest breaks or small walks throughout the day.
Using a chair or stool if prolonged standing is required.
Avoiding dangerous activities (climbing a ladder, moving boxes up and down stairs, handing chemicals without proper safety equipment).
Scheduling time off work to attend pregnancy appointments (ACOG, 2018).
Staying hydrated.
Packing easy to eat snacks that high in protein.
Ensuring that you are getting good sleep before a work day/night.

During the first trimester…

Keeping a pack of saltine crackers nearby to stave off nausea.
Keeping some TUMS or other medication nearby if heartburn is causing you to be nauseous.
Using seabands or an essential oil to ward off nausea.
Changing your work hours to when you are less nauseous or tired.
Planning for extra naps and rest at home during your time off.
Going for small walks outdoors – fresh air helps with nausea.

During the second trimester…

Using a belly band to support the back and pelvis.
Use proper body mechanics when standing and sitting.
Consider moving to a standing desk if sciatic pain starts to flare up from prolonged sitting.
Use your leg muscles for lifting, not your back.
Be aware that repetitive movements of hands and wrists can cause carpel tunnel syndrome in pregnancy.
Take frequent breaks to the bathroom or for small walks during the day. Try to get up from your desk and stretch out your shoulders, neck and back every hour.
Maintain an exercise and stretching routine. Aim for a 30 minute walk a day.
Stay hydrated, limit caffeine and abstain from energy drinks.
Continue to plan ahead to take time off for pregnancy appointments.
Continue to take naps and rest as needed on your days off – you’re growing a human baby!
Contact your human resource department to find out more information on your leave benefits.

During the third trimester…

Continue to use a belly band as needed.
Use a stool as needed to lean against, or prop a foot up on a step. Keep your knees bent while standing for long periods of time.
For lower leg swelling, consider using compression socks.
Continue frequent bathroom breaks, high protein snacks, good hydration and small walks throughout the day.
You may need to move through position changes slower as your belly grows bigger.
Meet with your human resources department if you have questions about your leave benefits.
Complete any leave paperwork as indicated.
Ask your obstetric provider ant questions you may have about your job or pregnancy leave.
Make a plan for your postpartum leave – are you going to come back to work? If so, when? Communicate your intentions with your employer.

When should I tell my employer I’m pregnant?

This is up to you. Some people choose to share news very early and some people wait until the second or third trimester. Consider what your employer can do to help accommodate you as you work during pregnancy as well as how you can help your employer prepare for your time away. Most employers appreciate honesty and transparency about your plans and want you to come back to work for them.

What are my rights in the work place?

Read all about it here and how to act if your rights have been denied or ignored.

I don’t think I can keep working. When is a good time to quit?

This is also up to you. Outside of really severe nausea and vomiting, most people can continue to work during pregnancy. If you don’t need the income or benefits, you could decide to stop working at any time.

Can I work more than 40 hours a week?

As reviewed in the evidence above, working more than 55.5 hours a week had a 10% increase in the odds of having a preterm birth (Cai et al., 2019). No current recommendation or guideline recommends working more than 40 hours a week in pregnancy, but you could choose to work more than 40 hours a week.

Is working the night shift harmful to my pregnancy?

We don’t have good evidence to say yes or no. Is your pregnancy or baby at increased risk for complications? There is a lot of lower quality evidence that points to yes (ACOG, 2018; Cai et al., 2019). The NHS states there is insufficient evidence.

What about standing, lifting and mixed work shifts?

This depends on the study you read and what the primary outcomes were (primary outcome is what the researchers were trying to measure). One study showed no increase risk for miscarriage with mixed shifts, lifting up to 220lbs in a work day and standing >6 hours in a day. Another study showed a lightly increased risk of miscarriage with 220-440lbs of lifting, but a 2-fold increased risk with 2,200lbs of lifting when compared to people not lifting during pregnancy (ACOG, 2018).

What about traveling for work?

Traveling in pregnancy is generally safe. Recommendations for travel are as follows:

Limit domestic travel after 36 weeks.
Limit international travel after 32 weeks.
Carry a copy of your pregnancy medical records with you in case you need care while away.
Coordinate long periods of travel with your pregnancy provider to ensure you are still getting the pregnancy care you need.

I think my workplace may have harmful exposures to me while i am pregnant or breastfeeding. Where can i get more information?

The CDC maintains a list of workplace exposures that may be hazardous to pregnancy. Read the list here.

When should I stop working during my pregnancy?

This is a personal decision and many factors go into the decision.

Do you need the money from working?
Has your pregnancy provider recommended that you stop working?
Are you unable to complete the requirements of your job?

These answers are different for everyone.

Generally, work during pregnancy up until you go into labor or your bag of water breaks is safe. Working until a planned cesarean section or induction of labor is also safe. Whether you need income or not is only something you can evaluate. Most people will tell you it is easier to work during pregnancy that it is to leave your newborn baby at home and return to work early; for this reason, most people choose to work until labor starts.

What is FMLA?

The Family and Medical Leave Act (FMLA) requires certain employers to provide time off or leave to eligible employees for specific medical reasons. Not all people are eligible for FMLA and not all employees offer FMLA or leave for pregnancy or postpartum periods. Only 60% of people are eligible for FMLA in the United States (ACOG, 2018).

FMLA usually starts on the day of birth and can be used during the 12 months after birth.

FMLA can be used to reduce your current work schedule while still pregnant if your employee agrees; remember that this means less time with the baby after birth.

FMLA can be used to attend your prenatal appointments (ACOG, 2018).

FMLA can be used for serious health conditions during pregnancy if you are not able to work for medical reasons (U.S. Department of Labor, 2023).

FMLA can be paid or unpaid. Only 42% of people reported access to paid leave (ACOG, 2018).

To use FMLA, employees need to notify their employer at least 30 days in advance, so contact your human resources department early and often as needed to ensure you have everything required (U.S. Department of Labor, 2023).

Read about FMLA and who is covered or not covered here.

Learn about your state’s specific coverage here.

What does FMLA paperwork look like?

The official form looks like this. Your employer may use the same form or have altered it with their information.

What about FMLA for my family?

Your family members may be eligible for FMLA at their own job and may be able to take time off to come help you during your pregnancy or after the birth. Often times, your obstetric provider or primary care provider will sign the FMLA paperwork. Discuss

What if I need a letter from my employer?

Just ask your provider, but be specific about what you need your employer to document. Remember, your obstetric provider isn’t your employer and doesn’t have a say in most things related to your job at the end of the day. Based on ACOG’s 2019 recommendations, work accommodation notes should include:

Restrictions or modifications only when medically necessary. Start with smaller accommodations before moving to larger requests.
Close evaluation and discussion about whether job modifications are essential functions to the person’s job. Example: Does sitting on an exercise ball affect the job at all?
Specifics instead than general statements. Example: “Provide a stool to lean or rest against while at cash register” versus “no prolonged standing.”
Statements that the pregnant person can continue to work.
Statements about how long the modification should last. Example: “Please provide a stool for the remainder of pregnancy.”

Pregnant@Work offers resources to professionals and pregnant or breastfeeding people. (In English and Spanish).

Also consider reviewing these recommendations with your provider to see if your job requirements are outside of recommended weight limits for lifting at work during pregnancy.

What about disability pay?

Some employers have you use disability pay to cover leave during pregnancy or postpartum. This is specific to your employer and often causes confusion among people and providers. Generally, pregnant or postpartum women are not disabled. Discuss employer paperwork, coverage and questions about disability with your provider team.

What about con leave?

Con leave stands for convalescent leave. This is the leave provided to members of the armed forces when they have a baby. Leave paperwork is assigned by your unit or by a provider (if you are at a MTF for birth or pregnancy care).

Resources

About FMLA
ACOG’s Policy on paid Parental Leave
FLSA Protections for Employees to Pump Breast Milk at Work
FMLA Tips for Providers
Physical Job Demands During Pregnancy
Physical and Shift Work in Pregnancy (NHS)
Pregnant@Work
PUMP Act: What to Know About The PUMP Act?
Research
- Shift and night work during pregnancy and preterm birth—a cohort study of Swedish health care employees (2021)
- The impact of occupational activities during pregnancy on pregnancy outcomes: a systematic review and metaanalysis (2020)
Weight Limits for L i fting at Work During Pregnancy
Work and Pregnancy (Standford Medicine)
Workplace Right Hub

My Personal Experience & Some Thoughts

Whew…was it helpful to you? I hope so.

Here’s what I did in my 4 pregnancies. I worked from beginning to end. I had 3 spontaneous labors that I worked up until the day before each one started and one planned induction that I worked the day before as well.

Working in pregnancy made me move a little slower and I was always more uncomfortable but the work itself was very doable. The most annoying thing to me was working in the hospital and clinic with a mask on during pregnancy since the pandemic started.

In all 4 pregnancies, I worked 8 hour clinic days and 16-24 hour labor and delivery shifts. Some of the labor shifts were strenuous and. I used my belly band to support my back and pelvis through most of the 2nd and 3rd trimesters. In 2 of my pregnancies, I had significant lower leg swelling and need epsom salt soaks and compression stockings. In 2 of my pregnancies, I had to stop assisting in cesarean sections at 35 weeks because the OR lights made me too hot and dizzy.

On the postpartum side, I was blessed to have 12 weeks off with each baby. The first three were in the military while I was active duty, the fourth babe was FMLA. To me, the babes are so little and grow fast, I always wanted to work as long as possible so I could have as much time with them on the back side of birth.

I only offer my experience for transparency.

Now I want to offer some thoughts based on hundreds of conversations I’ve had with pregnant people and their families.

If you are planning to become pregnant and don’t have a job, consider timing the pregnancy so that you will have leave benefits.
Remember, if you don’t need the money or benefits, you may choose to stop working. Do what is best for your family.
Working during pregnancy is generally safe for most people. Address specific questions or concerns at your first prenatal visits.
As reviewed in the evidence above, pregnant people who work rotating shifts, night shifts or longer hours at at increased risk for complications during pregnancy (Cai et al., 2019). Consider changing your shifts or your job hours if you are planning to become pregnant. Start these conversations sooner rather than later with your employer.
Bed rest is rarely recommended for anyone anymore.
The first trimester is miserable. Adjust what you can. Rest when you’re able. Ask for help if you need it.
Employers and state vary in benefits and coverage. Ask your human resource department or supervisor to explain coverage to you. Take time to read the black and white and understand what your benefits are and are not.
If you need a note from your provider or clinic, be specific about what you need it to say. Also plan for about 3 business days for the clinic to turn the letter around.
Turn FMLA paperwork in early to your provider for completion; most offices require 3 days to 2 weeks to complete it.
Discuss the time you plan to take off after birth with your employer. If you’re not comfortable talking to your employer casually, consider scheduling a meeting and prepare a list of your question or concerns.
If you’re planning on breastfeeding, I highly recommend reviewing a plan like this before your birth with your employer to ensure you both understand what you will need for breastfeeding. Complete this return to work checklist before going back to work.

I’ve seen many women and families be frustrated to the point of tears by their job or benefits. You can prevent a lot stress by learning about your job or state benefits before you are pregnant – or early in your pregnancy. Most employers want to support your pregnancy and provide leave if they are able. It costs the employer far less money to support you than to find a new employee.

Reach out for help early and often, and good luck!

If you want to see how far we’ve come or just need some reading to put you to sleep, read this 1977 report on “Guidelines on Pregnancy and Work.”

If you have more questions or resources to add, let me know at amidwifenation@gmail.com 🙂

Happy trails until then.

Jamie

1 year ago on the blog…What Happens At My 28 Week Visit?

2 years ago on the blog…Student Spotlight: 9 Tips for Success in School

3 years ago on the blog…Student Spotlight: What to do between graduation and your first job?

References

American College of Obstetricians and Gynecologists. (2018). Employment considerations during pregnancy and the postpartum period. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/04/employment-considerations-during-pregnancy-and-the-postpartum-period

Cai, C., Vandermeer, B., Khurana, R., Featherstone, R., Sebastianski, M., Davenport, M. (2019). The impact of occupational shift work and working hours during pregnancy on health outcomes: A systematic review and meta-analysis. American Journal of Obstetrics & Gynecology, 221(6), P563-576. https://doi.org/10.1016/j.ajog.2019.06.051

U.S. Department of Labor. 2023. Fact sheet #28Q: Taking leave from work for birth, placement, and bonding with a child under the FMLA. https://www.dol.gov/agencies/whd/fact-sheets/28q-taking-leave-for-birth-placement-child