Pregnancy in the Workforce: What Employers Should Know

Sarah Lucky

In years past it was not uncommon for employees to stop working once they found out they were pregnant. In the 1960s, only 44 percent of employees who had their first child worked at all during their pregnancy. That number significantly increased throughout the years, rising to 67 percent by the late 80s, where it seems to have leveled out.¹ Also continuing to rise is the number of employees who continued working far into their pregnancy. As of 2010, 8 out of 10 pregnant employees continued their role until within one month of delivery.¹

This increase in pregnancy among the workforce emphasizes the need for employers to consider the challenges at work that a pregnant employee may encounter. This is highlighted in the Pregnant Workers Fairness Act (PWFA), which went into full effect in June 2024.

The PWFA, put forth by the Equal Employment Opportunity Commission (EEOC), “requires a covered employer to provide a ‘reasonable accommodation’ to a qualified employee’s or applicant's known limitations related to, affected by, or arising out of pregnancy, childbirth, or related medical conditions, unless the accommodation will cause the employer an ‘undue hardship.’”²

More Information on the PWFA

The PWFA originally went into effect on June 27, 2023, and one year later, the EEOC issued a final regulation that offered clarifications on the act, including, but not limited to:

What pregnancy-related medical conditions or limitations would be considered for an employee to seek accommodation
Explanation of what would impose undue hardship on an employer
Encouragement of frequent and early communication between employers and their pregnant employees
Information for employers who would like to assert defenses or exemptions to providing accomodations³

The PWFA applies to all private and public sector employers with more than 15 employees, Congress and Federal agencies, and employment agencies and labor organizations. Under the PWFA qualified employers cannot:

Require unnecessary documentation to support the need for accommodation
Apply a different standard for requests related to pregnancy that is different than what is standard practice for non-pregnancy-related conditions or requests
Fail to make timely reasonable accommodations for the employee – unless it causes the employer undue hardship
Require the employee to accept an accommodation that is not considered reasonable
Deny a job or other employment opportunity to an employee because they require reasonable accommodation
Require the employee to take leave if there are other options that would allow the employee to remain at work
Issue punishment or retaliation against any employee who requests or uses reasonable accommodation, who reports or opposes an issue under the PWFA, or participates in a PWFA proceeding
Coerce any employee who is exercising their right under the PWFA

The Pregnant Employee – At A Glance

Once an employee becomes pregnant, their body is going to change. The most obvious change is the growing abdomen, but other changes will occur as well – both physical and mental. Many of these changes could affect the employee’s ability to perform their job functions, and in some cases, even the job can create a health risk for the employee and their unborn child. Some specific examples of work conditions that could create a health risk for a pregnant employee are⁴:

Extreme heat, which increases the risk of dehydration, and could also affect the growth of the fetus if the pregnant employee’s core temperature gets too high
Instances of lifting, pushing, pulling, or bending, which could increase strain on the back, as well as the chance of falling
Prolonged standing, which could lead to dizziness, high blood pressure, back pain, and other possible complications
Performance of activities that lead to the vibration of the employee
Prolonged shifts with minimal breaks provided
Radiation exposure
High levels of noise for extended periods
Occupational stress, which could arise from questions of job security, worry over personal health and the fetus' health, deadlines, workload, etc.
Harassment and discrimination in the workplace due to the pregnancy

But why is it important to consider the work conditions for pregnant employees? Beyond the requirements for the PWFA, limiting the occupational risks to the pregnant employee positively impacts the overall health of the employee and the fetus, and potentially limits the chance of miscarriage (pregnancy loss before 20 weeks) or stillbirth (pregnancy loss after 20 weeks). According to the Cleveland Clinic, in any pregnancy loss, whether miscarriage or stillbirth, 1 out of 3 times the cause is unknown⁵, “but issues affecting the [pregnant person] or the tissues and organs connecting them can lead to [pregnancy loss].” So, limiting needless hazardous work conditions while at work would also limit the pregnant employees’ exposure to circumstances that could lead to pregnancy loss.

What Can Employers Do?

While pregnancy can present the need for accommodations in the workplace for pregnant employees, this is not a decision employers should make on their own. The PWFA points out the importance of an interactive process between employer and employee when considering accommodation, and it is important to note this may not only come across as a direct request from the pregnant employee. At times, the employer should be alert to the needs of the pregnant employee with a sensitivity to a request, even if the employee has not directly verbalized that request. When the employee mentions the difficulty pregnancy has posed, the employer should recognize the need to discuss it with the employee and work quickly to make a change to overcome the challenge. Also, the most important action an employer can take is to have reasonable alternatives immediately available. That way, when there is a need, immediate action can be taken. It is important to foster an environment where communication between the employer and the pregnant employee is encouraged early and often as the pregnancy progresses.

Easy-to-implement accommodations that an employer could suggest include⁴:

Assessing the employee’s work environment and schedule and then making necessary modifications, such as allowing for more frequent water or bathroom breaks, schedule changes, allowing the employee to sit, as needed, and accommodating the employee’s doctor appointments related to the pregnancy
Requiring the use of personal protective equipment (PPE), as necessary, and providing re-sized PPE to accommodate the employee’s changing body
If the employee uses a respirator at work, update the respiratory fit testing to accommodate the changes in face and body brought on by pregnancy
Immediately removing the employee from any situation that may lead to radiation exposure
Seeking advice from medical professionals on possible modifications to the work environment
Providing re-sized uniforms

It is important to note, that workplace accommodations will not be one-and-done. As pregnancy progresses, the needs of the employee will change, and therefore, the workplace accommodations will need to change. “Workplace accommodations should be reviewed regularly as circumstances change. For example, early in the first trimester, the pregnant employee may be feeling nauseous or have strong aversions to food or scents, but as they progress through to the second trimester, they may have more energy and begin to experience more noticeable changes to the body, and by the third trimester, there may be more physical discomfort, fatigue, and limited range of motion,” said the Canadian Centre for Occupational Health and Safety. “Adapting the work environment to fit the changing needs of a pregnant worker will benefit not only the worker but also the organization.⁴”

Post-Partum Employees

The PWFA does not only apply to pregnant employees – it also includes postpartum employees who have returned to work. This time is just as important for the health of the employee as the pregnancy period. The employee’s body is often not fully restored to their pre-pregnancy condition until approximately six months after the pregnancy has ended⁷, which means their body may not be ready to perform pre-pregnancy duties until then. In addition to physical changes in the body, there are alterations in hormone levels as the body returns to the pre-pregnancy state. These fluctuations can lead to mental health issues including postpartum depression or anxiety. These conditions can be further aggravated by occupational stress. Also, if the employee chooses to breastfeed, there are additional factors an employer should consider to help accommodate the employee. For example, the employee may need time and a private area to pump while at work.

For some jobs, to ensure the employee is capable of undertaking all essential job tasks again, an employer could consider performing a fit-for-duty examination. This examination helps ensure the employee can safely perform all necessary tasks following the pregnancy and postpartum period.

Concentra’s Role

When it comes to defining the needs and potential health risks of the job duties or workplace exposures for the pregnant employee, providers at your local Concentra^® medical center can be a resource. In general, Concentra offers programs and training that can help prevent and treat employee injuries. Concentra providers work with employees in the injury and non-injury setting, including pregnant employees. Concentra’s goal is to improve employee health, both in general and in the workplace. Concentra therapists provide exercise guidelines, workplace stretching, injury prevention, and ergonomic services. Concentra provides surveillance services, pre-placement examination, vaccination, and respirator use clearance with fit testing for employees, including throughout pregnancy. Repeat fit testing may be necessary to help ensure respirator protection continues to fit as the pregnancy progresses. Finally, Concentra clinicians can perform return-to-work physicals or fit for duty evaluations, if needed.

It is important to note, that if a pregnant employee seeks urgent care at a Concentra medical center, they should follow up with their regular OB/GYN.

Notes:

“Working while pregnant is much more common than it used to be” Pew Research Center. March 31, 2015
“What you should know about the Pregnant Workers Fairness Act” U.S. Equal Employment Opportunity Commission
“Pregnant Workers Fairness Act set to go into effect June 18” Safety and Health Magazine. April 24, 2024
“Reproductive Health – Pregnancy in the Workplace” Canadian Centre for Occupational Health and Safety. Published March 3, 2023. Modified May 10, 2024.
“Stillbirth” Cleveland Clinic. Last reviewed September 6, 2023
“Understanding and Recovering from Stillbirth” Healthline. Current version June 24, 2024. Original version posted August 13, 2018.
“How to provide the postpartum care your employees need” Maven Clinic. March 23, 2022