Practicing Pregnant: How to Stay Safe While Working

You have many decisions to make if you are pregnant and practicing veterinary medicine.
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The career of equine veterinarian has transitioned to mainly female graduates, which means all the tasks that befall an equine practitioner might have to be done or avoided while pregnant.

Whether you are an associate, an owner or a staff member at a veterinary hospital, once you are trying to become pregnant or have confirmation that you are, you must take precautions for your developing child.

There are a number of hazards that are unique to veterinary medicine along with some that are common to all workplaces. Each woman is also an individual, and some of you will have a higher risk tolerance than others. Also, each pregnancy will be different. Flexibility and good communication will go a long way toward having a smooth experience.

All workplaces, including those outside of veterinary medicine, can affect your safety, even when you are not pregnant. Slipping on a wet floor, tripping on a cord, lifting something heavy, reaching overhead, using a stool or ladder, and climbing stairs are all hazards that can cause injury in the workplace. Being pregnant exacerbates those general risks due to changes in balance and hormonal softening of ligaments.

Working in veterinary medicine increases your risks due to possible exposure to radiation, anesthetic gases, pharmaceuticals, zoonotic diseases, and viruses or bacteria. In addition, because of physical changes, the personal protective equipment that you could wear correctly before pregnancy—such as a lab coats or lead aprons—might not fit properly. A fetus might be more vulnerable to some chemicals because of its rapid growth and development, particularly early in pregnancy when its organs are developing. Changes in your metabolism also can increase how quickly you absorb some substances. When pregnant, changes in your immune system, lung capacity and even ligaments can increase your risk of injury or illness.

In the veterinary field in particular, it’s important to share the news of your pregnancy promptly with your employer to avoid exposure to workplace hazards. Since the first trimester is the time of the most crucial development, avoiding risks as soon as possible simply makes sense.

Current occupational exposure limits were set based on studies of non-pregnant adults. What is considered safe for you might not be safe for your unborn baby.

Talk to Your OB-GYN

It is important to discuss possible job hazards with your physician. Although most women are able to safely do their jobs throughout pregnancy, sometimes they must adjust their job duties temporarily or take extra steps to protect themselves and their fetuses.

Your ability to continue working through your pregnancy depends on your overall health, the health of the fetus and what sort of work you do. Many jobs are safe to continue through the entire pregnancy. Other jobs might be fine at the beginning of pregnancy, but untenable near the end.

Later in pregnancy, some duties might need to be changed or stopped. Sometimes your schedule or hours will need to be changed. If you continue working, the goal is to stay safe and comfortable.

Specific Risks in Veterinary Medicine

Radiation—While taking radiographs, you could be exposed to small amounts of radiation. You might decide to try to eliminate the risk during your pregnancy by avoiding these duties, but for equine practitioners, this could be impossible. For those who cannot avoid taking radiographs, take steps to reduce the risk.

Radiation exposure during your entire gestation should not exceed 500 mrem. The most dangerous time for radiation exposure is following conception (preimplantation) up to the eighth week of pregnancy.

Many pregnant women wear the same protective equipment while taking radiographs as they did when not pregnant, but because of changes in body shape, a wraparound lead apron might be better suited for the pregnant woman. In addition, wearing an additional dosimeter badge at the level of your uterus can provide more specific measurements of exposure to the fetus.

Before you take films while pregnant, review the reports from your dosimeter badge for the last year to ensure that your equipment and radiation safety techniques are protecting you from excessive exposure. As always, keep the time of exposure as short as possible, and maximize your distance behind the generator.

In some equine practices, nuclear scintigraphy is used for diagnostics because of its sensitivity and noninvasive nature. A 99mTc labeled radiopharmaceutical is injected intravenously into the horse, and images are acquired immediately post-injection and several hours later.

Staff members are often in the room with the horse during the acquisition process.

If you must be involved, avoid additional radiation exposure by wearing protective gear and minimizing contact with the patient and patient’s waste for 48 hours after the procedure.

Waste Anesthetic Gases—Waste anesthetic gas (WAG) exposure concerns many pregnant health care workers in human and veterinary medicine. Although a recent meta-analysis concluded that occupational exposure to WAG is associated with increased risk of spontaneous abortion, most of the studies in the meta-analysis were conducted before WAG scavenging had become a legal requirement, and none of the studies attempted to establish a relationship between amount of exposure and magnitude of risk of spontaneous abortion.

The meta-analysis included 19 studies of various designs with anesthetists, operating room physicians and nurses, dental assistants, operating-room workers, hospital workers, health workers, and veterinarians and veterinary assistants as subjects. More recent studies have demonstrated that “rates of spontaneous abortion and low birth weight infants were statistically similar among female veterinarians and lawyers, leading one to conclude that WAG is being effectively scavenged in most settings.

However, if you can smell anesthetic gas, the level is too high for safe exposure, whether you are pregnant or not.

Appropriate operating procedures for safe anesthesia include always checking the machine for leaks before use, ensuring the scavenging system is connected and operational, and using a cuffed and properly inflated endotracheal tube. The most dangerous times for exposure are during induction and recovery. In order to allow time for the system to be flushed through the scavenging system, once the procedure is complete, the anesthetic gas should be turned off and the patient maintained on high oxygen flow. This will help to minimize exhaled WAG after the patient is disconnected from the anesthesia machine. Vapor respirators can also be purchased and worn as an extra barrier.

Bone cement—Bone cement is the common term for the chemical substance methylmethacrylate (MMA, also known as polymethylmethacrylate). Bone cement is used in various orthopedic procedures, particularly in orthopedic or neurology specialty practices. Bone cement is a clear liquid with a very identifiable sharp and fruity odor. It can be easily detected at levels far below those considered to be harmful to human health.

Toxicity studies performed on animals have had mixed results. Some studies have shown no serious adverse effects to the fetus. Other studies have found that pregnant animals exposed to very high levels of MMA experienced fetal abnormalities. These abnormalities included birth defects, issues with bone growth, and an overall decline in fetal weight.

Because MMA carries a potential risk of harm to a human fetus, it is commonly advised that pregnant women avoid direct contact with MMA and avoid inhalation of MMA fumes.

Pharmaceuticals—Some drugs prescribed to veterinary patients are dangerous for pregnant women to handle. Common examples in equine practice are chloramphenicol, misoprostol, altrenogest (ReguMate®), and dinoprost tromethamine (Lutalyse®).

Chloramphenicol has been associated with adverse effects in the neonate as well as heritable genetic damage and cancer.

Misoprostol might cause adverse effects on the developing fetus, miscarriage, uterine rupture, bleeding and death.

Altrenogest is an oral progestin used to suppress estrus or as an adjunct to help maintain pregnancy in some mares. Skin contact must be avoided, as altrenogest is readily absorbed through unbroken skin. The product label warns that pregnant women or women who suspect they are pregnant should not handle this product, as accidental absorption could lead to prolongation of pregnancy.

Dinoprost tromethamine is used for estrus induction and synchronization in farm animals and horses. It is readily absorbed through the skin and can cause abortion in pregnant women.

These are not the only pharmaceuticals that can cause harm. Use care, read labels and avoid handling hazardous substances as much as possible. If you do handle these drugs while pregnant, use double gloves or consider wearing thicker chemotherapy gloves. Wash your hands thoroughly and consider wearing a mask if handling tablets that could result in dust inhalation.

Chemotherapy—Chemotherapy is designed to fight cancer by killing fast-growing cells. Hence, these cytotoxic drugs are very harmful to the fetus’ fast-growing cells. Ideally, pregnant women shouldn’t interact with patients receiving chemotherapy or be involved in its administration. If there is no alternative, at least try to avoid the preparation of chemotherapy agents, the mixing of IV fluids containing chemotherapeutic agents and the injection or infiltration of tissues with these drugs, such as the injection of an equine sarcoid with cisplatin.

Wear a mask, as well as double chemotherapy gloves, if you must perform this service.

Formaldehyde and Formalin— Formalin is the name for saturated (37%) formaldehyde solution. Study results vary with regard to the hazard formaldehyde can pose for pregnant women, but it is known to be a carcinogen. Pregnancy is a particularly vulnerable time for exposure to indoor air pollutants, such as formaldehyde, which is linked to spontaneous abortion, congenital malformations and premature birth.

Avoiding contact with formaldehyde and formalin is wise and should not be difficult in most practices, as it is not frequently used.

Zoonotic or Infectious Diseases— Exposure to or infection with diseases such as rabies, tetanus, C. difficile diarrhea, listeriosis, salmonellosis, cryptosporidiosis, plague, sporotrichosis, methicillin-resistant Staphylococcus aureus, psittacosis, dermatophytosis, leptospirosis, bartonellosis and Q fever have all been documented in veterinary workers.

Pregnant women are more susceptible to certain zoonotic infections owing to physiologic suppression of cell-mediated immunity. Conditions to which pregnant women are more susceptible include toxoplasmosis, lymphocytic choriomeningitis, brucellosis, listeriosis and psittacosis.

Vertical transmission of certain zoonotic agents might result in miscarriage, stillbirth, premature birth or fetal congenital anomalies. The NASPHV Compendium of Veterinary Standard Precautions is recommended as a resource to minimize these hazards. In addition, the University of Wisconsin has a webpage devoted to zoonoses and pregnancy.

Other Considerations Lifting, standing and long shifts— Prolonged walking or standing increases the risk of preterm labor and intrauterine growth restrictions.

Consult with your obstetrician about appropriate restrictions, if any. If you must be on your feet for long periods of time, wear comfortable shoes with good arch support and take breaks to sit down. You might consider wearing support or compression socks.

If you’re repeatedly feeling exhausted, listen to your body and consider cutting back on your work hours or the time you spend standing.

Generally, 25 pounds is the limit for Lifting in most healthy pregnancies, but proper form is essential. Bend at your knees, not your waist. Keep the load close to your body, lifting with your legs, not your back. Avoid twisting your body while lifting. Don’t try to be a hero and do lifting all by yourself. In equine practice, use your assistant or a client to carry heavy equipment.

Traumatic Injuries—Equine veterinarians are at risk for injury simply from the size of the animals they treat. Kicks, strikes and crush injuries can be fatal to the fetus and/or mother.

Taking normal precautions might be inadequate, as a pregnant woman has a changed balance and body shape and might not be able to respond to threats as quickly as she could before she became pregnant. Do not hesitate to utilize sedation and ask for help in restraining animals for treatment.

Take-Home Message

Educate yourself about the risks in your workplace. Discuss these with your obstetrician and practice owner soon after you find out you’re pregnant. There will be many decisions to make, some of which will be difficult, but the detrimental effect of failing to take precautions could cause a lifetime of difficulty for your child.

Together with your employer and physician, you can decide whether you need to take special precautions or modify your work duties during your pregnancy. You need to feel comfortable with your choices. Most employers will be understanding, but not all.

The practice will be affected for about a year with each pregnancy, and as the child grows, the company might be affected further with childhood illnesses, medical appointments and school events. Some family-oriented practices celebrate those parts of life, but other practices don’t.

Remember that you have many choices in employment in equine veterinary medicine these days. It is your responsibility to shape the life you want to lead. 

References

  1. “Occupational Hazards of the Female Orthopaedic Surgeon” Accessed 8/26/19
  2. "Occupational exposure to inhaled anesthetic" Accessed 8/26/19
  3. “Hazards of bone cement: for patient and operating theatre personnel”, Kakazu, C. et al. BJA: British Journal of Anaesthesia, Volume 114, Issue 1, January 2015, Pages 168–169. Accessed 8/28/19
  4. Safety Data Sheet – Chloramphenicol  Accessed 8/27/19
  5. Safety Data Sheet – Misoprostol  Accessed 8/27/19
  6. ReguMate® Product information sheet  Accessed 8/27/19
  7. Safety Data Sheet – Lutalyse Accessed 8/27/19
  8. Compendium of Veterinary Standard Precautions for Zoonotic Disease Prevention in Veterinary Personnel”, National Association of State Public Health Veterinarians, JAVMA, Vol 247, No. 11, December 1, 2015  Accessed 8/28/19
  9. Zoonotic Disease and Pregnancy”  Accessed 8/27/19

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