Specific considerations for pregnant vets and their employers
Research into the effect of many occupational exposures is limited and by no means concrete but there are some prudent precautions that can help safeguard the wellbeing of both mother and unborn child. The Control of Substances Hazardous to Health (COSHH) Regulations 2002 require employers and the self-employed to assess risks to health from harmful substances, including micro-organisms, and to take steps to prevent or control those risks. The Management of Health and Safety at Work Regulations 1999 require employers and the self-employed to further assess any risks which affect pregnant women specifically. But what might these be?
While it might seem sensible (or perhaps just appealing) to avoid night shifts or on-call duties while pregnant, there is actually no lawful restriction that prohibits pregnant women from doing so. This is unless they are advised to avoid such work by a doctor or midwife, in which case written consent should be provided for the employer.1 If it is the case that night work should be avoided, then an employer should offer alternative, daytime equivalent work or if that is not available, suspend the pregnant employee on full pay.
Contrary to popular belief, as long as the standard procedures and rules are followed, then there is no need to vastly change practices when it comes to radiography in practice. The foetus is most susceptible to radiation in the first 12 weeks of pregnancy so some advocate the avoidance of partaking in X-rays altogether during this time if possible, although this is not a legal requirement.2
Exposure at work should be no more than 1mSv during the pregnancy (normal limits are set at 20mSv/year, with those receiving over 6mSv deemed ‘classified persons’ and requiring dose monitoring), which should be easy to achieve in general practice.2 1mSv is about the amount that would be incurred through natural radiation during pregnancy from the environment.
Pregnant employees should keep as far away as practicable from the patient and the X-ray tube while it is on, preferably behind the protective screen. If they have to be outside the protective screen during exposures, they must wear a lead apron that is comfortable to wear, fastened properly and covers their abdomen comfortably.2 Employers need to check that protective measures do not create other risks such as back problems. Although it is not a legal requirement, some employees may be reassured by being provided with an active dose monitor.
The jury is still out on the risks of exposure to anaesthetic gases during pregnancy but potential teratogenic effects and a higher risk of abortions at high concentrations, as well as reduced weight and size of the foetus at lower concentrations have been reported for many anaesthetic gases.3 Nitrous oxide is of particular concern. It is essential that active scavenging is used and that regular safety checks are carried out on the equipment to ensure a leak-free system. Face mask induction should be avoided so it’s sensible it is to have another vet on standby to take over an induction, just in case this is deemed necessary.
Pregnant employees should not handle griseofulvin, corticosteroids, prostaglandins or cytotoxic drugs and should avoid handling hormones and parasiticides. They should consider asking a colleague to inject animals with hormones or necessary parasiticides on their behalf. If it is necessary to apply parsiticides such as spot-on products, employees should do so wearing gloves and be in a well-ventilated room, although it is better to avoid this totally. The data-sheet information should always be read before handling any drug.
The protozoan parasite, Toxoplasma gondii can cause miscarriage, stillbirth, brain and other organ damage if contracted during pregnancy. It can be transmitted through broken skin or orally after handling infected cat faeces, new born lambs or consuming raw or undercooked meat, unwashed fruit or vegetables or unpasteurised goat’s milk and its products.4 A blood test can be requested from the GP to check toxoplasmosis antibody status.
Other diseases that can be contracted from animals that pregnant women need to be careful not to contract include Salmonella, Campylobacter, Cryptosporidia and Escherichia coli. Although many of these will not directly harm the foetus, they may cause severe gastroenteritis for the mother or lead to more severe complications than would otherwise be the case, which can obviously also have severe consequences for the foetus indirectly.
Chlamydiosis is an infection caused by Chlamydophilia abortus – the agent of enzootic abortion in ewes (EAE). It can cause serious disease in the unborn child, leading to stillbirth or abortion. Contact with aborting sheep, sheep at risk of abortion, dead lambs and placentae should be avoided by pregnant vets.
Leptospirosis can cause developmental abnormalities or foetal death, as well as death to the mother due to her compromised immune system. While contracting the disease from dogs is rare due to vaccination, vets are at a higher risk due to their increased contact. Leptospirosis can affect most mammals including sheep, cattle and pigs, so large animal vets need to be particularly vigilant. Humans mainly acquire infection by direct contact with infected urine through mucous membranes, eyes, or cuts and abrasions. Infection can also occur indirectly through contact with water, soil or foods contaminated with urine from infected animals. Pregnant women should not deal with any animals that could be affected by leptospirosis.
Listeria monocytogenes is widely distributed in the environment, including soil, decaying vegetation and fodder such as silage in which the bacteria can multiply. Consumption of foods contaminated with L. monocytogenes is the main route of transmission to humans but infection can be acquired directly from animals, although cases are rare. Listeriosis is thought to account for around 1-2 % of ovine abortions. Pregnant women are particularly susceptible and should not handle animals that could be infected.
Pregnant women should also ensure their tetanus vaccination is up to date – it is safe to have the vaccination during pregnancy.
This is by no means an exhaustive list of specific risks and potential zoonoses – pregnant women should seek further advice regarding their specific risks and necessary precautions.
Further information on zoonoses and appropriate control measures can be found on the HSE website. This includes links to information on many zoonoses and the 1997 publication Infection risks to new and expectant mothers in the workplace – a guide for employers, by the Advisory Committee on Dangerous Pathogens (ref: ISBN 0-7176-1360-7). Further information on the infection risks to pregnant women from cattle, sheep and goats that have given birth is available on the PHE website. Tommy’s, the baby charity, produces comprehensive guidance on Toxoplasmosis which is available at : http://www.tommys.org/Page.aspx?pid=193
Animal Handling and physical activity
Although there are no specific guidelines for pregnant mothers, standard procedures should be followed, as well as applying common sense when it comes to handling animals during pregnancy and moderating physical activity. For small animal vets, it’s sensible to avoid handling fractious patients or lifting heavy ones. It may also be the case that standing for long periods of time is extremely fatiguing. There’s usually someone around in the majority of practices to help with these situations, although large animal and equine vets may find avoiding them slightly trickier. However, special consideration should be given to avoiding situations that could result in getting kicked, squashed or barged. Although this may seem infeasible or impractical for many, there are usually ways around it, such as enlisting more help from the owner or farmer than you might usually request, or asking for the most suitable cases to be assigned to you. Practical measures to help best manage this aspect of the job while pregnant should be discussed and agreed with the employer when evaluating the risk assessment.
It’s clear that avoiding the many risks of veterinary practice is not an exact science, in many cases devoid of prescriptive guidelines or legal requirements. Each situation is also likely to be different, so openness, honesty and good communication between employer and employee is paramount when considering how best to ensure the health and safety of pregnant vets at work.
- HSE regulations for new and expectant mothers that work. Accessed 12.02.2015 http://www.nhs.uk/planners/breastfeeding/documents/new%20and%20exp%20mothers%20who%20work.pdf
- Health and Safety Executive (2001). Working Safely With Ionising Radiation: Guidelines for Expectant or Breastfeeding Mothers, HSE: 3, 6. http://www.legislation.gov.uk/uksi/1999/3242/contents/made
- https://www.osha.gov/dts/osta/anestheticgases/#C1 Accessed 12.02.2015
- Tommy’s Baby Charity (Date unknown). Toxoplasmosis problems in pregnancy