By Military Woman
Question: Do women need more military workplace considerations to ensure safe pregnancies?
Answer: In July 2020’s Military Women column we talked about military workplace considerations pre-conception. In this month’s column, we continue that conversation into the first three months, or trimester, of pregnancy.
Pregnancy may be a normal physiological life event but the risks, even in “normal” environments, are different for every person, every time. For example, during the first trimester, up to 70% of pregnant women experience nausea and vomiting that can vary in severity from mild to profound and up to 20% of pregnancies result in threatened or completed miscarriages. Miscarriage symptoms can vary from minor to debilitating uterine cramping, emotional distress and/or bleeding; and can require urgent access to specialized medical care. Ectopic pregnancies, the implanting and growth of the embryo outside of the uterus, affects up to 2% of first trimester pregnancies. Ectopic pregnancies can cause sudden incapacitation and even be life threatening—needing emergency surgical intervention. Other pregnancy-induced physiological changes increase a women’s risk of urine infections, kidney stones, and ear blockages.
So how should workplaces best accommodate for these baseline pregnancy risks for all while concurrently ensuring no additional or new risks? Unfortunately, there is no easy answer.
Workplace standards that ensure safety for the average healthy adult cannot be assumed safe for medically compromised adults, children and/or pregnancies. Specific reproductive hazard research is required to know if pregnancy loss and physical and cognitive birth defects are being kept to baseline “normal” levels or not. Because we can’t deliberately expose pregnant women to potential hazards, it’s not possible to do “gold standard double-blind randomized control trial” types of research. Most workplace reproductive safety standards are therefore determined “after the fact”, using observational studies documenting the workplace exposures of men and women and the final pregnancy outcomes from hundreds, if not thousands, of pregnancies.
Well-studied workspaces, such as office administration and teaching, are generally proven safe to work in while pregnant without limitations. Other large workplace studies, for example hospital nursing and commercial aviation flight attendants, identified the need for decreased exposures while pregnant to operating room anesthetic agents, radiation, circadian rhythm disruptions, and prolonged standing.
Less well-studied workspaces include the many areas women have only recently been entering in significant numbers (e.g., military, first responder services, mining). Given the research gaps of what, if any, sex-specific health impacts these non-traditional environments have on adult non-pregnant women, it’s no surprise even less is known about these workplace’s impact on pregnant women.
To establish pregnant military worker’s safety standards, researchers will need to review literally thousands of pregnancy records. Given the magnitude and complexity involved to study military specific exposures (e.g., military flying, diving, isolated field environments, serving at sea), international collaboration is likely needed. In the meantime, the gap between “what is known to be safe” during pregnancy and “what is known to be unsafe”, in military specific environments remains unacceptably wide.
Thermal, vibrational, biological, chemical, ergonomic or acceleration workplace exposures can negatively impact pregnancies at any stage, but especially so in the first trimester. Workplace reproduction hazard identification and avoidance are therefore especially important to enforce during the first trimester, the time when pregnancies are known to be the most sensitive to them.
The present lack of knowledge surrounding military workplace reproduction safety raises many questions. How can military operational effectiveness be best achieved without any worker discrimination based on sex? What is the employer’s responsibility to identify and minimize potential hazard exposures? What is the right of the military woman to decide the level of workplace risk she is willing to take vis-à-vis her own health and that of the pregnancy? How can informed decisions happen without more information?
One thing we can all agree on, is that more sex-specific (male and female) military workplace reproductive research is needed. When we know better, we can all do better.
