Physical and shift work
In 2009, The Royal College of Physicians wrote a guideline on “Physical and shift work in pregnancy” which can be viewed here.
It focuses on specific hazards such as lifting/manual handling and heavy physical work, prolonged standing, long working hours and shift work (including night shifts)
In Summary;
- The evidence for an association between preterm labour and heavy physical work (difficult to quantify!) is mixed. A large systematic review of the evidence found a moderate risk of IUGR/small for gestational age associated with heavy physical work and the evidence for preterm labour was inconsistent. RCP recommend employees are relieved of heavy duties, especially in late pregnancy. If an employee is informed of the risks and wishes to continue in their current role then restrictions should not be imposed
- Again, evidence around heavy lifting (>15lb) and preterm labour/IUGR is poor and mixed. A reasonable body of evidence suggests no relation between regular heavy lifting and IUGR but a modest increase in risk of preterm labour and pre-eclampsia. For many of us the heaviest thing we will lift while pregnant will be a chunky toddler at home!
- Prolonged standing has no effect on birth weight and a high quality meta-analysis showed a modest increase in risk of preterm labour (pooled risk 1.28) The college recommends that employers should alter your clinical activity to avoid standing for more than 3 hours/day.
- There is consistent evidence to show no more than a small risk of preterm labour and IUGR associated with long working hours. There is insufficient evidence to show any effect of pre-eclampsia risk. Recommendations state working hours should be limited to “a normal working week” of 40 hours, especially in late pregnancy.
- Evidence around shift work and risk of IUGR and preterm labour is conflicting with some studies showing high relative risks (more than double) and others showing no increase. A high quality meta-analysis supported no effect.
Effectively, the evidence is weak and conflicting but be sensible regarding heavy lifting, ensure you have a risk assessment by your employer and investigate options of “preloading on calls” into early pregnancy so you don’t have any log shifts after 30 weeks.
If you are struggling and feeling the fatigue then speak to a compassionate colleague about adapting your duties. As medics we are so used to putting everyone else first, don’t forget if you are fatigued, stressed or struggling, you need to adapt to ensure your own and your babies health and safety. You also have a duty to ensure your patient care is not compromised, speak up if you are not coping. Occupational health will be very helpful if your department are not.
For references and the full text of the RCP recommendations visit
https://www.rcplondon.ac.uk/guidelines-policy/physical-and-shift-work-pregnancy-occupational-aspects-management-2009
