*Updated on 4/9/20 to include pregnant nurse precautions for COVID-19. *Affiliate links.
As an ER nurse who delivered my second baby in early 2018, I have done a lot of research about pregnant nurse precautions to be aware of when you work in a hospital. My goal was to make sure that it was safe for me to continue working in such a physically demanding environment with so many potential occupational hazards.
Fortunately, I was able to work safely right up until a few weeks before giving birth. As a per diem nurse, I did not have any maternity or disability benefits, so I wanted to save up as much money as possible before I went out on leave. Thankfully, I was able to do just that. But safety was still my number one concern. I hope this information can help other nurses stay safe during their pregnancies as well.
Talk to your OBGYN
First off, you must talk to your doctor to discuss any occupational concerns you have during your pregnancy. Continue the dialog at your prenatal appointments as you move along your pregnancy. If you have questions in between your appointments, then contact your doctor.
My goal in writing this is not to make pregnant nurses afraid to work in the hospital. I am so glad that I was able to safely work as a pregnant nurse for as long as I did. Still, there is no shortage of occupational hazards for the pregnant nurse within the hospital setting. Working safely is the number one goal.
You must communicate with management and your charge nurse about your pregnancy. They cannot help you avoid potential pregnancy hazards if they don’t know that you are expecting.
Additional recommended reading: Prayers For The Sick And For Nurses During COVID-19
Pregnant nurse precautions and hazards to consider:
The novel coronavirus (COVID-19) has many pregnant healthcare providers, especially frontline nurses, uniquely concerned. Because COVID-19 is so new, there hasn’t been enough time to study its effects on breastfeeding or pregnant women. Also, many nurses who are working directly with COVID-19 patients say they don’t have enough personal protective equipment (PPE) to protect them from the virus safely. That maybe even more problematic for pregnant nurses who directly care for COVID-19 patients.
“We do not have information from published scientific reports about susceptibility of pregnant women to COVID-19. Pregnant women experience immunologic and physiologic changes which might make them more susceptible to viral respiratory infections, including COVID-19. Pregnant women also might be at risk for severe illness, morbidity, or mortality compared to the general population as observed in cases of other related coronavirus infections [including severe acute respiratory syndrome coronavirus (SARS-CoV)* and Middle East respiratory syndrome coronavirus (MERS-CoV)] and other viral respiratory infections, such as influenza, during pregnancy.”
On pregnant healthcare personal and COVID-19, the CDC stated:
“Pregnant healthcare personnel (HCP) should follow risk assessment and infection control guidelines for HCP exposed to patients with suspected or confirmed COVID-19. Adherence to recommended infection prevention and control practices is an important part of protecting all HCP in healthcare settings. Information on COVID-19 in pregnancy is very limited; facilities may want to consider limiting exposure of pregnant HCP to patients with confirmed or suspected COVID-19, especially during higher risk procedures (e.g., aerosol-generating procedures) if feasible based on staffing availability.”
Essentially, the CDC does not know at this time if pregnant women are at a higher risk when working with COVID-19 patients because the evidence is limited. As a precaution, pregnant women may want to consider working in lower-risk areas where they have less exposure to COVID-19 patients.
The most important take away is to always take care of yourself first. You can’t care for your family and your patients if you become sick.
Radiation from diagnostic imaging
In the ER and on most floor units within the hospital, patients often receive portable X-rays at the bedside. So naturally, I was concerned about radiation exposure and how it could impact the health of my unborn child. I felt it was wise to air on the side of safety by not exposing myself to unnecessary radiation during pregnancy.
If you are in an area where x-rays are being taken, you must wear a lead radiation apron to protect yourself, especially if you are within six feet of the machine. If possible, it is also a good idea to step outside the room while the image is taken.
In my nursing experience, x-ray technicians usually notify anyone within the vicinity of where imaging is being taken. I was able to leave the area for a few minutes, whether I was wearing a lead apron or not.
- Notify management of pregnancy
- Wear lead radiation apron
- Step outside of the room when portable x-rays are taking place
Dangers from working with chemo or other teratogenic medications
There is evidence that handling some medications, such as chemotherapy drugs, can cause adverse reproductive outcomes, including fetal loss, miscarriage, infertility, and preterm births. In addition, it may cause learning disabilities in babies exposed to some drugs if nurses are exposed during pregnancy.
Wearing protective equipment, such as gowns, masks, and gloves, can minimize occupational risk to a pregnant nurse. However, it does not completely eradicate it.
Nurses working in oncology or other areas where antineoplastics are prescribed may want to speak with management about the safest way to continue working. In addition, you can insist on getting help from co-workers or management to give teratogenic medications to patients. Moving to another work area may be a consideration if safety for the fetus is still a concern.
- Wear protective equipment when giving medications
- Ask for help from co-workers when working with teratogenic medications
- Consider temporarily working in another area of the hospital during pregnancy as your management allows
Additional recommended reading: Why I love being an ER nurse
Risk for infection
As a pregnant ER nurse, I was very concerned with the risk of infection from patients such as c-diff, tuberculosis, cytomegalovirus, and influenza during my pregnancy. Since the ER is often the first stop in the hospital for sick patients, I often didn’t know that a patient had a contagious infection until after they had been admitted. By then it was too late to protect myself if I hadn’t already.
Pregnant women need to be especially proactive with protective equipment and hand hygiene. It is ideal for all hospital employees to have their measles, mumps, and varicella-zoster vaccinations before pregnancy (most facilities require these vaccinations to work anyway). Hep B and influenza vaccination can also safely be administered during pregnancy.
As an added precaution, I made sure to change my clothes and shoes before leaving the hospital to minimize the risk of work-to-home contamination. The first thing I did upon getting home was take a shower to rid myself of any other possible bugs I could have inadvertently carried home with me.
- Stay up to date in all vaccines including the yearly flu vaccine
- Adhere to strict universal precautions and hand hygiene
- Request job modification to minimize exposure to specific patient populations
- Minimize work-to-home contamination by changing work clothes and shoes before going home
- Shower as soon as you get home from work
The physicality of nursing while pregnant
Being a nurse while pregnant is exceptionally hard work. Not only are we on our feet for up to 12 hours a day, but pregnant nurses are also carrying an extra 25-plus pounds towards the latter part of pregnancy. Additionally, the extra girth makes it significantly more challenging to fit into tight spaces.
Movement becomes even more awkward for pregnant nurses due to having an altered center of gravity. Also, high serum levels of progesterone and relaxin loosen muscles, ligaments, and connective tissues. For nurses who do a lot of heavy, repetitive work requiring lifting, pulling, or pushing their risk of musculoskeletal injury is increased.
It is wise for pregnant nurses to use patient transfer equipment and to ask co-workers for help with moving patients. However, if your work situation is still too physical for you to manage safely during pregnancy, you may want to consider a modified duty in a lower risk setting with a less physical patient load.
On another note, pregnant nurses also have a higher risk of developing varicose veins due to an increase in total blood volume caused by pregnancy. The added blood volume, combined with being on one’s feet all day, leads to poor circulation, puffy legs, and swollen ankles. Compression socks or stockings can help reduce the risk of blood clots and varicose veins as well as prevent swelling.
- Pregnant nurses may want to inquire about modified duty
- Understand how the altered center of gravity and hormonal changes in pregnancy predispose a nurse to injury (despite using best lifting practices)
- Use patient transfer equipment when available
- Ask for additional staff help with transfers
- Wear compression socks or stockings
Additional recommended reading: Top 30 Ultimate List Of Nursing School Supplies And Essentials
I worked in our ER psychiatric hold area several times throughout my pregnancy. There were a few incidences where I had patients verbally threaten me or begin to escalate towards violence. I always had a security guard with me, and I stayed a reasonable distance away from patients when I felt that my safety could be at risk. I was likely overly cautious at times, but it is better to be safe than sorry.
Violence against nurses is not uncommon, especially in the ER setting. Stay vigilant and keep away from any potentially threatening situations. If a patient is escalating towards violence, then leave and call for help immediately.
Working during flu season
The CDC recommends that pregnant women get a flu shot. Not only do hormone changes during pregnancy often make pregnant women more susceptible to getting the flu, but a common flu symptom is a fever, which may be associated with neural tube defects and other adverse outcomes for a developing baby. Getting vaccinated can also help protect a baby after birth from flu through passive immunity.
My experience: The flu season in December 2017 was unusually bad. Many patients came to our ER for flu symptoms. Unfortunately, almost every nurse was infected with the flu or a cold at least once during the season. Myself, included.
At the time, I was over eight months pregnant, and I was struggling with how horrible I felt. I always get a flu shot to reduce my chances of getting sick during flu season. However, if I ever got pregnant again, I might consider starting my maternity leave towards the beginning of the flu season – especially, if I was that close to my due date.
An unexpected benefit of working as a nurse during pregnancy
One of the best gifts that pregnancy gave me was that it forced me to not be sedentary on days that I felt fatigued. (Although while you are carrying an extra 25-35 pounds of extra weight, you may not consider it a benefit).
Many studies show that not moving enough during pregnancy is bad for both mom and baby. If fact, exercise during pregnancy can boost your baby’s brain development and make them smarter. Who knew that working a 12-hour shift might promote health for both you and your unborn baby?
Good luck to you during your pregnancy and take care of yourself!
Additional Recommended Reading:
I had an appointment with my OB two weeks ago and everything appears to be progressing normally with my pregnancy (thank goodness!).
However, I did have one tiny little scare. When looking at the screen I noticed that our baby was measuring at about 26 weeks, which totally freaked me out since I was 28 weeks.
When I brought it up to my doctor she said “No, everything looks great and you are 26 weeks.” To which I responded: “but I’m 28 weeks!” She looked at my dates and said, “No hon you’re 26 weeks and right on target!”
Seriously? How is that even possible? That is one of the biggest differences between my first pregnancy and my second. I was an entire two weeks off on how far along I was. And I have been so busy with a toddler that I didn’t even know it.
First pregnancies are magical. Second pregnancy’s are cool too, just way busier.
Caring for this little one is a lot of fun. But I’m so much busier with a toddler these days that I lose track of time.
In my first pregnancy, I could tell you to the day exactly how far along I was. Weekly belly selfies were taken every Sunday to mark my progress. I knew exactly how big my baby was in terms of vegetable size, weight and length.
I practically studied fetal development on a daily basis. Weekly emails were delivered to my inbox telling me each and every detail of our baby’s milestones. I knew the exact time when she could open her eyes, suck her thumb, hear noises from outside the womb and every other possible developmental detail.
During my first pregnancy I practiced yoga at a studio several times a week, alternating between Vinyasa and prenatal. Then I would watch Netflicks and chill, sometimes marathon style. After all, why not? I was pregnant and I had the time.
Also, I also read every single baby book ever published (fyi, Baby Knows Best and Bringing Up Bebe where my favorites!).
My husband and I even started taking weekly Bradley Method classes. Which didn’t help me at all during my emergency c-section at 33 weeks. But hey, I ultimately still got my healthy baby girl, so who cares?
My second pregnancy has been cool too, sans all the extra me time that I had with my first. Toddler care taking has replaced pretty much all of those activities this time around. That is how I ended of forgetting how far along I was by two entire weeks!
Busyness aside, I love being a mom and I wouldn’t change it for the world.
Baby Boy has reached eggplant size. Yum!
I’m trying to enjoy the joys of pregnancy while they are here. Despite the weird symptoms, there is something so amazing about being pregnant.
I have joined the third and final trimester, yahoo!
Our amazing veggie is now 14 1/2 inches and weighs in at 2 1/2 pounds. Right on track! Nice job, little dude.
Even though I haven’t met my mini-man yet, he has definitely been making an impact in my life. Many of the symptoms of my first pregnancy have returned. I’m suddenly clumsy. I’m fatigued. I have heartburn at least once a day. And I have the worst pregnancy brain (so embarrassing).
In addition, I have even welcomed a brand new pregnancy symptom that I didn’t have last time: lovely varicose veins, on my left leg only. They are SO delightful, I tell you. Once the temperatures finally dip below 90 in Los Angeles I’m going to have to resort to daily compression stockings – toe to waist – for the remainder of the third trimester. Pregnancy sure knows how to make a women feel sexy!
Zoe is going to have big sister responsibilities soon.
Zoe is going to have big sister responsibilities soon!
I love watching how my little girl is reacting to my belly bump with amazement. She now looks at it and says “baby” in the cutest, innocent voice. I don’t think she fully grasps that there is an actual human is in there… yet. But we are trying to verbalize it to her and are reading her a few children’s books about becoming a big sister.
Tonight she was able to say “baby boy” which pretty much melted my heart. She is going to be an excellent big sister! I can’t wait.
I have a few goals to reach before childbirth.
We are only five weeks away from the time when I had Zoe via emergency C-section. Although I am planning on having a full term baby, truth is that you can’t always plan ahead. Therefore, I have a few goals I am presently working on in advance:
#1. Have a healthy full term baby.
I will be relieved to finally pass the 33 week mark. My doctor says the chances of having another placental abruption are extremely low, which is reassuring.
#2. Continue working as ER nurse until it makes sense to stop.
With the help of my nifty 30mm graduated compression stockings, I am going to continue working as an emergency room nurse until I am either:
a) too big, or
b) too exhausted, whichever comes first.
As a per diem registered nurse I am not granted disability or maternity leave benefits. I can take up to 6 months time without losing my position, but I receive zero compensation before or after childbirth. Once I’m out, I’m out for a while. So I’m trying to hang in until it makes sense for me to stay home.
#3. Figure out how to have a 2 year old and newborn share a bedroom without constantly waking one another up.
This one has been a real zinger for me as I can’t figure out how I’m going to make this work. The newborn will stay in our room for several months but then what?
If anyone has any tips on goal #3, I am all ears. Any expertise in this area is appreciated.
At the end of the day I am so thankful for a healthy, happy family.
Life is busy and tiring, but it’s all good. Pregnancy is a gift. Having children really is a miracle. I am overwhelmed with gratitude for a wonderful life and good health for my family and friends. That is the only thing that matters.
Thanks for reading.
Sarah, Mother Nurse Love
I am happy to announce that our pregnancy is entering its 24th week! Our little boy is growing faster by the day and weighs about 1.2 pounds. In a few more weeks I will be starting the 3rd and final trimester. Its all uphill from here!
This is the app on my iphone. It reminds me to keep moving. Today at work I got 17,000 steps!
Sarcasm aside, I’m actually feeling pretty good these days, with the exception of a little fatigue and annoying pregnancy brain. My bump is finally pretty obvious now so I so I can walk around proudly displaying a pregnant belly instead of just feeling full-figured and puffy.
I am still practicing yoga and working out when I can. My goal is to walk 10-15,000 steps a day, so I started using the activity app on my I-phone to track my progress. I admit, I am becoming so much dorkier as a second time mommy-to-be. I’m just a busy mom with a toddler trying to take good care of herself when she can.
Thankfully, this pregnancy has been pretty non-eventful. All of my prenatal testing has come back showing no signs of any health issues. Each appointment has gone smoothly without any big scares or hiccups (unlike my last pregnancy, which is a long story for another post!). I know nothing is 100% certain, but I feel optimistic that things will run relatively smoothly this time around (fingers crossed!).
The compression stockings are back (pregnancy is sexy!)
Last week I had to bring my lovely waist-high, graduated compression stockings back out of the drawer (they have been in hiding since the birth of our daughter in October of 2015).
As a nurse who works 12 hour shifts at a busy level 1 Trauma hospital, I have been a little concerned with the amount of time I spend in my feet everyday. I am specifically concerned about varicose veins which are a common side effect of pregnancy (and being a busy nurse). Pregnancy increases your blood volume by 50% and I’m also carrying an extra 12 pounds right now so its no wonder that my legs swell after 12 hours of being on my feet!
It just doesn’t get any sexier than maternity compression stockings (not my legs). The joys of pregnancy are many.
Alas! Compression stockings to my rescue! My legs are so much more energized at the end of a long shift after wearing compression stockings on then they are without them. They don’t feel swollen and they actually look visibly less swollen too.
I am sure you are profoundly intrigued and want details so I’ll tell you more about my compression stockings. I wear the Jobst 20-30 Waist High Closed Toe Compression Maternity Pantyhose. It just doesn’t get any sexier then that! Just a word of warning for ladies needing compression hosiery: this is not a place you want to be thrifty. I have tried the cheaper versions and quite frankly, they suck and are a waste of money. Mine are so well-made and will actually last through an entire pregnancy, unlike the cheaper ones.
I look like a whale trying to put them on in the morning. They are so tight on my legs it takes me about 6 minutes to get them all the way up (believe me, its a treat to watch!). Per recommendation, I put them on before I even get out of bed in the morning. Before the blood even has a chance to swim around my ankles.
I have a love/hate relationship with these darn things, but they work wonders I tell you. So I will continue to wear them until I stop working towards the end of this pregnancy.
More joys of pregnancy: heart burn and nosebleeds
Due to daily, mild-to-severe bouts of heartburn, I have Tums strategically stashed in my work bag, the kitchen cupboard, the diaper bag, and at my bedside. Heartburn is just another great side effect of all those fantastic pregnancy hormones!
At about this time in my first pregnancy I started having frequent heartburn, which is something I never have had non-pregnant. Unfortunately, as I get bigger, it will only get worse. Another one of the awesome joys of pregnancy that I get to deal with!
On another note, I luckily haven’t experienced any nosebleeds this yet. As mentioned earlier one of many fun physiologic changes during pregnancy is that your blood volume doubles. So nose bleeds can be unfortunate side effect. My last pregnancy I got a few nose bleeds right before laying down to sleep at night. Then I was up for over an hour each time trying to stop them!
VBAC or c-section?
At my 22 week appointment my OBGYN asked me of I wanted to have a VBAC (vaginal birth after cesarean) or another c-section. She really caught by surprise by this question.
I was under the impression that since my last pregnancy resulted in a c-section (due to a placental abruption at 33 weeks) that I had to have another c-section. In fact, I thought it was considered dangerous not to. Friends have told me that they had to have c-sections for their subsequent babies since they had one the first time.
My OB explained that I was still a good candidate for vaginal birth since I didn’t have a situation that prevented me from having a natural birth while laboring in my first pregnancy. Like, for example, if the baby wouldn’t descend down the birth canal, or I had gestational diabetes or severe preclampsia while I was trying to deliver naturally. She said that for women in my situation, most are still able to have a successful vaginal delivery. (I’ve since done a bit of research, and it does look like the statistics are in my favor).
I never even had an opportunity to go into labor with my first pregnancy. Instead, I had a freaky, rare and life-threatening situation called a placental abruption at 33 weeks. (Essentially, my placenta detached from my womb. Not good. You can read about that here.)
By some existential miracle our daughter is OK. She is perfect, actually. She is smart, funny, precocious, brave, and absolutely amazing in 1000 different ways. On Halloween Day she will be two years old.
Anyways, back to my VBAC versus c-section decision. I have done a lot of thinking about it lately. Due to the fact that I will have a 2 year-old at home to take care of in addition to a newborn, I have decided to forgo my original c-section plan in lieu of a new VBAC plan.
My reasoning: a c-section requires major abdominal surgery that cuts through many abdominal muscles resulting in weeks of recovery. I want to be able to take care of my family the best I can when I get back home. Another c-section will make that even more difficult for me.
So my new plan is to have a regular, vaginal delivery. That is, if I can help it. If there is any concern whatsoever over the health of the baby, by all means, I’m 100% all for having another c-section. Priority #1 is to have another healthy baby.
There is no rest with a toddler in a second pregnancy
It just doesn’t get any better than a sleeping baby Zoe.
I don’t have the time to rest like I did in my first pregnancy. I do get tired and nap on my days off when my daughter naps. Working in the ER now is also much more tiring. It’s doable, just harder.
Fortunately, in some ways I also feel more resilient then before. I know what to expect this time around so there are fewer surprises. I’m not checking my baby apps every week to see what developmental stage our baby is in (I wouldn’t have the time to anyway). I just get to be pregnant and focus on what ever is going on that day.
That may be the biggest unexpected benefit of pregnancy the second time around. I’m forced to live in the present because I’m so busy and I have an extremely energetic toddler to take care of.
And I’m feeling the baby kick a lot! I love that part.
Weird side effects and all, I am glad to have the opportunity to go through pregnancy a second time. This will be the last time so I’m trying to enjoy it while I can.
Thanks for reading!
Sarah, Mother Nurse Love