New and Expectant Mothers at Work Policy and Procedure
Documentation Control
Reference HS/SP/004 Date approved 13 May 2009 Approving body Directors’ Group Implementation date 13 may 2009 Version 2 Supersedes NUH Version 1 (5 February 2007) Consultation undertaken Occupational Health, Infection Control, Matrons and department leads, safety representatives, Procurement, Trust H&S Committee, Organisational Risk and Patient Partnership Committee Target Audience Line managers Supporting procedure (s) Maternity Guidelines (part of Work-life Balance Policy) Review date November 2011 Lead Executive(s): Medical Director Author / Lead Manager Health and Safety Manager/Jenny Hennin Further Head of Organisational Quality, Risk and guidance/information Safety, Health and Safety Manager, from Occupational Health, Trade Union/Staff Association accredited reps Carole Jackson, Human Resources
New and Expectant Mothers at Work Policy and Procedures 1 Version 2 May 2009 CONTENTS
Paragraph Title Page
1. Policy Statement 3
2. Definitions 3
3. Diagnosing and managing those at risk 3
4. Roles and responsibities 3
5. Consultation 5
6. Equality and Diversity Statement 5
Appendix 1 Guidance on Physical, Chemical & Biological 6 Hazards Appendix 2 Procedures and Guidance 9
Appendix 3 Employee Record of Having Read the Policy 15
New and Expectant Mothers at Work Policy and Procedures 2 Version 2 May 2009 1. Policy Statement
Pregnancy is not an illness. Its health & safety implications can be adequately addressed by normal health & safety management procedures. Many women work whilst pregnant and return to work whilst breast-feeding. Some hazards at work, however, may affect the health and safety of new and expectant mothers and their children. This policy covers the actions that managers need to take to minimise risks.
On 1 December 1994, legislation required to implement the European Directive on Pregnant Workers was introduced into the Management of Health and Safety at Work Regulations 1992. The legislation requires employers to undertake a risk assessment of working conditions for pregnant women. As a result of the assessment, employers may need to take action to minimise risks.
2. Definitions
Under the regulations, new and expectant mothers are defined as females who have a pregnancy, which has been confirmed in writing by a health professional (registered doctor or midwife), or have given birth to a healthy child within the last 6 months, or are continuing to breastfeed a child. It also includes women who have delivered a stillborn child of more than 24 weeks’ gestation.
3. Diagnosing and managing those at risk
Risk assessment is an intrinsic part of the Management of Health and Safety at Work Regulations 1999, the Control of Substances Hazardous to Health Regulations 2002 (COSHH), the Manual Handling Regulations 1992 and the Ionising Radiation Regulations 1999. Managers should assume that there would be female staff of childbearing potential carrying out the tasks at any time. Some risks to the unborn child are greatest in the very early stages of pregnancy, often before the mother realises she is pregnant.
4. Roles and Responsibilities
It is the employee’s responsibility to notify her manager in writing that she is pregnant. It is advisable that the manager is notified as soon as possible, since some risks are greatest in early pregnancy. Managers may require confirmation in writing from a health professional.
New and Expectant Mothers at Work Policy and Procedures 3 Version 2 May 2009 When notified of pregnancy, the manager is required to carry out a risk assessment of the work done by the individual. Appendix 1 contains guidance on working conditions and physical, chemical and biological hazards can be obtained from the Health and Safety Executive (HSE) internet. The risk assessment proforma on page 10 will help to recognise risks that have been unidentified or underestimated. The proforma requires that actions to remove the risks or reduce them to acceptable levels are documented. The risk assessment should be filed with the worker’s personal management file. The employee should have the opportunity to express their views on risks before reaching a final decision on risk controls. She should be informed of the outcome of the risk assessment, and any necessary actions. Nottingham Occupational Health department are able to give advice on medical aspects of pregnancy or risks involved with work. Advice can be sought from the Trust Radiation Protection Advisers where employees are working with x-rays or radioactive materials or the Health Safety and Ergonomics department in relation to general workplace risks.
The risk assessment will need to be repeated at appropriate intervals to take account of pregnancy related changes in the worker, such as increasing size and ergonomic considerations. A repeat assessment every 3 months (or sooner if work circumstances change) may be reasonable, but frequency will depend upon the hazards in the environment.
If it is not possible to remove the hazard, or reduce the risk to an acceptable level, the manager must consider:
4.1 Temporarily adjusting her conditions of work and/or hours of work; or 4.2 offering her suitable alternative work, if available; or 4.3 suspending her on full pay for as long as necessary to protect her safety or safety and that of her child
The Health and Safety Executive states that they are not aware of any additional risks to pregnant or breastfeeding women or their unborn children from working at night. However, other factors associated with night work should be considered when performing the risk assessment. Increased risk may arise because fatigue associated with working nights may compound pregnancy related fatigue. Night work may also alter working conditions, e.g. lone working may occur, and opportunities to take regular breaks for rest, refreshments, expression of breast milk or use of the toilet may be fewer. Where a new or expectant mother undertakes night work and has been given advice by a health professional, who states that New and Expectant Mothers at Work Policy and Procedures 4 Version 2 May 2009 night work could affect her health and safety, or that of her unborn child, her manager must consider:
4.4 offering suitable alternative daytime work if available; or
4.5 suspending the worker on full pay
Managers are advised to consult Human Resources and Occupational Health for advice when this situation arises.
Mothers are expected to inform their line manager on return from maternity leave if they are still breast-feeding.
Managers will need to ensure that workers who are breast-feeding are not exposed to hazards, which may damage the health and safety of the mother or child for as long as they continue to breast- feed. The regulations do not put a time limit on breast-feeding; some mothers may continue for twelve months or longer. It is the responsibility of local managers to provide mothers with a suitable private and hygienic place to express and store breast milk.
Where managers are controlling risks in line with regulations, it is unlikely that mothers who continue breast feeding will be exposed to risks which require them to be offered alternative work or given paid leave.
5. Consultation
Undertaken in accordance with Trust protocols as listed in this Policy’s “Documentation Control”
6. Equality and Diversity Statement
The NUH is committed to ensuring that, as far as is reasonably practicable, the health, safety and welfare of staff, visitors, patients and students is paramount and does not discriminate against individuals or groups on the basis of their ethnic origin, physical or mental abilities, gender, age, religious beliefs or sexual orientation.
Appendix 1 New and Expectant Mothers at Work Policy and Procedures 5 Version 2 May 2009 GUIDANCE ON PHYSICAL, CHEMICAL & BIOLOGICAL HAZARDS
Below is some information on each of the above areas. This is not exhaustive. Please contact the Occupational Health Department for additional advice on completing your employee’s risk assessment. Advice can usually be given by telephone more quickly than by making a written referral. This is our preferred initial contact when advising on a risk assessment for new or expectant mothers. Further information may be obtained from the HSE’s web site or the health and Safety department.
PHYSICAL Movements and posture Pregnant and postnatal mothers [up to 3 months postnatal] are at greater risk of injury due to the effects of hormones of pregnancy on the musculoskeletal system. Additionally, prolonged sitting or standing may cause dizziness, faintness or fatigue. There is also an increased risk of blood clots with prolonged sitting or standing. The opportunity to sit or stand as comfort dictates may be beneficial. Working in confined spaces may be uncomfortable with increasing size. Post-Caesarean section, extra restrictions may apply.
Ionising and Non Ionising Radiation Consult Ionising Radiation Regulations – specific Policy for Ionising Radiation and new and expectant mothers.
Optical radiation. No increased risk.
Electromagnetic fields .
Within current recommendations, not known to cause harm to the unborn child or the mother.
CHEMICAL Toxic chemicals Risk assessment dependant on chemical identified.
Cytotoxic drugs These can cause genetic damage to sperm and eggs. Some can cause cancer. A safe level of exposure cannot be determined for these drugs. Consider preparation of the drug, use and disposal of waste. A pregnant worker preparing chemotherapy drug solutions should be transferred to New and Expectant Mothers at Work Policy and Procedures 6 Version 2 May 2009 another job. Consider spillage risk as a source of exposure with use of prepared solutions.
BIOLOGICAL Infectious Diseases For most workers the risk of infection at work is not higher than the risk from infection outside the work environment. However, if there is a known high risk of exposure to an infectious disease within the workplace, which could have an adverse effect on the unborn child or the mother, and the mother is not protected by immunity, then a risk assessment is recommended. In healthcare settings, consideration should be given to risk assessing possible exposures to hepatitis B, HIV, herpes, tuberculosis, syphilis, varicella, and measles as a basic minimum.
WORKING CONDITIONS Fatigue Fatigue has been associated with miscarriage, premature birth and low birth weight. Tiredness increases during and after pregnancy and may be exacerbated by work-related factors. Rest is important for new and expectant mothers. Facilities such as rest rooms may be appropriate. If this is not possible the risk of fatigue should be controlled as much as possible. Fatigue is difficult to assess objectively and managers may wish to ask how day-to-day activities are affected by the pregnancy, then deciding what adjustments they can consider to the role to try to accommodate fatigue. Adjustments might include reductions in number of hours, duration of shifts and/or spacing out of days worked, and allowing regular rest breaks.
Night work/On call work Health and Safety Executive experts are not aware of any additional risks from working at night. It may be worth considering allowing the pregnant worker to cease cardiac arrest team duties at 28 weeks.
Stress including Post Natal Depression New and expectant mothers can be particularly vulnerable to both occupational and domestic/personal stress due to hormonal, physiological and psychological changes during and after pregnancy,
Working with VDUs Levels of ionising and non-ionising radiation generated by display screen equipment are not considered to pose a significant risk.
Working alone Pregnant women are more likely to need urgent medical attention. Consider access to communication with others. New and Expectant Mothers at Work Policy and Procedures 7 Version 2 May 2009
Working at heights It is hazardous for pregnant women to work at heights. Consider ladders, platforms and kick stools. Consider hazards related to overbalancing, particularly when over reaching.
Violence Violence to a mother may lead to miscarriage or premature delivery. This risk particularly affects workers in direct contact with customers and clients.
Working with Personal Protective Equipment Consider fit and comfort of PPE.
Nutrition Appetite and digestion are affected by pregnancy and breast-feeding changes. More frequent meal breaks and more frequent access to drinking water and other refreshments may be required. In early pregnancy particularly the mother may only be able to eat little and often. Morning sickness may cause difficulties working early shifts, or with strong smells which may worsen symptoms.
Heat and Cold Pregnant women are less tolerant of heat stress. No additional risks from cold work.
Hygiene Facilities Pregnant women often have to go to the toilet more frequently and more urgently than others. Failure to do this may cause bladder and kidney infection.
Breast Feeding Provision of private and hygienic facilities for the expression of breast milk; together with appropriate storage of same.
Passive Smoking This poses a risk to infant health.
New and Expectant Mothers at Work Policy and Procedures 8 Version 2 May 2009 Appendix 2 PROCEDURES AND GUIDANCE
Stage 1 – Initial Risk Assessment
The flowchart shows what you must do if you have female workers, including students, of childbearing age.
Are there Inform workers of the any risk and the need to hazards notify you of the present? pregnancy or if they Assess risks, are breastfeeding or reduce or Inform have given birth in the YES remove if employees last six month, as possible of outcome early as possible.
When you do the initial risk assessment you must take into account any hazards and risks to females of childbearing age. This includes new and expectant mothers. Risks include those to an unborn child or the child of a woman who is still breastfeeding and not just risks to the mother herself.
Look for hazards
The physical, biological and chemical agents, processes and working conditions, which may affect the health and safety of new or expectant mothers, are outlined in the attached table. They include the following possible hazards.
New and Expectant Mothers at Work Policy and Procedures 9 Version 2 May 2009 Physical Risks
Movements and postures Manual handling Shocks and vibration Noise Radiation
Biological Agents
Infectious diseases
Chemical agents, including:
Toxic chemicals Mercury Cytotoxic drugs Carbon monoxide Lead
Working conditions
Facilities (including rest room) Mental and physical fatigue and working hours Stress (including postnatal depression) Passive smoking Temperature Working with Visual Display Units (VDU) Working alone Work at heights Travelling Violence Working and personal protective equipment Nutrition
New and Expectant Mothers at Work Policy and Procedures 10 Version 2 May 2009
Decide who might be harmed and how
Your risk assessment may show that there is a substance or work process in your workplace that could damage the health and safety of new and expectant mothers or their children. You will need to bear in mind that there could be different risks depending on whether workers are pregnant, have recently given birth, or are breastfeeding.
Take into account that there is usually a period of between 4-6 weeks during which a worker may not be aware she pregnant and is therefore unable or reluctant to inform her employer. You can overcome this problem by taking special care in respect of all workers by reducing their exposure to harmful agents.
Consult your employees and inform them of any risk
You must consult your employees on any health and safety matters, including decisions you are planning to make which might affect their health and safety. You should inform your employees or their representative of what is being proposed, allowing them time to express their views and should take account of their views before you reach a final decision.
If your assessment does reveal a risk you should tell all female employees of childbearing age about the potential risks if they are, or could in the future be, pregnant or breastfeeding. You should also explain what you plan to do to make sure that new and expectant mothers are not exposed to the risks that could cause them harm. It is important that you reiterate the need for written notification of pregnancy, or that they are breastfeeding or have given birth in the last six months, as early as possible.
New and Expectant Mothers at Work Policy and Procedures 11 Version 2 May 2009 Stage 2 – On Notification of pregnancy, birth or breastfeeding
Carry out a specific risk assessment based on initial assessment
Has a risk been Can the risk Remove NO Has a risk been YES Can the risk YES Remove identified?identified? bebe removed?removed? riskrisk
Monitor and Monitor and NO reviewreview
ACTIONACTION 11 Adjust Adjust YES CanCan thethe mother’smother’s workingworking condition/hours condition/hours condition/hourscondition/hours ofof workwork bebe adjusted?adjusted?
NO ACTIONACTION 33 SuspendSuspend herher fromfrom ACTIONACTION 22 workwork onon paidpaid leaveleave CanCan sheshe bebe givengiven forfor asas longlong asas NO suitablesuitable YES necessarynecessary toto alternativealternative work?work? protectprotect herher healthhealth andand safety,safety, oror thatthat GiveGive suitablesuitable ofof herher childchild alternativealternative workwork onon samesame termsterms andand conditionsconditions
All of the above actions should be monitored and reviewed on a regular basis. If there is a significant risk at work to the health and safety of a new or expectant mother, which goes beyond the level of risk found outside the workplace, then you must take the following actions to remove her from the risk: Action 1 Temporarily adjust her working conditions and/or hours of work; or if it is not reasonable to do so, or would not avoid risk Action 2 Offer her suitable alternative work (at the same rate of pay) if available; or if that is not feasible, you must Action 3 Suspend her from work on paid leave for as long as necessary to protect her health and safety, and that of her child. These actions are only necessary where, as the result of a risk assessment, there is a genuine concern. If there is any doubt, you may want to seek professional advice on what the risks are, and whether they arise from work, before offering alternative employment or paid leave. Any alternative work you offer should also be subject to a risk assessment.
New and Expectant Mothers at Work Policy and Procedures 12 Version 2 May 2009 RISK ASSESSMENT CHECKLIST THAT CAN BE USED AT STAGE 1 OR STAGE 2, AS CONTAINED IN THE PROCEDURES AND GUIDANCE
Date of Risk Assessment:
Name of employee:
Department/Ward:
Date of delivery:
Maternity leave commences:
Date returned from maternity leave:
Proposed date of repeat risk assessment:
Any significant risks must be carried forward to Trust’s Risk Assessment Tool and scored appropriately. Risks >20 to be placed on Directorate’s Risk Register.
New and Expectant Mothers at Work Policy and Procedures 13 Version 2 May 2009 HAZARD LEVEL OF LEVEL ACTION RESIDUAL COST OF RISK TO OF REQUIRED? RISK (IF ACTIONS? MOTHER? RISK ANY)? TO CHILD? PHYSICAL Movements and Posture (Including Manual Handling) Radiation CHEMICAL Toxic Chemicals Cytotoxic drugs BIOLOGICAL Infectious Diseases WORKING CONDITIONS Fatigue Night Work / On Call work Stress Working with VDUs Working alone Working at heights Violence Working with PPE* Nutrition Heat and Cold Hygiene Facilities Breast Feeding Passive smoking Travelling
* Personal Protective Equipment
New and Expectant Mothers at Work Policy and Procedures 14 Version 2 May 2009 Appendix 3
Employee Record of Having Read the Policy
New and Expectant Mothers at Work Policy and Procedure
I have read and understood the principles contained in the policy and procedures
Print Full Name Signature Date
New and Expectant Mothers at Work Policy and Procedures 15 Version 2 May 2009