The U.S. Centers for Disease Control and Prevention (CDC) states that pregnant people are at an increased risk for severe illness from SARS-CoV-2 infection compared to non-pregnant people. Additionally, the CDC notes an increased risk of adverse pregnancy outcomes, such as preterm birth, among pregnant people with COVID-19. [CDC – MMWR Weekly. (2020, November 6). Birth and Infant Outcomes Following Laboratory-Confirmed SARS-CoV-2 Infection in Pregnancy – SET-NET, 16 Jurisdictions, March 29 – October 14, 2020. Retrieved from https://www.cdc.gov/mmwr/volumes/69/wr/mm6944e2.htm]
CDC data from about 400,000 women with symptomatic COVID-19 found that ICU admission, invasive ventilation and death were more likely in pregnant than non-pregnant women during the first wave of the pandemic. The report recommends that “measures to prevent SARS-CoV-2 infection should be strongly emphasized for pregnant women…” [CDC – MMWR Weekly. (2020, November 6). Update: Characteristics of Symptomatic Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status – United States, January 22 – October 3, 2020. Retrieved from https://www.cdc.gov/mmwr/volumes/69/wr/mm6944e3.htm?s_cid=mm6944e3_w]
The Society of Obstetricians and Gynecologists of Canada in their updated statement on pregnant workers during COVID-19 (November 2020) notes:
…it should be recognized that PPE is not infallible and certain work-related encounters are inherently higher risk for exposure to COVID-19. These include situations where appropriate PPE is substandard; situations where physical distancing cannot be achieved and situations with repeated exposure to persons with COVID-19 (e.g. COVID-positive wards in the healthcare setting). Importantly, it should be recognized that changes in local epidemiology can modify work-related risk dramatically, and decisions should be reassessed if there is significant change in local epidemiology (e.g. an outbreak in the workplace).
In situations where work-related exposure is substantive and not able to be modified with a safe work plan or an individual’s risk for severe COVID-related morbidity is high, it may be appropriate to advocate for accommodations or excused absence from work for pregnant workers. In these situations, a pregnant person’s autonomy to make informed decisions about their health, balanced with their other priorities, should be respected. [SOGC. (2020, November 19). SOGC Statement on Pregnant Workers during the COVID-19 Pandemic. Retrieved from https://sogc.org/common/Uploaded%20files/Covid%20Information/SOGC%20Statement%20on%20Pregnant%20Workers%20during%20the%20COVID-19%20Pandemic%20(November%2019,%202020).pdf]
Given the potential risks of severe illness among pregnant health care workers, and the above recommendations, employers should exercise the precautionary principle and err on the side of compassion to alleviate the anxiety of workers and any potential health risks to the mother and her fetus.
The CFNU recommends that pregnant health care workers who are concerned about their health – especially those with co-morbidities – seek an accommodation from their employer if they are asked to care for presumed or confirmed COVID-19 patients in COVID-19 ‘hot zones’ (such as designated COVID-19 units, intensive care units, emergency rooms, operating rooms, post-anaesthetic care units, negative pressure rooms, single-occupancy patient rooms used to isolate patients in absence of negative pressure rooms, and trauma centres), and accommodation be readily granted based on language in collective agreements and provincial human rights legislation.
Provincial human rights laws indicate that pregnancy is a category protected from discrimination, to the point of undue hardship on employers. Nurses, for their part, have an obligation to cooperate to find a suitable accommodation. If a nurse seeks an accommodation, a union representative should be consulted.
If physical changes due to pregnancy make it difficult for a pregnant health care worker to don and wear the required personal protective equipment in a safe manner, they should not be providing care for COVID-19 suspected or confirmed patients. The pregnant health care worker should seek an accommodation from their employer.