1. Pregnancy Risk Assessments
Vanessa Davies
Head of Occupational Health
Hywel Dda NHS Trust
Carmarthen
Introduction
RCN UK Safety Representative Conference
October 2011

2. Personal history Head of OH for Hywel Dda Health Board
Joint Chair of Welsh NHS OH Forum for 6 years
Twelve years OH experience both in and outside of NHS
Awarded by RCN Best OH Nurse 2006
Personal history

3. How do you become a occupational health nurse?
Usually by accident……

4. Qualifications… Minimum: Registered Nurse (Adults)
Occupational Health qualification, i.e. Diploma or Degree in OH, ideally Specialist Practitioner qualification
Masters for nurse managers
Essential – A sense of humour
together with lots of life skills
& experience!

5. What is Occupational Health…..
DEFINITION: Occupational Health is the promotion and maintenance of the highest degree of physical, mental and social well- being of workers in all occupations by preventing departures from health, controlling risks and the adaptation of work to people, and people to their jobs. (ILO/WHO 1950)

6. That is the accepted definition, what do we do?
We are advisors … on just about everything that relates to people and their jobs. What ever job that may be… And that includes any employee who becomes pregnant!

7. Initially….
Lets confirm the obvious….. Pregnancy, just had a baby or breastfeeding are not illnesses!! It is a perfectly normal event, however…….

8. Pregnancy risk assessment
The legal responsibility for health and safety rests primarily with the employer……
It is important to remember some hazards are particular to pregnancy or breastfeeding mums,
Pregnancy risk assessment

9. Pregnancy risk assessment
Aims of today's workshop:
To provide a brief overview of pertinent legislation
Provide an opportunity to explore the issues relevant to you?
Conclude by identifying a framework for PRA
A very brief overview!
Pregnancy risk assessment

10. First thing…. Lets start by:
Form groups & in 5 – 10 minutes:
Identify the present practice in relation to pregnancy risk assessment in your organisation
Identify what works?
Identify what are the
problems?

11. Relevant legislation /Directives
Equality Act 2010
European Directive
Management of Health and Safety at Work Regulations Health and Safety at Work etc Act 1999
Control of Substances Hazardous to Health regulations
Employment rights Act 1996

12. To whom do the regulations apply?
“Any woman who is, or in the future could be, a new or expectant mother”
Which is women of child bearing age
who are or in the future could be
pregnant, have given birth within
the previous six months, or are
breastfeeding” (HSE, 2004)
Given birth:
is defined in MHSW Regs as ‘delivered a living child or, after 24 weeks of pregnancy, a stillborn child’

13. Equality Act 2010 Pregnancy and maternity discrimination: work cases
Section 19(5) identifies:
A person discriminates against a woman if in the protected period in relation to a pregnancy of hers, A treats her unfavourably:
Because of the pregnancy, or
Because of illness suffered by her as a result of it
Because she is on compulsory maternity leave
Is seeking or has exercised the right to ordinary or additional maternity leave
These directions are fairly general and need to be more closely considered and it is easy to fall foul of these! Discuss

14. Management of Health and Safety at Work Regulations 1999
These require an assessment of risk:
Where there are persons in an undertaking which include women of child bearing age and
The work is of a kind which could involve risk by reason of her condition, to the health and safety of a new or expectant mother, or to that of her baby, from any processes or working conditions, or physical, biological or chemical agents…… to encourage improvements in the safety and health at work of pregnant workers and workers that have recently given birth or are breastfeeding.. (Management of Health and work, 1999)
You are required to assess risks to your employees and do what is reasonably practicable to control those risks, however identifying specific risks and establishing the level of hazard posed can be difficult. Despite undertaking a literature review there is little empirical evidence of pregnant women on which to base the assessment in some cases; for example night shift working!

15. Management of Health and Safety at Work Regulations 1999 by regulation 3 (1) an “assessment of such risk” Which is part of routine occupational health surveillance……
Well, that sound simple …. Doesn’t it? Or is it in an environment as diverse as the NHS?
What does that mean……

16. health surveillance is….
“Identification and assessment of the risks from health hazards in the workplace. Which involves surveillance of the factors in the working environment and working practices which may affect the workers’ health. It also requires a systematic approach to the analysis of occupational accidents and occupational diseases” ILO 1985
health surveillance is….

17. What do you need to do?
A competent person is required to undertake a risk assessment! In most organisations that is not the OH nurse or the H&S manager, however most managers are always a little apprehensive of undertaking the assessment!
Stage one- initial assessment NO
Yes
Are there any hazards present?
Inform employee of outcome
Take into account any hazards and risks to females of childbearing age;
Assess risks, reduce or remove if possible
This is a good place to start……… HSE’s guidance

18. On notification of pregnancy…
Specific risk assessment
NO YES Yes No
Yes No
No yes
Has a risk been identified
Can the risk be removed
Remove the risk
Monitor and review
Action 1
Can the mothers hours/conditions of work be adjusted
Adjust conditions /hours
Give suitable alternative work on same terms and conditions
Action 3
Suspend her from work on paid leave for as long as necessary to protect her or/+ child
Action 2
Can she be given suitable alternative work
This is the specific risk assessment; decide who might be harmed and how bearing in mind that the risks may vary between pregnancy and breast feeding; note any medical advice received on the health of the employee;
Consult and discuss these issues with the employee
On notification of pregnancy…

19. The range of potential hazards & risks to health is truly awesome in a NHS environment….. There are the obvious….
Health surveillance…

20. And the not so obvious……
Chemicals use and storage
Workload, demands and stress
Working relationships
Environmental risks
Manual handling of people and objects
Aggression and violence
Radiology
Infection control issues…..

21. How are the hazards identified….
Epidemiological evidence, we know some products have been found to be potentially hazardous to health and that their use needs to monitored
Annual health surveillance programmes to look at respiratory sensitizers‘ and other hazards
Health issues identified during day to day collaboration between different agencies in the Health Board i.e. Health and safety manager, infection control department, the staff or a manager raises a concern
How are the hazards identified….

22. The European directive lists the following hazards
Physical risks
Movements & postures
Manual handling
Shocks and vibrations
Noise
Radiation
Chemical agents
Toxic
Mercury
Cytotoxic drugs
Biological agents
Infection
Working conditions
Facilities
Mental/physical fatigue
Stress (inc postnatal depression)
Temperature
Working with visual display units
Working alone
Travelling
Violence
Working and PPE
nutrition
The HSE provide a comprehensive list of potential hazards and how to manage them

23. Please form groups and for about 10 minutes consider the following scenarios!

24. For the pregnant, newly delivered or breast feeding woman:
There are the responsibilities
of the:
Employer
employee
How are they managed….

25. Employee
To notify the employer that she is: pregnant, newly delivered or breastfeeding Or Advise further if she continues to breastfeed beyond six months May need to provide certificate from midwife or general practitioner

26. Employer responsibilities:
To ensure that appropriate and current policies related to staff health and safety are formulated and implemented
Competent person to undertake the risk assessment to identify hazards ideally in collaboration with the employee
To implement any adjustments to address any identified hazards
The employee should be offered a health assessment during her pregnancy
Re-evaluate any risk assessments if there are any changes
When an employee is breastfeeding, the employer should ensure she has access to appropriate facilities and be protected from identified hazards
If in doubt then contact your occupational health service
Employer responsibilities:

27. Employer : Management of health and safety regulations 1999
If following risk assessment, these hazards cannot be avoided, the employer will need to:
Alter working conditions or hours of work, if not
Identify and offer suitable alternative work, if not then the employee is to be suspended on full paid leave from work!

28. Special considerations…..
Breastfeeding
Provide appropriate rest areas for pregnant employees
Recommended to provide an appropriate environment for mothers to express and store milk
Night work
any new or expectant mother who works at night, who has a medical certificate stating that night work could affect her health and safety:
Offer suitable alternative daytime work or
Suspend her from work, on paid leave as long as is necessary to protect her health and safety
If the risk arises from work!
Special considerations…..

29. The Management of Health & Safety at Work Regulations 1992 and 1999 specify these responsibilities:
All employers have a statutory responsibility under Section 2 (1) of the Health and Safety at Work Act (1974) 1 to create as safe an environment as is reasonably possible.

30. Summary … The relevant legislation requires:
Safe environment for pregnant employees
Ensured by a risk assessment undertaken by competent person
If suitable adjustments or an alternative role cannot be identified, suspend on full pay
Documented and evaluated as needed by responsible manager
Summary …

31. Any questions….?

32. HSE (1992) Management of health and safety at work, management of health and safety regulations Approved code of practice and guidance, HSE
HSE (2002) New and Expectant mothers at work. HSE
Lubick, N (2011) Advising parents in the face of scientific uncertainty: An Environmental Health Dilemma. Environmental Science and Technology, Nature and Earth
HSE: Biological agents: Managing the risks in laboratories and healthcare premises: The advisory Committee on dangerous pathogens
References