Employee health professionals can provide education and compassionate support for pregnant nurses so they can continue working safely as they approach their due date, notes Laura Kinsella, BSN, RN, CEN, an ED nurse in Washington, DC.
Kinsella recently wrote1 about the occupational hazards to the pregnant nurse, citing risks that include sick patients, infectious agents, teratogenic chemicals, and radiation. There also are risks posed by the physical demands of patient lifting and handling. Kinsella worked as an ED nurse while pregnant. Hospital Employee Health asked her to share her experience and perspective in the following interview.
HEH: Can you describe how you felt as a pregnant nurse? Did you have any concern about vaccinations, exposure to medical chemicals, and other potential risks?
Kinsella: I was extremely vigilant as a pregnant ER nurse. I work triage often, and in that role I interact with many acutely ill patients per day. I had a lot of concern that I would become ill — especially last winter, which was a particularly bad year for influenza. Our emergency department saw hundreds of people with influenza, so I was always extra diligent about wearing a mask and performing hand hygiene. I always wore gloves when preparing or administering medications.
HEH: Were you able to continue work during your pregnancy with a feeling of safety for your and your baby’s health?
Kinsella: My situation is a little different because I had a high-risk pregnancy, but I worked in the ER until two days before I went into labor. It was tough toward the end, but I had supportive co-workers who helped me avoid some physical strain such as lifting patients or pushing heavy stretchers or hospital beds. I felt that my colleagues and I tried our best to keep me and my baby safe.
HEH: Is there anything employee health professionals can do to better reassure, educate, and support pregnant nurses?
Kinsella: I was unaware of many of the risks for pregnant nurses before becoming pregnant. I researched what I should avoid exposing myself to, and I was very diligent about protecting myself and my baby. I was lucky to have extremely supportive management who were able to help me modify my schedule later in pregnancy to work more eight-hour shifts and fewer 12-hour shifts, since those were taxing on me physically.
I did not seek out resources from my occupational health department, but it would be useful if there were some articles or guidelines available about what to avoid to be a safer pregnant nurse. Many nurses are women in their childbearing years, so it is important to support this particular nurse population as best as possible so they are willing and able to return to the workforce. Compassion, understanding, and support for the physical demands of the nursing profession on a pregnant woman’s body are crucial.
HEH: Just to clarify, did you receive the seasonal flu shot when you were pregnant?
Kinsella: I absolutely received the flu shot last year, and every year. Getting a flu shot is one of the most important ways a pregnant woman can protect herself and her baby. Infants cannot receive the flu shot until they are six months old, so they rely on passive immunity from their mothers. It is completely safe for a woman to get a flu shot while she is pregnant.
Myths and Misinformation
That last point is important to emphasize, as the CDC says some misinformation may undermine its recommendation for pregnant women to get immunized against flu this season. The CDC recently emphasized it has not issued any recommendation for pregnant women to get written consent from their doctor “if they get vaccinated at a worksite clinic, pharmacy, or other location outside of their physician’s office.”2
Erring on the side of caution, the primary caveat is that pregnant women should get a regular flu shot and not the live attenuated influenza vaccine, also known as the nasal spray vaccine.
At the annual flu press conference in 2018 at the National Foundation for Infectious Diseases, the CDC and its clinical partners made immunization of pregnant women a high priority.
Indeed, pregnant women are recommended for vaccination because they are at high risk of serious complications of flu infections, said Laura Riley, MD, chair of the Department of Obstetrics and Gynecology at Weill Cornell Medicine and obstetrician and gynecologist-in-chief at New York-Presbyterian/Weill Cornell Medical Center in New York City.
“Pregnant women who get the flu do very poorly,” she said at the NFID press conference. “They do way worse than any other nonpregnant individual. It is absolutely critical that we prevent pregnant women from getting the flu.”
Immunization can be given at any stage of pregnancy. If flu infection does occur, the later the pregnancy, the greater the danger of severe respiratory illness in the mother, said Riley, a member of the American College of Obstetricians and Gynecologists.
“In every flu epidemic, we know that as you get into the second and third trimester of pregnancy, you’re more likely to die and more likely to be hospitalized,” Riley said.
While the CDC is looking into outlier data that has been interpreted by some as linking repeated flu vaccination with increased miscarriage risk, the current recommendation is based on the consensus that vaccination protects the mother and fetus and confers immunity into the early months of life.
“When pregnant women get a high fever for an extended period of time, we know that fever actually causes birth defects,” she said.
In addition, women who get the flu may deliver early, raising a host of issues associated with premature birth.
“Not only has ACOG and CDC been recommending it to pregnant women, we’ve also been trying very hard to convince providers — nurse practitioners and midwives and obstetricians, family practitioners, anyone who takes care of pregnant women — they have to be on board,” Riley said.
“They have to remember to strongly recommend it to pregnant women.”
Only about half of pregnant women were vaccinated in the 2017-18 flu season. The CDC and partners are pushing to achieve an “80-plus” percentage of vaccination in pregnant women this season.