What To Expect When You Are Expecting

Author: Emma Everitt / Editor: Nikki Abela / Codes: HAP27, ObP3, SLO1 / Published: 10/11/2020

First of all congratulations- you’re expecting!

When I found out I was pregnant, the aspect I was most surprised about was how tired I was. At 6 weeks growing something the size of a blackcurrant inside of me I would come home from every shift exhausted and I’d fall asleep as soon as I sat on the couch. At work I did not want to tell anyone I was pregnant until I had had an ultrasound scan at 12 weeks. This meant that I had to sneak away between patients to be sick.

Some people like to keep pregnancy private for as long as possible whilst others shout it from the rooftop as soon as they see that second blue line on the stick. Looking back I wish I had confided in one of the consultants earlier as I perhaps would have benefitted from speaking to someone at work at the time so I’d definitely recommend considering this.

I rotated round to a new post when I was about 14 weeks pregnant and immediately told my supervisor and rota coordinator. One of the consultants carried out a risk assessment for me and gave me lots of useful advice. These should be carried out every few weeks and rota considerations can be discussed then. I was taken off nights at around 28 weeks as I was struggling with the shift patterns by then but this is totally dependent on individuals. Some people are taken off nights and lates around 20 weeks and others continue throughout their pregnancy. Don’t be a hero, do what’s right for you at the time. 

The Royal College of Physicians released a useful document in 2013 which addresses risk of adverse outcomes in pregnancy for those that work prolonged hours; shift work; perform heavy lifting; stand for prolonged time or have a heavy physical workload. Shifts in the ED can encompass all of these so the document and attached leaflets are well worth a read prior to educational meetings or risk assessments when pregnant.

What you need to do:

Tell your employer officially before you are 25 weeks pregnant. This means tell human resources and send in your MATB1 form. Don’t forget to make sure your educational supervisor, training program director and deanery are all also told. I managed to forget this as assumed that they all communicate with each other, it doesn’t always work out this way!

Leave and pay

You are entitled to have your antenatal appointments off work and should not have any pay deductions. I have heard of some people having to prove their appointments so be prepared to take appointment records in to HR.

You can choose to take your maternity leave at any point from your 29th week of pregnancy. Personally, I waited until my 38th week but I took annual leave the week before so did my last shift at 37+1. That was right for me as I was doing ok until then and felt like I was still able to work well.  It is difficult to plan during your first pregnancy as you cannot tell how you are going to be feeling at the latter stages of pregnancy. I had to state when I wanted to start my maternity leave when I sent in my MATB1 form at 25 weeks. You can change the start date but have to give 28 days notice. I also had to give my return-to-work date at that point. This can be changed too but with 8 weeks notice.

Deciding how long to take for maternity leave is a very personal decision. Although I would have loved a full year my finances were a little bare with moving house shortly after my baby was born and I was also keen to return and crack on with what was left of my training. I took 8 months but with accrued annual leave this turned out to be over 9 months. I was so anxious and sad about the prospect of going back to work. I had a meeting with my educational supervisor prior to starting and this really helped. I also was taken off nights for the first 4 weeks to ease me back in which was great. I actually really enjoyed going back to work and think that 9 months was the right amount of time for me. Another way to ease going back to work is to take keeping in touch (KIT) days. I took some of these during regional teaching and a couple at the hospital I had worked in prior to maternity leave. You can take up to 10 and get paid for them but the amount of pay depends on when during your maternity leave you take them so discuss this with your payroll department.

Pay

To get NHS maternity pay you have to have 1 year of continuous employment without a break of more than 3 months by the time you are in your 29th week of pregnancy. This does not have to be with the same trust so moving between jobs or roles is ok. You can have 8 weeks of full pay, 18 weeks of half pay, 13 weeks of statutory maternity pay or maternity allowance followed by 13 weeks of unpaid leave if you take a full year of maternity leave. How much your pay is depends on your average weekly pay for 8 weeks leading up to your 25th week of pregnancy. I was able to spread my maternity pay out equally over the 8 months I had off. This meant that I did not suddenly drop in pay between full pay, half pay or statutory maternity pay. Speak to your payroll about this as an option as it makes budgeting much easier and means that you do not find yourself suddenly penny-less! 

Those adopting a child are entitled to the same leave and pay as detailed above and the BMA have useful information for those considering adoption.

Patients to avoid in pregnancy

Infections which pose a special risk to a pregnant healthcare workers include: CMV, influenza, measles, mumps, parvovirus B19, pertussis, rubella and varicella-zoster virus (chickenpox and shingles).

The problem in the ED is that most patients come with an undifferentiated rash and being pregnant means you should avoid contact with any patient with an undiagnosed rash compatible with a systemic viral illness because of this. You may find that this will wipe out most of your paediatric practise.

I know some pregnant colleagues who have avoided the children’s side of the department and others who have just carried on as normal. Personally, I felt that it was impossible to avoid all feverish children so carried on as normal but if I saw that the patient had any rash resembling measles or rubella I would have asked a colleague to see them.

RCOG have weekly updates on their advice on pregnant health care workers and COVID-19 so it is worth checking their website for current advice.

And if you’re not expecting…
Some of you will want to be expecting, but it hasn’t happened yet. Some of you have been expecting, but have had tribulations on the way. There’s some podcasts and tips in the latest anaesthesia news newsletter.

If you want to support a pregnant co-worker, there’s some tips here.

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