Oh, baby! 8 risks to avoid in your veterinary practice during pregnancy

Someday you—or someone you work with—might decide to expand the family to include a baby that doesn't sport fur, wear a collar or use the litter box. You may be less familiar with infants of this species, and their lengthy gestation means you'll need to take extra care to keep mother and baby safe.

You probably didn't learn how to care for this species in school, so make sure to point any mothers-to-be to their human doctors for medical advice. Meanwhile, you can help make the workplace a little safer by keeping these tips—and the potential risks—in mind.

Educate your team

When I told my employers I was expecting, they were very accommodating. But not all bosses are so accepting. It helps to remember that this is a mere nine months the practice may be slightly inconvenienced.

A piece of advice for expecting mothers: In the end, when you're pregnant you need to feel comfortable with the decisions you make, and you shouldn't feel pressured by anyone else. Remember, this is your body, your health, your pregnancy and your baby. If you stand by your decisions, when your baby is born you will feel confident that you took care in the best way possible in their first months of growth.

In the veterinary field in particular, it's vital for employees to share news of their pregnancy as soon as possible to avoid exposure to many workplace hazards. It may be nerve-wracking sharing such personal information so early on, but remember that it's in your child's best interest, as the first trimester is the time of the most crucial development.

Many factors will determine a veterinary team member's risks when she's expecting. For example, receptionists who spend most of their time in the front office may pass through treatment or be exposed to different hazards briefly, while medical support team members who spend most their time in the back office might experience longer exposure. Regardless, it's important for managers to educate every team member of possible dangers. It's a good idea to present this information to team members when they're hired so they can take immediate precautions when they discover they're expecting.

1. Radiation

Exposure to radiation can occur in a few different ways besides taking radiographs. Fluoroscopy procedures also use radiation, and I-131 treatments for hyperthyroid cats employ radiation as well. As with most risks, if you can eliminate the risk during your months of pregnancy and ask other team members pick up these duties, then discuss how you can still be productive in these months while avoiding these risks.

However, some team members will have a more difficult time avoiding these hazards—for example, perhaps you're a radiology technician in a specialty practice or the only credentialed technician in a practice. In these cases, take steps to reduce the risk. Radiation exposure during the entire gestation of pregnancy should not exceed 500 mrem.1 It may be helpful to review your exposure history for the past nine to 10 months before your pregnancy to ensure that your badge readings add up to less than this amount. If you've been exposed to more than this amount, you'll need to discuss with your hospital manager what changes you can make, and make sure your equipment is up-to-date on inspections and deemed safe.

Many pregnant women wear the same protective equipment during radiographs as before: apron—wraparounds are better for full coverage of that belly—lead goggles, gloves and a thyroid shield, but add in a dosimeter at the baby's level. This allows for more specific measurements of exposure to the fetus. If possible, take images with you and the pedal outside of the room if the patient is sedated and securely positioned.

2. Waste anesthetic gases

Another concern is the risk for waste anesthetic gas exposure. When a gas reaches the level where you can smell it, it's entirely too high to be safely exposed to, pregnant or not. You can avoid most risks by following appropriate operating procedures for the anesthetic machine. Always check the machine for leaks before you use it, and make sure the scavenging system is in working order and connected, which should be performed before every use outside of pregnancy as well. It's also important to make sure the endotracheal tube is cuffed and inflated appropriately to avoid leakage.

Once the procedure is complete and the patient is off of anesthetic gas, maintain the oxygen with the patient still connected to give time for the system to be flushed through the scavenging system. The most dangerous times for exposure are during induction and recovery, so swapping with another employee during these periods can help. It's a good idea to avoid mask and box inductions completely, as a much greater amount of gas seepage can occur.

3. Bone cement

This danger may not be an issue in most general practices, but in orthopedic or neurology specialties especially, bone cement can be used for surgical procedures. Bone cement is made up of liquid methyl methacrylate, along with polymethyl methacrylate. It can create strong fumes, and manufacturers advise pregnant women not be present during the mixing of bone cement.2 If you're pregnant and you see a surgery where bone cement is needed on the schedule, it may be best to either swap shifts or take the day off. With the exposure of fumes from bone cement, there may be an adverse effect on bone growth and overall fetal health, according to the FDA.3 A threshold limit of 125 ppm per 10 minutes was determined by the Substances Hazardous to Health Guidelines. However, without scavenging systems devices, measurements can range from 2 to 374 ppm, and with a scavenging system, 90 to 100 ppm.4 Since the detrimental effects are unknown, err on the safe side and try to avoid bone cement altogether, if possible.

4. Oral drugs

Some oral drugs prescribed to veterinary patients are dangerous for pregnant women, even to handle. Among these are diethylstilbestrol (DES), chloramphenicol, misoprostol and cyclosporine.5, 6 If possible, ask another employee to fill these medications and medicate patients. If you opt to, or can't avoid, handling these drugs while pregnant, use double gloves and consider wearing thicker chemotherapy gloves. Wash your hands thoroughly after preparing. It's also advisable to wear a mask to reduce dust inhalation.

5. Chemotherapy

Once you take the time to think about why we use chemotherapy, it's clear how this could harm a developing baby: This is a cytotoxic drug with the intention of killing fast-growing cells. Since babies have a lot of fast-growing cells developing in their bodies, ideally, pregnant women shouldn't interact with patients receiving chemotherapy. However, if you can't avoid it during pregnancy, try to at least avoid the mixing of IV fluids containing chemotherapeutic agents and the preparation of chemotherapy agents.

When handling a patient receiving chemotherapy, the biggest danger is elimination, such as urine. Let others clean up accidents, and wear double chemotherapy gloves when performing treatments. You can also use other protection, such as a gown and mask, but you are less likely to need these after the medication is prepared. Remember, certain chemotherapeutic agents are more dangerous than others, so it's a good idea to learn more about these drugs before handling them if you're pregnant.

6. Formaldehyde

As with many substances, studies vary about the hazard formaldehyde can pose for pregnant women. Some studies show that there's an increased risk of spontaneous abortion,7 and both major and minor birth defects have been noted in exposed nurses.8 Given that it's a known carcinogen, it's advisable to avoid contact with formaldehyde, which in most practices is easy since it's not used frequently.

7. Toxoplasmosis

Most pregnant women have heard of the dangers of toxoplasmosis. Those of us in the field know that you don't have to relinquish your cats, and you don't have to avoid cats in the practice altogether during your pregnancy. However, since the parasite can be found in feline feces, it's a good idea to allow other team members to clean litter boxes. Pregnant employees may opt to be serologically tested to achieve peace of mind that with a seropositive result, they are not at risk of contracting the protozoa. However, you should still take sanitary precautions when handling litter boxes, even if you aren't pregnant.9 Anytime you handle a cat in the practice, make sure to wash your hands thoroughly, as you should be doing already between handling patients. Good personal hygiene will go far to protect you and your baby in many cases. And remember, the most frequent exposure is eating undercooked pork, so thoroughly cook your pork chops.

8. Lifting and long shifts

Frequent rest breaks are recommended for those who are on their feet most of the day—which is most of us in the field. Prolonged walking or standing increases the risk of preterm labor and intrauterine growth restrictions. Consult with your obstetrician about how much is too much, along with lifting restrictions. If you're feeling exhausted and pushed to the limit, usually your body is guiding you for a reason, so discuss with your manager cutting back on hours or the time you spend standing. Generally, 25 pounds is the limit for most healthy pregnancies10 when it comes to lifting, so don't try to be a hero and do it all by yourself. It can be better for the patient as well to have more hands on deck when lifting.

Keep in mind these are only a handful of possible risks. Educate yourself and discuss your risks with your obstetrician and manager when you find out you're expecting. There are many decisions you need to make, and it can be overwhelming, but you need to feel comfortable with your choices. Most employers will be understanding.

Remember, this is only nine to 10 months of change for the hospital, but the detrimental effect of failing to take precautions could cause a lifetime of difficulty for your child. Protect yourself, but also learn to enjoy your pregnancy; a stress-free you gives way for a happy, healthy baby.

Oriana D. Scislowicz, BS, LVT, VDT, is a technician in Richmond, Va.

References

1. University Research Services and Administration—Georgia State University. Occupational Radiation Exposure Limits. Available at: gsu.edu/research/41639.html. Accessed April 11, 2013.

2. Insulmed. Stryker Orthopaedics. OR Handbook for Simplex P Bone Cement. Available at: http://isulmed.com/archivos/complementos-cemento/Cemento Simplex p - Handbook (ingles).pdf Simplex p - Handbook (ingles).pdf. Accessed April 30, 2013.

3. U.S. Food and Drug Administration. FDA. Class II Special Controls Guidance Document: Polymethylmethacrylate (PMMA) Bone Cement; Guidance for Industry and FDA. Available at: fda.gov/medicaldevices/deviceregulationandguidance/guidancedocuments/ucm072795.htm. Accessed April 30, 2013.

4. Medscape. Medscape Education, 2013. Occupational Hazards of the Female Orthopaedic Surgeon. Available at: medscape.org/viewarticle/420417. Accessed March 1, 2013.

5. American College of Rheumatology. Cyclosporine page. Available at: rheumatology.org/practice/clinical/patients/medications/cyclosporine.asp. Accessed April 30, 2013.

6. Obiçan S, Scialli AR. Teratogenic exposures. Am J Med Genet Part C Semin Med Genet 2011;157:150-169.

7. California Dept of Public Health. Formaldehyde. Available at: cdph .ca.gov/programs/hesis/Documents/formaldehyde.pdf. Accessed April 30, 2013.

8. Birth Defect Research for Children Inc. Formaldehyde and Birth Defects. Available at: birthdefects.org/research/factsheets/fact formaldehyde.pdf. Accessed April 30, 2013.

9. Office of Occupational Health and Safety. University of Minnesota. Medical Recommendations for Workers Exposed to Cats. Available at ohs.umn.edu/prod/groups/ahc/@pub/@ahc/@ohs/documents/asset/ahc_asset_168085.pdf. Accessed April 30, 2013.

10. San Jose State University Human Resources Guideline. Pregnancy and Ergonomics. Available at sjsu.edu/ hr/docs/risk/info/ergo_pregnancy.pdf. Accessed April 30, 2013.

On radiation, Seibert says:

"Exposure occurs only during the millisecond when the button is pressed. Wearing full gown and full hand gloves is often adequate protection. So in most cases, the pregnant worker does not need to completely avoid the radiation area—just minimize the exposure and wear the appropriate safety devices."

On waste anesthetic gases, Seibert says:

"If you follow the safety rules—such as avoiding hard-to-scavenge procedures like masking, using the scavenger hooked to the machine, checking the machine for leaks before use, using the proper protective equipment when handling chemicals and practicing good personal hygiene—then there's really no increased exposure or risk to the fetus.

"If you are using any scavenger properly and in the case of the air canister, changing it regularly, you should have no exposure to waste anesthetic gasses during the procedure. However, animals do give off some gas during recovery since they don't metabolize all of the gas they inhale while on the machine. The only way to deal with that issue is with good general ventilation in the recovery area and for you to avoid very close face-to-face contact with recovering animals."

Tip for managers: "I don't recommend using masks for protection against anesthetic gasses. A better solution is to do the procedure safely. By allowing the employee to use a mask as personal protective equipment (PPE), the practice is required to comply with the full provisions of the Respiratory Protection Standard for the respirator, including logs for monthly leak checks, test fittings, cleanings and so on. Furthermore, OSHA expects you to use engineering controls—fans, scavengers, etc.—and procedural controls to alleviate the hazard before you use PPE for protection. So before you go straight to PPE, consider testing the employee's exposure." Visit dvm360.com/safetyvet for links to information about masks and testing badges, including instructions on how to use them.

On hazardous chemicals, Seibert says:

"I would avoid the chemotherapy treatment, even handling patients that have undergone the procedure elsewhere.Use good personal hygiene and pharmacy practices when handling medications, such as washing hands and using the pill counter instead of counting tabs in the palm of the hand."

On zoonotic diseases, Seibert says:

"Personal hygiene and knowledge of disease transmission routes is the best defense. It's a good idea to review zoonotic disease textbooks to educate yourself on commonly transmitted diseases of wild animals, even if you aren't pregnant."

On lifting limitations, Seibert says:

"When you're expecting, it's important to understand your limitations. No matter how busy the practice gets, you must allow the other team members to do physical tasks like lifting even small dogs and restraining patients, especially fractious animals. Wear good slip-resistant footwear. And of course, be careful when you get into or out of the car, go up and down the stairs and even while sitting down in a chair or standing up from a sitting position."

Tip for managers: "You can't regulate most of this advice, but you can remind team members if you see them pushing the limits."

Great expectations for expecting moms

Firstline Editorial Advisory Board member Rachael Simmons offers this advice on how to be a great employee when you're pregnant:

1. Recognize that you can't do all the things you could do before. For example, let your coworkers do the heavy lifting—literally.

2. Help out in other areas. You want to keep on task, not take hour-long breaks all day. Offer to do jobs that allow you to sit down for periods of time. If you aren't working, then maybe you shouldn't be at work.

3. Don't use pregnancy as an excuse—not for being late to work or taking a long lunch.

4. Try to schedule your doctor visits around your work schedule, if possible. There's no such thing as a quick doctor visit.

5. Don't spend all day discussing your pregnancy with your coworkers. Although they're happy for you, they may not want to hear about it day after day for nine months. And not everyone wants to hear all the details.