Pregnant in health care : when protection harms

Pregnant women in healthcare professions are often banned from working. The wrong implementation of the maternity protection law was to blame.

Two hands tie the bow of a surgical gown

Many pregnant women in the healthcare sector want to work – despite the right to maternity leave Photo: Patricia Kuhfuss/laif

"After all, that was a brief interlude!"was all Anja Schmidt* (37) got to hear from her head physician. That was 2018. At the time, Schmidt was an assistant physician in an operating department at the University Hospital in Bochum and pregnant for the second time.

Your first parental leave was six months ago. She intended to keep her second pregnancy a secret for as long as possible. In the first one, work was immediately stopped when she reported it to the personnel department.

But the plan with secrecy could not be kept up. An operation did not go as planned. The anesthesiologist could not administer the anesthetics directly into the blood via a drip as usual and had to spontaneously switch to gas anesthesia. This involves administering a cocktail of anesthetic gases through a mask that rests on the patient’s larynx. Inevitably, gas particles from the anesthetic escape into the air.

Schmidt knew that some anesthetic gases could have a harmful effect on the unborn child and no longer felt safe. Still at the operating table, in gown and mask, hands fully sterilized, she told her attending that she was pregnant and did not want to do the surgery.

Violation of the Equal Treatment Act

Nothing about Schmidt’s case is in the spirit of the current maternity protection law. It actually seeks to protect pregnant women from dangers at work. Schmidt’s story, however, is the story of many pregnant employees in German hospitals. It shows how hospital and department managers naturally weed out highly qualified women if they become pregnant.

The fact that the boss immediately assumed that a ban on employment would be imposed, Schmidt’s return from parental leave was therefore only a "brief interlude", is wrong under labor law and a violation of the General Equal Treatment Act. It would have been fairer and more correct if the supervisor had examined how Schmidt could continue to work in a meaningful way. He is even legally obligated to do so.

In the event of a ban on employment, the woman is released from her work on the same day. For the rest of the pregnancy, she continues to receive her usual salary. She’s allowed to do whatever she wants from now on – just not work as an employee.

The fact that female doctors, nurses, midwives, medical assistants and medical students are also able to report their pregnancies over the 12. Concealing pregnancy beyond the second week is not uncommon. In a survey by the German Association of Women Physicians (DaB), more than 43 percent said they had reservations about reporting their pregnancy to their employer. Women want to avoid the career crunch more than anything else in the process.

Starting from scratch again

Around seven months of employment ban plus parental leave often means being out for over a year and a half. Out of the team and the collegial relationships, out of the routine of operating, out of the complicated decisions regarding the administration of medication or resuscitative measures.

It’s like a board game: with each pregnancy, a woman moves back to "go" and starts again from zero. When it comes to handing out attractive tasks and management positions, women have long since been overtaken – and often by men – when they return from parental leave.

Even chief physician PD Dr. Mandy Mangler (43) has kept all her pregnancies secret for a long time. Mangler heads the department in a dual leadership role with PD Dr. Malgorzata Lanowska two Vivantes gynecology clinics in Berlin. She has had five children "at all stages of their careers," she says. With her last pregnancy, she was already chief of staff and didn’t inaugurate her team until she was 32 weeks pregnant. Pregnancy week one. She finds "nothing worse than being controlled and patronized".

With the powerful position as chief physician, she had comparatively little to fear. She decided to return to work eight weeks after giving birth and use her right to breastfeed the baby during working hours.

"You have to want to do it, because of course it was really exhausting," admits Mangler. The reason she didn’t exercise her right to breastfeeding time with her first four children was because she found it difficult to discuss "these very intimate topics like pregnancy and breastfeeding" with her male superiors.

Can I be a good mother?

Many women probably feel the same way as Mangler. This could explain why women in medicine, who are often well aware of their rights and are themselves able to assess the medical dangers excellently, rarely resist and involuntarily give way to the employment ban.

Women are often overwhelmed by new, difficult feelings and thoughts during their early pregnancy. Many things have to be re-evaluated. What should life with a child look like? Also, not all pregnancies are planned – statistically one in three are not.

Many male colleagues would then be satisfied with the loss of the competitor

The women ask themselves: Will I be able to raise the child alone?? Can I be a good mother? Especially with the first child: What kind of stress can I put myself and the child through?? Add to that the fact that many pregnant women struggle with nausea, vomiting, circulation problems and fatigue, especially in the first trimester of pregnancy.

It is in this mixture of physical discomfort and insecurity that women then meet their superiors, who are still mostly male today. Mangler observes that employers often have neither interest nor incentive to keep their employees on the job.

"It’s much easier to just replace the woman than to figure out how and where exactly to use her now."Since the Maternity Protection Act prohibits night work for pregnant women, clinic managers tend to look for new, fully operational replacements as quickly as possible.

Talking to pregnant women

Because of the tight personnel budget, it is more worthwhile for employers to send the pregnant woman to the employment ban, to have her salary reimbursed by the health insurance and to hire a new employee. Many male colleagues would then be happy with the loss of the competitor. "There’s no need to have any illusions about that," says Mangler.

Anja Schmidt would have liked to be able to coordinate with her boss on how she could continue to operate. She would still have been allowed to perform most of the surgeries, and only a few would have needed some sort of contingency plan. She could have protected herself from infections on the ward by wearing a mask. The solution sounds banal, but talking to the pregnant women is often the best way to support them.

Mangler herself, as chief physician, does everything she can to allow her pregnant employees self-determination over their own bodies, and warns them "against the trap of employment prohibition". She also regularly argues with the company doctor. They try "first to find out what the women want and can imagine.

Most want to work and not be reduced to a mother image, be their experience. In her team, pregnant women are also allowed to continue operating. With Mangler, there would certainly not have been an employment ban for Anja Schmidt.

Olga Herschel is a child and adolescent psychiatrist in further education and a freelance journalist

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