Despite increasing attention to the occupational impact of fire fighting, little is known specific to the health of female fire fighters, including pregnancy
While on the job, I fell down a flight of stairs when I was pregnant with my second child. Everything checked out okay. It wasn’t until later that I learned the fall had resulted in pelvic tears,” says Stephanie White, a member of Fairfax County, VA Local 2068. “Because of the physical demands of the job, doctors should be on the lookout for these types of injuries. This one took three years to fully heal, which affected my ability to do many parts of my job.”
After her pregnancy, White was diagnosed with diastasis recti, also known as abdominal separation. This condition occurs when the connective tissue that binds the abs together separates during pregnancy and fails to reconnect afterwards. This made it difficult for White to engage her core.
Becoming injured following pregnancy is not the only concern for women fire fighters.
“I felt strongly that breastfeeding was the best option for my baby and wanted to continue that when I returned to work,” says Vice President of Women in Fire and former member of McMinnville, OR Local 3099 Amy Hanifan.
But there was no refrigerator to store milk and no department policy about breaks needed for pumping. “It was up to me to bring in a small fridge and to inform department management about federal laws that require certain accommodations for nursing mothers, such as making a space — even if temporary — for pumping,” she says.
Pumping on the job definitely brought challenges. “I was not comfortable storing pumped milk alongside everyone else’s personal items,” she says.
Fairfax County Local 2068 member Rachel Blakely says, “On more than one occasion, I had to pump in the back of a rig at the end of a call because we had been gone too long.”
Injury prevention and nursing accommodations are some of the concerns female fire fighters say need to be addressed regarding pregnancy in the fire service. Others include light versus full duty, maternity leave and inadequate or lack of a department pregnancy policies and guidelines.
“We were called to the fire service not only because we want to help people, but because we want a more active job,” says White. “A system or a set of practices needs to be in place that sets us up for success during pregnancy and when we return to the job. There shouldn’t be any guesswork.”
Women in Fire President Angela Hughes, who is also a member of Baltimore County, MD Local 1311, says,
“We field a lot of questions about fire department policy as it relates to pregnancy. For those wanting help making changes or creating policy, we can offer suggestions, but it is difficult because every state is different. There is no one-size-fits-all.”
The IAFF is now in the beginning stages of developing resources, tools and protections to ensure members who become pregnant stay healthy and return to the job successfully.
According to the U.S. Department of Labor, only about 4 percent of fire fighters in the United States are women. In Canada, it’s about 3 percent. The percentage of female fire fighters who have experienced a pregnancy while on the job is even less. Furthermore, there is little research on reproductive health among female fire fighters, making it difficult to develop policies that address this issue.
Dr. Sara Jahnke, director of the Center for Fire, Rescue and EMS Health Research at the National Development and Research Institutes, is the principal investigator or co-investigator on several studies and pilot projects related to women’s reproductive health and the fire service.
“The results from these studies will provide important information for doctors treating pregnant fire fighters and the conclusions will also help fire departments create pregnancy-related policies that set women fire fighters up for success before, during and after pregnancy,” says Jahnke.
While more data is needed for the findings of any of these studies to be conclusive, preliminary results show that there is an increased chance of miscarriage, potential exposure to toxins in the first trimester and a probable need for nursing moms to pump and dump for several hours after responding to a fire due to contamination/exposure.
Researchers seem to agree on one thing: even departments that have yet to hire a female fire fighter need to have a pregnancy policy in place that prevents/discourages discrimination based on a fire fighter’s pregnancy status. In addition, fire department doctors should be knowledgeable about the risks specific to female fire fighters and be able to monitor pregnant fire fighters accordingly, watching for risks and communicating those risks to the fire fighter.
Hanifan says, “If you have an active policy in place that addresses issues and concerns before, during and after pregnancy, then everyone knows what accommodations need to be made to comply with the law and, perhaps, what additional resources need to be made available in areas where the law falls short.”
The IAFF policy regarding reproductive hazards mirrors NFPA 1582, Standard on Medical Requirements for Fire Fighters. In addition, the IAFF advocates that fire fighters who become pregnant should be treated no differently than other fire fighters with medical conditions that may inhibit their ability to do the job. Fire departments should have a designated physician to guide/advise fire fighters throughout their pregnancies, and when a fire fighter is no longer pregnant, she must be allowed to return to the position she held prior to being pregnant.
At the federal level in the United States, the Family Medical Leave Act (FMLA) allows employees to take up to 12 weeks of unpaid leave. Employees may also use sick or vacation leave.
Some state and local governments go beyond FMLA to provide maternity leave benefits similar to partial disability benefits. For example, in Washington, DC, the Paid Leave Act — effective in 2020 — will provide up to eight weeks of paid leave for new mothers.
The Affordable Care Act (ACA) amends the Fair Labor Standards Act (FLSA) to require that employers provide “reasonable break time for an employee to express breast milk for her nursing child for one year after the child’s birth each time such employee has need to express the milk.” Employers are also required to provide “a place, other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public, which may be used by an employee to express breast milk.”
In Canada, federal law allows for maternity leave and benefits administered by provincial employment insurance plans. Depending on length of employment history and hours worked, new mothers can take up to 63 weeks of leave. Employers must accept them back into the same — or equivalent — position. Through the Canadian federal insurance plan, paid leave is offered to one or both parents for up to 15 weeks. Only British Columbia and Ontario have laws that provide specific instructions on how best to accommodate nursing moms in the workplace.
Women in Fire estimates that only about half of fire departments in the United States and Canada have a pregnancy policy. And those that do often do not fully address issues surrounding pregnancies. One department policy simply read, “Upon submission of medical proof, the employer shall assign pregnant employees to duties other than suppression without any loss of any wages or any benefits.”
Even fewer departments have a pregnancy-specific manual or guidelines to aid female fire fighters as they work through their pregnancies and re-enter the field afterwards. While there are exceptions, in general, these manuals tend to reiterate only basic prenatal and postnatal care guidelines. And there is nothing that addresses what women fire fighters should be doing to ensure they can perform their duties at the same capacity after their pregnancy.
“Our guide is too general,” says Blakely. “What we need is information about potential injuries and steps to prevent them, prenatal and postnatal.”
Requirements for light versus full duty and returning to the field post-partum vary widely, in part because it is a contentious issue among female fire fighters. Some want to work if they feel able to and some want light duty because of concerns related to on-the-job exposures or for personal health reasons.
But the common thread is that it should be up to the fire fighter and her doctor to make that decision, not a blanket fire department policy or fire department management.
The 2019 John P. Redmond Symposium/Dominick F. Barbera EMS Conference, held in August, featured a workshop, Women Fire Fighters and Their Occupational Health, which was streamed live and is now available at youtube.com/IAFFTV. The workshop addressed risks related to exposures, shift work and the physiologic impact on maternal and child health, in addition to the overall health of female fire fighters. At the Affiliate Leadership Training Summit/Human Relations Conference in January 2020, the IAFF will offer a workshop, Understanding Pregnancy and Parental Rights and Accommodations, which will focus on existing laws and standards related to the rights of women who become pregnant.
In addition, the IAFF is working with subject matter experts to develop guidelines and resources to better meet the needs of female fire fighters who are pregnant to include injury prevention, fitness and nursing accommodations.