Protection of pregnant women at work in Switzerland: practices, obstacles and resources. A mixed-methods study protocol

Predictors of the return to work for pregnant employees on preventive leave: Patients from an occupational medicine consultation in Switzerland

According to the Swiss legislation on maternity protection in the workplace (OProMa), if pregnant workers are exposed to occupational hazards and no protective measures are taken, a gynecologist will prescribe a certificate of preventive leave and the women must stop working. Returning to work is only possible if job adjustments are made. This study aims to evaluate the burden of absences on companies and to examine the predictors of the return to work for pregnant workers on preventive leave, by examining both the probability of return to work and the time required to return to work. The study sample includes data on 258 workplaces of pregnant workers on preventive leave, collected during an occupational medicine consultation aimed at supporting the implementation of the OProMa. Information is available on the worker (age, date of consultation), the hazards to which she is exposed, the company's knowledge of the OProMa and whether a risk analysis exists. Descriptive statistics and multivariate regression analysis are carried out. In 58% of the workplaces, it was not possible to return to work before the end of the pregnancy. This corresponds to an average absence of 4.5 months. In 42% of the workplaces, a return to work was possible thanks to workplace adaptations. A conforming risk analysis and a full knowledge of the OProMa for companies, and an early visit to the occupational medicine consultation for workers are good predictors of the likelihood of returning to work. Younger age and exposure to certain types of risks are factors that influence the duration of preventive leave. The implementation of OProMa in Switzerland poses serious challenges, but early identification of occupational hazards and practices that anticipate compliance with the law in the company increase the return to work in safety for pregnant workers.

Evaluation of a blended care programme for caregivers and working pregnant women to prevent adverse pregnancy outcomes: an intervention study

Objective

Work-related activities can be a risk factor for pregnancy complications such as preterm birth. This study evaluates the effectiveness of a blended care programme, Pregnancy and Work, that provides pregnant workers and their obstetrical caregivers with advice on work adjustment.

Methods

Women less than 20 weeks of gestation, in paid employment or self-employed, in the care of four participating hospitals and their referring midwifery practices in the Netherlands received either the blended care programme (n=119), consisting of a training for professionals and a mobile health application, or care as usual (n=122) in a controlled intervention study with a follow-up in intervention and control populations. All participants completed three questionnaires concerning health and working conditions at 16, 24 and 32 weeks of pregnancy. Primary outcome was the percentage of women who received advice from their obstetrical caregiver about work adjustment. Secondary outcomes were work status, realised work adjustment and working conditions. Groups were compared using univariate and multivariate regression analyses.

Results

A total of 188 (78%) completed all three questionnaires. In the blended care group, women received more advice from obstetrical caregivers to adjust their work than in the control group, 41 (39%) vs 21 (18%) (adjusted relative risk (aRR) 2.2, 95% CI 1.4 to 3.4), but less from their employer 8 (8%) vs 31 (28%) (aRR 0.29, 95% CI 0.14 to 0.61). There were no significant differences in realised work adjustments. At 24 weeks, 30% of the pregnant women in both groups continued to work in hazardous workplaces.

Conclusion

Among working pregnant women, the blended care intervention increases advice on work adjustment given by midwives and obstetricians, but does not lead to more work adjustments.