According to the U.S. Department of Labor, women account for 46% of the country's work force. However, women make up only 3.7% of the country's 350,000 paid firefighters.

This slow emergence of females into the fire service has given fire departments ample time to prepare the workplace for their employment. Yet most municipalities have done very little to ready their fire departments for their first female firefighter. One major example of this lack of preparation is the absence of a pregnancy policy.

Developing a pregnancy policy for a fire department should start with an understanding of the hazards that firefighters face and what impact they may have on a pregnant woman and her fetus, the physical limitations a pregnancy places on a woman, the legal guidelines that must be followed during the policy-making process, and the additional details that will make the policy work for the particular organization.

Workday risks

Firefighters are routinely exposed to extreme temperatures during suppression operations. Increased physical exertion while wearing personal protective equipment alone is enough to cause hyperthermia. A body core temperature of 38.9°C (102°F) is considered a teratogenic hazard. Teratogenic hazards are those agents able to disturb or interfere with the growth and development of an embryo or fetus. More often than not, specific teratogenic agents produce specific teratogenic responses. Exposure to teratogens can result in birth defects such as cleft lip, cleft palate, dysmelia, anencephaly, spina bifida, chromosomal abnormalities and ventricular septal defect. Mother's exposure to extreme temperatures has been linked to a number of these birth defects.

Fires also create toxic atmospheres. The by-products of combustion vary depending on what types of materials are fueling the fire. Some of the common ones include carbon monoxide, hydrogen cyanide, acrolein, formaldehyde, benzene, acetaldehyde and formic acid. The most prevalent of these gases is carbon monoxide, an asphyxiant that interferes with the delivery of oxygen to the body by attaching to the hemoglobin in red blood cells faster than the oxygen can. An elevated breathing rate caused by the strenuous activities of firefighting increases this process.

Although the mother may be asymptomatic following a small exposure to carbon monoxide, the developing fetus is at greater risk. And while there are no known links between maternal exposure to carbon monoxide and birth defects, there is an increased risk of behavior problems, low birth weight and fetal mortality.

Hazmat incidents expose all firefighters working the incident to certain risks. Although it is unknown whether chemicals and compounds are mutagens or teratogens, the warning labels on prescription bottles and household solvents indicate the dangers various chemicals can pose.

Pregnant firefighters responding to hazmat incidents at medical facilities may be exposed to unsafe levels of ionizing radiation. Both the Occupational Safety and Health Administration and the U.S. Nuclear Regulatory Commission warn of the risk ionizing radiation may have on a pregnant patient or medical workers. Exposure to levels above normal could increase the chance of miscarriage, malignancies or major congenital malformations in embryos. A fetus is most vulnerable to radiation-induced central nervous system damage eight to 15 weeks after conception. Ionizing radiation also has been linked to childhood cancer.

Many of the same agents used in bioterrorism are present at typical EMS incidents. These agents can enter a body through inhalation, skin contact or ingestion. The National Institute for Occupational Safety and Health lists a number of disease-causing agents that are hazards to pregnant firefighter/EMS workers. Human parvovirus (B19) is linked to miscarriage. Hepatitis B is linked to low birth weight. German measles and chicken pox are linked to low birth weight and birth defects. Cytomegalovirus is linked to low birth weight, birth defects and developmental disorders. And the human immunodeficiency virus is linked to low birth weight and childhood cancer. In addition to the harm these agents or diseases could cause, a combative or belligerent patient could physically injure both the firefighter and fetus.

Technical rescues can be draining, both physically and emotionally. NIOSH lists strenuous physical labor such as prolonged standing and heavy lifting as a reproductive hazard to women. The agency also notes that emotional stress can have a detrimental effect on a woman's overall health. Strenuous activity involved in rescue operations can result in miscarriages late in the pregnancy or premature delivery.

The pregnancy in and of itself may increase the firefighter's risk of injury. The nausea, vomiting and dizziness often common early in the pregnancy and the changes in weight and center of gravity in the second and third trimesters could make a pregnant firefighter a liability to herself and her co-workers at an incident.

The firehouse itself can be an unpleasant environment for a pregnant firefighter. The piercing noise of sirens, air horns and loud speakers mixed with sleepless nights and long shifts can make the surroundings anything but comfortable.

Legal guidance

There are two federal laws and two Supreme Court decisions that set the guidelines for pregnancy polices. They are the Pregnancy Discrimination Act of 1978, the Family Medical Leave Act of 1993, California Federal Saving and Loan v. Guerra, and United Auto Workers v. Johnson Controls.

The PDA states that “women affected by pregnancy, childbirth, or related medical conditions shall be treated the same for all employment-related purposes, including receipt of benefits under fringe benefit programs, as other persons not so affected but similar in their ability or inability to work.” It covers employers with 15 or more employees and applies to employment agencies; labor organizations; and federal, state and local governments. In essence the PDA guaranteed pregnant women the availability to the benefits already in place for other employees.

Although the PDA's intent is equality of treatment to all employees, several states developed policies authorizing specific benefits to women during pregnancy and childbirth. The California state legislature guaranteed up to four months of unpaid leave for childbirth and recovery. The California Federal Savings and Loan Association challenged the law on the grounds that it violated the PDA by providing special benefits not afforded to others. The case made it to the Supreme Court, which upheld the California law and in doing so clarified the intent of the PDA. In the majority opinion Justice Thurgood Marshall stated that the federal law was intended to “construct a floor beneath which pregnancy benefits may not drop, not a ceiling above which they may not rise.”

The California Savings and Loan decision gave employers the ability to offer pregnant workers benefits better than those offered to other workers. This led to the development of “fetal protection policies” by employers who felt it clearly was within their rights. The policies did not take into consideration the ability to do the job; they dealt only with the reproductive health of men and women and the developmental health of a fetus. In the majority opinion in United Auto Workers, Justice Harry Blackmun stated, “Decisions about the welfare of future children must be left to the parents who conceive, bear, support and raise them rather than the employers who hire those parents.”