The Pregnant Officer

Fabrice Czarnecki. M.D.

From Clinics In Occupational and Environmental Medicine
Volume 3, Issue 3, Pages 641-648 (August 2003)

In 2000, women accounted for 10.6% of local law enforcement officers and 14.4% of federal law enforcement officers. These numbers are likely to rise in the next few years. New issues that are relevant to female officers have been raised, such as adjusting the working conditions of pregnant officers.

Every employer must make the workplace as safe as possible for all employees. Pregnant employees tend to be more susceptible to chemical and physical hazards and deserve special consideration to minimize risks to the fetus. Law enforcement agencies should implement policies to ensure the best possible outcome of the pregnancy and to decrease the woman's professional risks. This article presents these professional hazards and how to mitigate them while complying with the law.

Occupational chemical hazards faced by pregnant workers include exposure to heavy metals (lead, mercury), organic solvents (acetone, benzene, formaldehyde, halogenated hydrocarbons, styrene, toluene, trichloroethylene, xylene), and pesticides. Physical hazards include trauma, radiation, and noise. Additional pregnancy hazards that are specific to the law enforcement profession include firearms training and an increased likelihood of trauma.

Firearms training

The safety of firearm use during pregnancy has been questioned. A search of the medical literature and a survey of a large number of police physicians and firearms instructors revealed no definitive answer. Several police departments and military units from the survey had policies regarding firearms training during pregnancy, but these policies were not consistent. Instructors at one training facility claimed that pregnant officers could shoot there because lead-free ammunition was used. None of these agencies could articulate why shooting was allowed during one part of the pregnancy but not at others. Most police departments relied on the officer's personal physician to make recommendations regarding weapon use during pregnancy; however, obstetricians and family physicians were unlikely to have access to appropriate information on that topic.

Lead toxicity

There is an extensive body of research showing that lead exposure is harmful to the fetus. Lead crosses the placenta and is transmitted from the mother to the fetus [1]. Lead exposure during pregnancy has been associated with serious complications, including spontaneous abortion, premature membrane rupture, preeclampsia, pregnancy hypertension [3], and neurobehavioral effects in infants and children [1]. Even at low levels, lead exposure has been associated with preterm delivery; congenital abnormalities [4]; and decreased birth weight, length, and head circumference [2].

Noise toxicity

Noise usually is considered to be detrimental during pregnancy. In most European countries, health regulations forbid pregnant women from working in surroundings with a continuous noise level greater than 80 dB or a rapid-impulse noise level greater than 40 dB, which is much less than the noise of a firearm [6]. In the United States, the Occupational Safety and Health Administration permissible exposure limit for rapid-impulse noise is 140 dB, with additional regulations for continuous noise. The sound levels of firearms are about 125 to 140 dB for rimfire rifles; 140 to 150 dB for rimfire pistols; and 150 to 160 dB for centerfire rifles, pistols, and shotguns [7].

Intrauterine measurements showed that the fetus was not significantly protected against loud noises [8]. One study in human volunteers found a maximal intrauterine noise attenuation of 10 dB at 4000 Hz [9]. In a study of ewes, the noise attenuation was 20 dB at 4000 Hz, but the noise inside the uterus was 2 to 5 dB greater at 250 Hz [10]. In comparison, foam plugs offer attenuation of 12 to 20 dB and are considered to be the least effective hearing protection [7].

Noise exposure during pregnancy has been associated with several disorders, including miscarriage [11,12], intrauterine growth retardation [13,14,16], preterm delivery [12,15,16], hearing loss in babies and children [17], altered immune response in the fetus [18], and hypertension [12]. A combined exposure to noise and lead seems to have an increased toxicity, causing heart lesions, which are not observed for those agents alone [19].

Other chemical hazards

Besides lead, firearms training exposes officers to other metals, including barium, antimony, copper, and arsenic [5]. These metals could be toxic, depending on the concentration. Their concentrations seem to be nontoxic for nonpregnant adults at a shooting session, but their safety has not been assessed for pregnant shooters. Another source of chemical hazards related to firearms are the cleaning products, which contain organic solvents. Some of these solvents are known to be teratogenic.

Recommendations

The available scientific knowledge does not provide evidence that firearm use is safe during pregnancy. Data also show that noise and lead are significantly toxic during pregnancy.

Pregnant officers should not shoot firearms, unless in self-defense, and should avoid shooting ranges. Officers who are breastfeeding should only shoot lead-free ammunition. Pregnant women should not clean their guns because of possible exposure to chemicals. The guns should be cleaned by other people and away from the pregnant woman.

Law enforcement agencies should not require pregnant officers to train and qualify with live ammunition and should inform them about the health hazards involved with firearms training. Alternative solutions to live-fire qualification should be developed. One alternative is the use of a simulation shooting system, which employs lasers and CO2 or compressed air to create recoil. These systems are available commercially. Progressive law enforcement agencies already possess these simulators to train officers in the judgmental aspects of the use of deadly force.

If a pregnant officer chooses to attend a firearms training session, the author recommends the following steps to reduce the health hazards to the fetus:

• Use lead-free ammunition (with lead-free primers)

• Shoot outdoors (to reduce exposure to noise and chemicals)

• Shoot the smallest possible number of rounds

• Wear a respirator with a high-efficiency particulate air filter

• Wash hands and face carefully after a shooting session

• Avoid drinking and eating within 1 hour after shooting session

• Use a silencer

• Wear heavy clothing that covers the abdomen

• Avoid picking up spent brass

• Avoid cleaning firearms

Traumatic risks

The work of pregnant officers should be adapted to decrease the risk for trauma, whether it results from assaults or accidents, which would expose the mother and the fetus. Typically, the patrol position is the most vulnerable position and should be avoided during pregnancy.

The law enforcement agency should reduce the exposure of pregnant officers to physical confrontations. Assaults seem to be most frequent during patrolling, arresting, and search-warrant service. Custody of prisoners should be avoided if it involves direct contact with prisoners.

Light duty positions include office work and certain investigative positions. The optimal level of physical activity during pregnancy is unknown. It usually is suggested that pregnant women keep the same level of work until 32 weeks of gestation, in the absence of a clear professional hazard and pregnancy complications. Work by itself is not correlated with the incidence of birth defects [20]. Lifting heavy objects should be avoided during pregnancy. The risk for low back injury and back pain is increased in pregnant women, especially during the last trimester.

Training should be limited and adjusted to avoid accidental injuries. During defensive tactics (hand-to-hand combat) training, pregnant officers should not participate in combat simulations. Training that involves physical contact should be limited to restraint techniques. Falls and blunt trauma should be avoided. Ground-fighting techniques that require the officer to lie on her back should be avoided after the third trimester, because the uterus could compress the inferior vena cava.

The taser is an electrical restraint device that is used in law enforcement. It is common for officers to have the taser applied to themselves during training. One study suggested an association between the taser and miscarriage after reviewing a case report and the literature on electrical injuries during pregnancy [21]. Pregnant officers should not be subjected to the taser and should not try to restrain subjects during a taser application.

Other risks

Pregnant officers should be protected against other job-related hazards as much as possible. Physical confrontations [22] or close contacts could increase the risk for transmission of several infectious diseases, including HIV, viral hepatitis, and tuberculosis. Avoiding patrol and prisoner custody would decrease that risk.

The chemical hazards that are faced by police officers are likely to be more toxic to the fetus than to healthy adults. Situations should be avoided that, although acceptable to most officers, might be dangerous pregnant officers, such as clandestine drug laboratories, traffic enforcement, and hazardous-material scenes. Clandestine drug laboratories can expose officers to a variety of toxic chemicals, some of which are potentially deadly (eg, phosphine). Traffic enforcement might be dangerous because of exposure to benzene and other organic solvents from motor vehicles. A study found that benzene exposure in traffic officers was about twice as high as in a control population of office workers [23]. In developing countries that use leaded gasoline, lead exposure is a significant problem for traffic officers [24]. Pregnant officers probably should avoid any type of traffic enforcement on foot patrol, especially near tunnels and tolls, where the concentration of traffic is high.

Shift work and night work have been associated with preterm birth [25]. Shift work also results in increased fatigue in pregnant women.

Policies

 
Law enforcement agencies should design and implement policies that address the needs of pregnant officers. These policies should cover issues that are specific to law enforcement and those that are not included in the Family and Medical Leave Act of 1993 (FMLA), which established federal minimum leave requirements for private and public sector employees.

The Pregnancy Discrimination Act of 1978 states that discrimination on the basis of pregnancy or childbirth constitutes unlawful sex discrimination under Title VII of the Civil Rights Act of 1964 [26]. Women who are pregnant or have related conditions must be treated in the same manner as other applicants or employees with similar abilities or limitations. An employer cannot force a pregnant employee to take disability leave if she is able to work and cannot remove her from her duty assignment if she is able and willing to perform it.

The US Supreme Court ruled in 1991 that an employer cannot exclude pregnant women from hazardous jobs [27]. Police agencies should give options to pregnant officers, but ultimately it is up to the individual officers to decide, after consultation with their personal physician, whether they want a light duty assignment or other reasonable changes in their job assignments.

Notification of pregnancy
Officers should be encouraged to report the pregnancy as soon as possible. They should receive an information package describing the available benefits, the occupational hazards, and the steps taken by the employer to mitigate the hazards. Pregnant officers should be encouraged to stop working after 32 weeks of gestation, or sooner if they have complications, after consultation with their personal physician. Female officers should understand that changes in their jobs are implemented after the pregnancy has been detected and reported. They might be exposed to reproductive hazards during the early part of the pregnancy before they know that they are pregnant.

Benefits

Benefits for law enforcement officers usually include paid and unpaid leave. The FMLA allows 12 weeks of unpaid leave. Employers should not require that a pregnant employee exhaust all her paid leave before applying for unpaid leave.

Light duty assignments

Pregnant officers should be accommodated as much as feasible. The employer should encourage the officer to have her personal physician involved in deciding how to make the job as safe as possible for herself and the fetus. Pregnant officers should not be mandated to stop a crime in progress, as they would not have their full physical capacity.

Pregnant officers should be given the option not to participate in aggressive law enforcement functions, which include restraining and arresting suspects, performing search and arrest warrants, conducting vehicular stops, and taking prisoners into custody. Daytime assignments should be offered, with no night shifts and no shift work.

Typical light duty positions include office work. An investigative position may or may not be appropriate, depending on the risk for physical confrontation. White collar crime investigations are probably safer than narcotics investigations. Not every job inside a police station would be considered safe for pregnant officers, especially if the duties include contact with prisoners, such as work in a booking area.

Training requirements

Mandated training should be limited to what is recommended to be safe during the pregnancy, after consulting with the officer's personal physician and the employer's medical advisor. Defensive tactics training that involves physical contact should be limited. Pregnant police officers should not be required to participate in live-fire range qualification. Alternative firearms training should be implemented, using simulation systems instead of real ammunition.

Firearms

 
Some agencies remove arrest powers and previously issued firearms from pregnant officers; however, pregnant officers should be allowed to keep their firearms. Officers are more vulnerable during the pregnancy and could be targeted by criminals for revenge or crimes of opportunity. Pregnant officers need their firearms for self-defense even more than nonpregnant officers.

Maternity uniform

 
Regular uniforms may not be appropriate for pregnant officers. These officers should be given the option to wear specially designed maternity uniforms or civilian maternity clothing if a regular uniform cannot be worn because of problems with size and comfort.

Summary

Law enforcement agencies must ensure the best working conditions for all employees, including pregnant officers. Knowledge of possible medical problems and work-related hazards help agencies design appropriate policies to inform and protect the officers and their families, while also serving the public and complying with current laws.


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References

[1]. Gardella C. Lead exposure in pregnancy: a review of the literature and argument for routine prenatal screening. Obstet Gynecol Surv. 2001;56(4):231-238 MEDLINE
[2]. Osman K, Akesson A, Berglund M, Bremme K, Schutz A, Ask K, et al. Toxic and essential elements in placentas of Swedish women. Clin Biochem. 2000;33(2):131-138 MEDLINE

[3]. Winder C. Lead, reproduction and development. Neurotoxicology. 1993;14(2–3):303-317 MEDLINE

[4]. O'Halloran K, Spickett JT. The interaction of lead exposure and pregnancy. Asia Pac J Public Health. 1992–93;6(2):35-39 MEDLINE

[5]. Dams R, Vandecasteele C, Desmet B, Helsen M, Nagels M, Vermeir G, et al. Element concentrations in the air of an indoor shooting range. Sci Total Environ. 1988;77(1):1-13 MEDLINE

[6]. Brezinka C, Lechner T, Stephan K. The fetus and noise. Gynakologisch-geburtshilfliche Rundschau. 1997;37(3):119-129 MEDLINE

[7]. Shimm DS, Passamaneck M. Shooting noise, hearing loss, and hearing protection. Berryville (AR): International Defensive Pistol Association 2001

[8]. Gerhardt KJ, Abrams RM, Huang X, Griffiths SK, Peters AJ. Intra-abdominal sound pressure levels during impulse noise exposure in sheep. Mil Med. 2000;165(2):153-156 MEDLINE

[9]. Richards DS, Frentzen B, Gerhardt KJ, McCann ME, Abrams RM. Sound levels in the human uterus. Obstet Gynecol. 1992;80(2):186-190 MEDLINE

[10]. Gerhardt KJ, Abrams RM, Oliver CC. Sound environment of the fetal sheep. Am J Obstet Gynecol. 1990;162(1):282-287 MEDLINE

[11]. Zhang J, Cai WW, Lee DJ. Occupational hazards and pregnancy outcomes. Am J Ind Med. 1992;21(3):397-408 MEDLINE

[12]. Zhan C, Lu Y, Li C, Wu Z, Long Y, Zhou L, et al. A study of textile noise influence on maternal function and embryo-growth. Hua Xi Yi Ke Da Xue Xue Bao. 1991;22(4):394-398

[13]. Hruba D, Kukla L, Tyrlik M. Occupational risks for human reproduction: ELSPAC Study. European Longitudinal Study of Pregnancy and Childhood. Cent Eur J Public Health. 1999;7(4):210-215 MEDLINE

[14]. Hartikainen AL, et al. Effect of occupational noise on the course and outcome of pregnancy. Scand J Work Environ Health. 1994;20(6):444-450 MEDLINE

[15]. Luke B, Mamelle N, Keith L, Munoz F, Minogue J, Papiernik E, et al. The association between occupational factors and preterm birth: a United States nurses' study. Research Committee of the Association of Women's Health, Obstetric, and Neonatal Nurses. Am J Obstet Gynecol. 1995;173(3 Pt 1):849-862 MEDLINE

[16]. Nurminen T. Female noise exposure, shift work, and reproduction. J Occup Environ Med. 1995;37(8):945-950 MEDLINE

[17]. Pierson LL. Hazards of noise exposure on fetal hearing. Semin Perinatol. 1996;20(1):21-29 MEDLINE

[18]. Sobrian SK, Vaughn VT, Ashe WK, Markovic B, Djuric V, Jankovic BD. Gestational exposure to loud noise alters the development and postnatal responsiveness of humoral and cellular components of the immune system in offspring. Environ Res. 1997;73(1–2):227-241 MEDLINE

[19]. Cary R, Clarke S, Delic J. Effects of combined exposure to noise and toxic substances–critical review of the literature. Ann Occup Hyg. 1997;41(4):455-465 MEDLINE

[20]. Shi LM, Chia SE, Chan OY, Chew SK, Foong BH. Prevalence of birth defects and parental work in Singapore live births from 1994 to 1998: a population-based study. Occup Med (Lond). 2002;52(6):325-331

[21]. Mehl LE. Electrical injury from Tasering and miscarriage. Acta Obstet Gynecol Scand. 1992;71(2):118-123 MEDLINE

[22]. Abel S, Cesaire R, Cales-Quist D, Bera O, Sobesky G, Cabie A. Occupational transmission of human immunodeficiency virus and hepatitis C virus after a punch. Clin Infect Dis. 2000;31(6):1494-1495 MEDLINE

[23]. Tomei F, Ghittori S, Imbriani M, Pavanello S, Carere A, Marcon F, et al. Environmental and biological monitoring of traffic wardens from the city of Rome. Occup Med (Lond). 2001;51(3):198-203

[24]. Kamal AA, Eldamaty SE, Faris R. Blood lead level of Cairo traffic policemen. Sci Total Environ. 1991;105:165-170 MEDLINE

[25]. Bodin L, Axelsson G, Ahlborg Jr. G. The association of shift work and nitrous oxide exposure in pregnancy with birth weight and gestational age. Epidemiology. 1999;10(4):429-436 MEDLINE

[26]. Pregnancy Discrimination Act, 42 USC §2000e(k)

[27]. Automobile Workers v. Johnson Controls, Inc., 499 US 187 (1991)


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a The Gables Group, Inc., 1172 South Dixie Highway, Coral Gables, FL 33146, USA
b Family Health Center, Franklin Square Hospital Center, 9101 Franklin Square Drive, Suite 205, Baltimore, MD 21237, USA
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* Family Health Center, Franklin Square Hospital Center, 9101 Franklin Square Drive, Suite 205, Baltimore, MD 21237

doi: 10.1016/s1526-0046(03)00078-5

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