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Being pregnant and working an eight-hour (or longer) hygiene day isn’t for the faint of heart.
The pregnant body accelerates through a biological, physiological, and chemical metamorphosis that brakes for no one. Hygiene school may have covered “how to treat a pregnant patient,” but it did not include “how to survive being a pregnant dental hygienist.”
ALSO BY CHRISTIE LINCOLN | Overcoming the challenges of pumping breast milk as a dental hygienist
When to tell your employer
There is no set answer as to when an employee should inform an employer of a pregnancy. One suggestion is to wait until after the early months have passed, when the risk of miscarriage is lower. (1) However, keeping a lid on the news when there are significant pregnancy symptoms can be difficult. The one consistent piece of advice is to tell the employer first. (1) A pregnant hygienist may fear being treated differently or losing a position after revealing her condition. An open conversation regarding the commitment to work performance and laying the groundwork for the upcoming maternity leave and plans for returning to work can most often remove these fears. (2) Also, pregnant women are a federally protected class. The Pregnancy Discrimination Act was put into play in 1974 to protect the employment and employability of pregnant women. Although it has not obliterated discrimination, it offers a measure of protection. If a question of pregnancy discrimination arises, seek legal advice. (2, 3)[Native Advertisement]
Morning sickness, fatigue, and nausea
Of the numerous pregnancy symptoms, morning sickness (i.e., general nausea with or without vomiting and fatigue) may be the most challenging for the working hygienist. Waiting for multiple episodes to pass is typically not an option. Hygienists are much like a stage actor—once they are alerted to the arrival of a patient, it’s ready, set, action! This article doesn’t need to expand upon recommendations such as:
Eating as soon as you wake up;
Snacking often; don’t leave your stomach empty;
Asking your OB about possible medications to help reduce symptoms if vomiting is significant;
Ginger, ginger, ginger;
but a helpful hack, such as knowing ginger takes a few days of use before relief kicks in, or that the dental chair is the perfect place for a nap during lunch, may make a world of difference. (4, 5, 6)
Proceed with caution
Pregnant RDHs may find they justifiably question the safety and health of their unborn children when working in a dental office that administers nitrous oxide. (7) Staying out of a treatment room where nitrous is in use may seem sufficient, but having proper ventilation and a fully operational scavenger system is imperative for the whole office. The article “Nitrous nightmares?” written by Debbie Grant RDH, CA, and Catherine Haas, RDH, BS, for RDH magazine is an eye-opener on the matter and a must read. (8)
What about the chemicals used for sterilization and disinfection? Victoria Leonard, RN, FNP, PhD, of the Western States Pediatric Environmental Health Specialty Unit shares, “Recent research suggests that there are ‘windows of vulnerability’ in the development of the fetus and the child. These windows have no equivalent in adult life. During these critical periods, very small amounts of toxic chemicals can have profound effects on organ formation, amounts that would have no effect on an adult.” (9, 10) Different brands of disinfectants have specific and unique active ingredients. Always read the labels and follow the recommended protocols.
Although it is the responsibility of an employer to provide safe working conditions, including proper ventilation, hygienists have the capability of testing the air quality of their breathing zone to measure personal exposure. Companies like Kem Medical Products offer dosimeters for personal and area monitoring of hazardous vapors from primary sterilants, high-level disinfectants, and nitrous oxide gas. (11)
Radiation
Placing a film or sensor in a patient’s mouth and running behind a lead-lined wall to take an x-ray may not concern a pregnant hygienist. But what if she has to stand in the room every time x-rays are needed? Using a FDA-cleared handheld x-ray unit such as the Nomad MD may trigger some apprehension. (12)
The NOMAD website reports, “when the NOMAD is properly used and zone of occupancy is maintained, operator dose is characteristically below the minimum detectable level on monthly reading dosimetry worn by technologists.
However, for increased safety and peace of mind, Aribex supports the use of additional cautionary measures during pregnancy through the use personal protective apparel as well as monitoring via the use of personal dosimetry. (Numerous personal dosimetry badging services are available and can be found via web searches).” (13) Nomad’s website also lists links to the Health Physics Society and the National Council on Radiation Protection and Measurements web pages to support their position statements. (13)
This is important: Safety and peace of mind are two things no employer, coworker, or company have authority to minimize.
The final trimester
After surviving the tumultuous first trimester symptoms and navigating the safety concerns of being pregnant while working in a dental office, the third trimester does offer its own set of unique challenges. Thanks to pregnancy hormones and their ability to relax everything except the brain, increased heartburn and backaches are common during the third trimester. Smaller, more frequent meals may help with the heartburn. For backaches and overall third trimester woes, I have one word: swimming! It takes the pressure off everything. Other low impact exercises, such as yoga and walking, have also yielded good results for some women. Always consult your OB first on appropriate and safe exercises and stretches during pregnancy. (14, 15)
Another challenge we face working a busy schedule while pregnant is staying hydrated. Dehydration can trigger false labor contractions, called Braxton Hicks. Drink plenty of water throughout the day and if these contractions start up, americanpregnancy.org recommends drinking two glasses of water right away, among other things. Always contact your doctor or healthcare provider if nothing works to minimize these types of contractions. (16)
Finally, if wrist pain starts up in the third trimester, no need to think “surgery” or “retirement.” Increased fluid retention in the final stretch of pregnancy not only makes the ankles swell, it is also known to bring on carpal tunnel pain. The website womenshealth.gov recommends ice and wrist splints during the day and at nighttime to help with symptoms, which usually cease after the baby is born. (17)
There are many different symptoms and emotions that pop up during pregnancy. This article would be a book if it covered everything. In conclusion, never underestimate the negative effects of stress or the power of prevention. Rest, eat well, always seek the advice of a medical doctor and take one day at a time.
References
1. 10 tips to working while pregnant. Ask Dr. Sears website. https://www.askdrsears.com/topics/pregnancy-childbirth/pregnancy-concerns/10-tips-working-while-pregnantuwudxuuaycec.
2. Erickson B. Doctor, I’m pregnant! http://www.dentaleconomics.com/articles/print/volume-90/issue-10/features/doctor-im-pregnant.html. Dental Economics website. Published October 1, 2000.
3. Pregnancy discrimination. US Equal Employment Opportunity Commission website. https://www.eeoc.gov/eeoc/publications/fs-preg.cfm.
4. Working during pregnancy: do’s and don’ts. Mayo Clinic website. https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/pregnancy/art-20047441?pg=1. Published April 15, 2017.
5. Goddard J. Working while pregnant: How to handle it. Parents magazine website. https://www.parents.com/pregnancy/my-life/maternity-paternity-leave/working-while-pregnant-how-to-handle-it/.
6. Ginger for morning sickness . WebMD website. https://www.webmd.com/baby/tc/ginger-for-morning-sickness-topic-overview.
7. Controlling exposures to nitrous oxide during anesthetic administration. The National Institute for Occupational Safety and Health website. https://www.cdc.gov/niosh/docs/94-100/. Updated June 6, 2014.
8. Grant D, Haas C. Nitrous nightmares? RDH magazine website. http://www.rdhmag.com/articles/print/volume-29/issue-12/about-the-site/nitrous-nightmares.html. Published December 1, 2009.
9. Leonard V. Health effects of chemical exposures during pregnancy and early childhood. University of California San Francisco website. http://sustainability.ucsf.edu/upload/sustainability/files/Health_Effects_of_Chemical_Exposures_During_Pregnancy_and_Early_Childhood.pdf. Published July 23, 2015.
10. What we do. Western States Pediatric Environmental Specialty Units website. https://wspehsu.ucsf.edu/about-us/what-we-do/.
11. Home page. Kem Medical Products Corp. http://www.kemmed.com/index.html.
12. Watterson D. Safety of x-ray units: Hygienist needs reassurance about handheld radiation devices. http://www.rdhmag.com/articles/print/volume-37/issue-1/contents/safety-of-x-ray-units.html. January 16, 2017.
13. Frequently asked questions. Nomad MD website. http://www.nomadmdxray.com/faq/#safety3.
14. Exercise and pregnancy. American Pregnancy Association website. http://americanpregnancy.org/pregnancy-health/exercise-and-pregnancy/. Updated February 16, 2017.
15. Third trimester pregnancy: What to expect. Mayo Clinic website. https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/pregnancy/art-20046767?pg=1. Published April 14, 2017.
16. Braxton Hicks contractions. American Pregnancy Association website. http://americanpregnancy.org/labor-and-birth/braxton-hicks/. Updated March 24, 2017.
17. Carpal tunnel syndrome. Office on Women’s Health, US Department of Health and Human Services website. https://www.womenshealth.gov/a-z-topics/carpal-tunnel-syndrome. Updated April 28, 2017.
Editor’s note: This article first appeared in RDH eVillage. Click here to subscribe.
Christie Lincoln, RDH, is a practicing clinical hygienist, mother of three and cohost of the MOMgienists podcast. She created “Your Smiling Hygienist” as a social media outlet to inspire the public, to seek and engage the fullest potential of a registered dental hygienist, in an effort to uplift and highlight the integral role of this unique, often underestimated, health-care provider.
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