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In part 1 of this article (rdhmag.com/pregnancy1), we explored the physiological changes that can impact a dental worker's health and safety. We summarized concerns about exposure to a variety of hazardous materials found in dental offices. Part 1 also discussed the impact of laws that protect pregnant dental professionals. In part 2, we explore additional stressors for pregnant workers when progressing through each trimester and then returning to the work environment.
Physical strain and stress
Due to the nature of the job, the dental profession can lead to varying degrees of physical strain. Practitioners manipulate their bodies to adjust to clients’ needs, use repetitive movements, and depending on the schedule, have intense workloads.1 The neck, back, and upper limbs pose the majority of musculoskeletal strain.1
During pregnancy, women experience elevated progesterone and relaxin levels that increase joint laxity.2 They also experience weight gain and fluid retention, which make pregnant women more susceptible to musculoskeletal disorders (MSDs). Commonly affected areas coincide with areas where dental professionals already experience strain, such as the spine and upper and lower extremities.2 Pregnancy exacerbates preexisting conditions, which can lead to a recurrence or worse case of a condition such as carpal tunnel.2
Physical changes during pregnancy
First trimester
The first trimester (weeks 0-13) comes with a plethora of symptoms for a pregnant practitioner. They may experience mood swings, fatigue, frequent urination, shortness of breath, and nausea, to name a few.3 They may have difficulty completing direct patient care. Accommodations may need to be made, such as an altered work schedule, due to morning sickness, frequent breaks, and restrictions in exposure to nitrous and radiation (either from personal discomfort or advice from their physician). In this trimester, the woman needs time for pregnancy-related appointments every four weeks. (The first appointment is usually between weeks six and 10.)
Second trimester
The second trimester (weeks 13-27) often brings more complications. A pregnant dental professional may experience dizziness, leg cramps, Braxton Hicks contractions, nasal problems, or urinary tract infections.4 Accommodations may need to be continued or altered. For example, the professional may need a larger size gown and gloves, or alterations in the fit of their masks.
Obstetrician appointments continue every four weeks during this trimester unless the pregnant woman is deemed high risk. In this case, there may need to be more accommodations in the schedule for her absences due to more appointments. During this time, the dental team should find out how long their pregnant coworker intends to take for maternity leave and how the office will cover her workload.
Third trimester
It may be increasingly difficult for the dental professional to work during the third trimester (weeks 28-40). During this trimester, the pregnant professional may experience Braxton Hicks contractions, backaches, sciatic nerve pain, shortness of breath, heartburn, and frequent urination.5
Studies show that 31% to 62% of pregnant women experience carpal tunnel.6 While research is ongoing, evidence suggests that pregnancy may increase the occurrence of carpal tunnel syndrome in dental professionals. This is likely due to the hormonal changes that can exacerbate preexisting conditions, combined with the repetitive hand motions common in dentistry.6
These conditions may lead to continued or adjusted work accommodations. To manage pregnancy-related symptoms, the pregnant worker might require longer appointments to complete nonsurgical periodontal therapy or other types of debridement, may need more frequent breaks throughout the workday, and may take additional time off to attend appointments for massages, chiropractic care, or physical therapy.
In this trimester, a pregnant worker usually has prenatal appointments every two weeks. By this time, the dental office should have a plan for maternity leave coverage and have backup plans in the event of an early delivery or inability of the pregnant practitioner to complete her job duties.
Fourth trimester
The fourth trimester (weeks 0-12 after delivery) is not widely discussed but is important to consider. Maternity leave averages six to 12 weeks depending on the woman’s delivery method. The fourth trimester may present with a new set of challenges, such as decreased sleep, fatigue, physical discomfort, breastfeeding complications, stress, and possible onset/exacerbation of mental health disorders.7
After childbirth, some mothers experience the baby blues, which can last a few days to a few weeks. These are feelings of sadness, anxiety, and mood swings caused by hormonal changes. However, in some cases, a more serious condition called postpartum depression can develop. Postpartum depression may be mistaken for the baby blues, but it's more severe and lasts longer, sometimes up to a year after giving birth.8 Everyone in the office can help identify problems and offer intervention by checking on the new mother to see how she’s doing. The office may want to have a list of referral resources available should postpartum depression be suspected.
Returning to work
Returning to work is often an adjustment for a new mother. Here are two practical tips to make this transition as seamless as possible.
Test out childcare before the first day of returning to work: During the fourth trimester, mother and baby have been together daily, so the transition will be smoother if a routine is established before the first day back at the office.
Communication is key between employer and employee: The employee needs to communicate their expected return-to-work date and discuss a plan for breaks that allow for milk expression. The new mother should discuss the absences needed for pediatrician and OBGYN appointments, and any other appointments that may arise. By sharing this information, new mothers and their coworkers can prepare for a smooth transition. This will ensure a supportive environment when the new mother returns.
During pregnancy, a dental practitioner experiences a variety of challenges navigating the workplace. Knowing what to expect and planning carefully with the employer and dental team can make this experience positive for the new mother and her colleagues.
Editor's note: This article appeared in the October 2024 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.
References
1. Saccucci M, Zumbo G, Mercuri P, et al. Musculoskeletal disorders related to dental hygienist profession. J Dent Hyg. 2022;20(3):571-579. doi:10.1111/idh.12596
2. Fiat F, Merghes P, Scurtu A, et al. The main changes in pregnancy: therapeutic approach to musculoskeletal pain. Medicina (Kaunas). 2022;58(8):1115. doi:10.3390/medicina58081115
3. First trimester. Cleveland Clinic. Updated August 22, 2022. Accessed May 20, 2024. https://my.clevelandclinic.org/health/articles/9699-first-trimester
4. Pregnancy: second trimester. Cleveland Clinic. Updated November 8, 2021. Accessed May 20, 2024. https://my.clevelandclinic.org/health/articles/16092-pregnancy-second-trimester
5. Third trimester. Cleveland Clinic. Updated March 15, 2024. Accessed May 20, 2024. https://my.clevelandclinic.org/health/articles/third-trimester
6. Horsager-Boehrer R, Carpal tunnel syndrome and pregnancy go hand in hand. UT Southwestern Medical Center. October 20, 2020. Accessed May 20, 2024. https://utswmed.org/medblog/carpal-tunnel-syndrome-pregnancy/
7. Optimizing postpartum care. Obstet Gynecol. 2018;131(5):140-150. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/05/optimizing-postpartum-care
8. Postpartum depression. Mayo Clinic. Updated November 24,2022. Accessed May 20, 2024. https://www.mayoclinic.org/diseases-conditions/postpartum-depression/symptoms-causes/syc-20376617
