Agriculture is one of the most high-risk industries. ACOG advises that prenatal care providers play a critical role in assisting patients working in high-risk occupations to have a safe pregnancy.
Hazards in farm work include falls, heat exposure, heavy lifting, joint and ligament injuries, and exposure to dust and farm chemicals, including pesticides, mold, bacteria, and animal droppings.[i] Studies show that prenatal pesticide exposure increases the risk of negative health effects for the pregnancy and developing fetus.[ii] According to the CDC, “exposure to pesticides could increase [the] chances of having a miscarriage, a baby with birth defects, or other problems. Some pesticides also may be able to pass into breast milk.” Additionally, the high physical demands commonly associated with farm work, such as heavy lifting, prolonged standing, or bending, may increase adverse birth outcomes.[iii]
State Disability Insurance (SDI) benefits are available to farmworkers and others whose job makes it unsafe to work during pregnancy due to exposure to chemicals or other hazardous conditions.
According to the Employment Development Department (EDD), which administers SDI, “If your patient’s job requirements (e.g., lifting, continuous standing, chemical exposure, etc.) pose a danger to the health of your pregnant patient or the fetus, she can file for Disability Insurance benefits. You must submit the medical certification with a valid pregnancy-related diagnosis code and the applicable diagnosis code for the occupational hazard.” For instructions on how to certify, including relevant ICD-10 Codes, see California State Disability Insurance for Farmworkers During Pregnancy.
Medical care providers can write work accommodation notes for pregnant, breastfeeding, and postpartum patients to recommend changes at work needed for safety, health, and comfort.
For instructions on how to recommend work accommodations, including a template work note, see California Guidelines for Drafting Work Accommodation Notes for Pregnant and Postpartum Patients, a resource from the Center for WorkLife Law at the University of California that has been recommended by ACOG. For information on breastfeeding work accommodations, including a sample work note, see Helping Patients Seek Breastfeeding Accommodations.
Many thanks to the Dar a Luz Advisory Committee on Environmental Exposure for their contributions!
[i] Rural Health Information Hub, Rural Agricultural Health and Safety, https://www.ruralhealthinfo.org/topics/agricultural-health-and-safety
[ii] Freinkel S. Warning Signs: How Pesticides Harm the Young Brain, The Nation, March 2014, https://www.thenation.com/article/archive/warning-signs-how-pesticides-harm-young-brain/; Eskenazi B, Harley K, Bradman A, Weltzien E, Jewell NP, Barr DB, et al. Association of in utero organophosphate pesticide exposure and fetal growth and length of gestation in an agricultural population. Environ Health Perspect. 2004;112: 1116–1124; Young JG, Eskenazi B, Gladstone EA, Bradman A, Pedersen L, Johnson C, et al. Association between in utero organophosphate pesticide exposure and abnormal reflexes in neonates. Neurotoxicology. 2005;26: 199–209; Eskenazi B, Marks AR, Bradman A, Harley K, Barr DB, Johnson C, et al. Organophosphate pesticide exposure and neurodevelopment in young Mexican-American children. Environ Health Perspect. 2007;115: 792–798; Marks AR, Harley K, Bradman A, Kogut K, Barr DB, Johnson C, et al. Organophosphate pesticide exposure and attention in young Mexican-American children: the CHAMACOS study. Environ Health Perspect. 2010;118: 1768–1774; Bouchard MF, Chevrier J, Harley KG, Kogut K, Vedar M, Calderon N, et al. Prenatal exposure to organophosphate pesticides and IQ in 7-year-old children. Environ Health Perspect. 2011;119: 1189–1195; Raanan R, Harley KG, Balmes JR, Bradman A, Lipsett M, Eskenazi B. Early-life exposure to organophosphate pesticides and pediatric respiratory symptoms in the CHAMACOS cohort. Environ Health Perspect. 2015;123: 179–185; see also ACOG Committee Opinion 575.
[iii] Centers for Disease Control and Prevention, Physical Job Demands– Reproductive Health, https://www.cdc.gov/niosh/topics/repro/physicaldemands.html