If a patient's pregnancy begins to interfere with her work, and her employer has 15 or more employees, she may have the right to obtain work adjustments that allow her to remain employed, without jeopardizing her health, under the Pregnancy Discrimination Act (PDA) and the Americans with Disabilities Act (ADA). This fact sheet briefly explains how you, the health provider, can help your patient obtain these adjustments.
Your patient may be able to get an accommodation that allows her to do her regular job safely. Examples of accommodations include permission to sit or stand, ergonomic office furniture, shift changes, elimination of marginal job functions, permission to work from home, and altered break and work schedules, for example breaks to rest or use the restroom.
Your patient may be able to get an accommodation under the PDA if her employer gives accommodations to employees who have limitations that are similar to hers, but were not caused by pregnancy.
Your patient may be able to get an accommodation under the ADA if the source of her problem at work is a pregnancy-related medical condition that meets the ADA definition of "disability." Examples of pregnancy-related medical conditions that may meet the ADA definition of disability include cervical insufficiency, anemia, sciatica, preeclampsia, gestational diabetes, and depression. A condition meets this definition if it would, when left untreated, "substantially limit" one or more major life activities (e.g., lifting, standing, sitting, walking, reaching, bending, eating, sleeping, or concentrating) or major bodily functions (e.g., digestive, genitourinary, bowel, bladder, neurological, circulatory, or cardiovascular functions). A condition does not have to be permanent or severe, or result in a high degree of functional limitation, to be "substantially limiting." It may qualify by, for example, making activities more difficult, uncomfortable, or time-consuming to perform compared to the way that most people perform them. Further, if symptoms come and go, what matters is how limiting they would be when present.
If your patient needs an accommodation to do her regular job because of a disability, the employer must give her one, without reducing her pay, unless doing so would involve significant difficulty or expense.
Your patient might be able to get a reduced workload, removal of an essential job function, or a temporary reassignment under the PDA, depending on how her employer treats non-pregnant employees with similar limitations. However, even if this type of light duty assignment is available, you may first want to consider whether an accommodation is available that would allow your patient to do her regular job, particularly if light duty would come with reduced pay. (See Question 1 above.) The employer is not allowed to reduce your patient's pay because it gave her an accommodation that allows her to do her regular job.
If your patient can't return to work at all and has no paid leave, she still may be entitled to unpaid leave as an accommodation. She may also qualify for unpaid leave under the Family and Medical Leave Act. More information about this law can be found at www.dol.gov/whd/fmla. Some states and localities have passed laws that provide additional protections.
Your patient may ask you to provide a note stating that she is pregnant, and describing her pregnancy-related restrictions and limitations.
Sometimes an employer will ask for additional information, particularly if the employer is considering whether it can provide an accommodation under the ADA for a pregnancy-related medical condition. Documentation is most likely to help her to get an ADA accommodation if it explains, using plain language, the following:
The employer, perhaps in consultation with a health care professional, will use the information to determine whether a work adjustment is required under the PDA or ADA. The employer also may contact you to ask for clarification of what you have written, or to provide you with additional information to consider. For example, you may be asked whether a different work adjustment would be effective if the requested accommodation would be too difficult or costly to provide.
The ADA and the PDA do not alter a health provider's ethical or legal obligations. You should request an accommodation on behalf of your patient or disclose her medical information only if she asks you to do so and signs an appropriate release. Employers are required to keep all information related to accommodation requests confidential.
The PDA and ADA prohibit employers from engaging in discrimination and harassment based on pregnancy and pregnancy-related medical conditions, and from retaliating against employees.
More information about pregnancy discrimination and accommodations can be found in the EEOC publication Legal Rights for Pregnant Workers under Federal Law, and on the Equal Employment Opportunity's (EEOC's) website (https://www.eeoc.gov). The EEOC can be contacted by phone at 800-669-4000 (voice) or 800-669-6820 (TTY).