Guidance for doctors who are pregnant or breastfeeding

Case studies and resources

Updated: Tuesday 9 July 2024

Risks associated with working patterns during pregnancy:

Both research and anecdotal evidence suggest that exposure to shift work and long working hours during pregnancy is associated with the risk of adverse outcomes such as:

  • Preterm birth
  • Low birthweight
  • Small for gestational age
  • Miscarriage
  • Gestational hypertension
  • Pre-eclampsia
  • Stillbirth

Research on this subject included:

  1. A recent analysis of 62 independent studies from 33 countries, which revealed that pregnant women working a fixed night shift had 21% higher odds of preterm delivery and 23% higher odds of having a miscarriage than pregnant women working a fixed day shift. The analysis also indicated that longer work hours (more than 40 hours per week) was associated with a 21% higher chance of preterm delivery and a 38% higher chance of miscarriage
  2. A study examining the influence of occupational activities during pregnancy on maternal and foetal health outcomes, which found that physically demanding work during pregnancy is associated with an increased risk of adverse pregnancy outcomes
  3. A study has found that women who work two or more night shifts in one week may have greater risk of miscarriage the following week
  4. Studies which concluded that pregnant women who work rotating shifts, fixed night shifts, or longer hours have an increased risk of adverse pregnancy outcomes, with up to a 10% increase in the odds of having a preterm delivery for pregnant mothers who worked the longest hours compared to those who worked shorter hours.
  5. An analysis by the IFS that found that the average contracted hours of doctors/dentists drops to 85% of full-time hours following their return from maternity leave, mainly driven by switches to cotracts of 60%–65%, or 80%, thereby highlighting that the current situation is preventing these doctors and dentists from fully contributing to the NHS.

BMA data

The BMA collected data through a survey looking at the experiences of being a pregnant doctor working in the NHS.

While there were examples of good practice, multiple respondents highlighted their negative experiences, with one respondent stating that ‘the support returning to work was abysmal.’ The results of the survey demonstrated that work must be done to address the issues raised and ensure that employers are delivering their legal obligations. Further information on the findings of the survey is included in our final report.

Case studies

  • ‘Ahead of my risk assessment, I wanted an exemption from night shifts and patient-facing work from 28-week gestation. However, after the risk assessment, there were no adjustments made. I felt unsupported. I remained on the on-call rota till I went on maternity leave at 36 weeks and I was patient facing till then as well. In terms of further support, I would have liked better working conditions, exemption from on call rota and long hours and support to pump breast milk when I returned to work.
  • ‘Ahead of my assessment, I wanted exemption from working night shifts. After the risk assessment, my employer stopped all night shifts from the 1st trimester which was essential due to my fatigue. I continued on-call duties up until 9pm however due to risks conducting MHA (assessments including violence) I expressed concerns about continuing from 23 weeks. I started to feel vulnerable in certain situations. I discussed this with my supervisor & medical staffing who agreed to stop my on calls completely at 23 weeks. It has been refreshing to be listened to and not feel guilty for these adjustments. In terms of further support, it would be useful to have clearer guidance and have more understanding of the risks - with guidance in place it places less pressure on the trainee to raise their concerns and worries.
  • ‘Ahead of my risk assessment, I wanted an exemption from night shifts. After my risk assessment, the adjustment was made, and I was also exempt from having the crash bleep. However, there could have been more support with breast feeding in return to work – it was not brought up at all.

Readers may find the following link useful:

Further information

The BMA’s Sexism in Medicine Report found a lack of support for pregnant doctors, both structurally and culturally. Doctors shared that they had been expected to put their careers ahead of their own health and the health of their unborn child and many examples were shared that pregnancy was viewed by some doctors as a negative implication of women joining the profession. The BMA’s Ending Sexism in Medicine pledge identified guaranteeing safe and supportive environments for pregnant doctors and medical students as one of the ten goals to ending sexism in the medical profession.