Pregnant women who work have an increased risk of high blood pressure, according to new research from University College, Cork. And not just any old high blood pressure. Working women are almost five times more likely to get the worst kind, called pre-eclampsia, which can lead to swollen hands and feet, fits and even death.
Professor John Higgins, the author of the study, says the pressure of work (he didn't specify what sort of work) may increase levels of stress hormones and hence blood pressure. But his findings, he says, shouldn't frighten pregnant women into giving up work. "Working during pregnancy has become the norm," he points out.
Well that's all right then. But what about the other research that tends the same way? There's a 2000 study of nearly 170,000 pregnant women in the journal Obstetrics and Gynaecology, which showed that prolonged standing and shift work increases the risk of premature birth and that physically demanding work is associated with high blood pressure. And there's a study from California in the Journal of Occupational and Environmental Medicine a few years ago, which showed that women lawyers working more than 45 hours a week are three times more likely to miscarry in the first 12 weeks than women working less than 25 hours.
Economic necessity has made women more resilient to studies like that of Professor Higgins. Instead of feeling guilty, many women raise their game when they're pregnant, stifling their new physiological needs so as not to draw attention to their condition.
Pregnancy is physically challenging. The amount of blood you carry round your body increases by at least a third, making your heart pump faster. You feel breathless because there is a growing baby trying to push your diaphragm into your lungs. Your ankles swell, you're exhausted from not sleeping. You need to pee constantly because your womb is now the size of a giant rugby ball pressing on your bladder.
This collection of symptoms may not be pathological but being pregnant does make work harder. Throw in a hot summer day and a journey into work where no one's stood up to offer you a seat (pregnancy's normal isn't it?) and a pregnant woman may have reached heroic status before lunchtime.
But do women slack off when pregnant? Far from it. In fact, it is traditional for women to keep the first 12 weeks of pregnancy, often the worst, to themselves. They will quietly throw up in the toilet at work and then return, exhausted (a normal part of early pregnancy) back to work. In many workplaces there is even kudos attached to not acknowledging your pregnancy at all, even as you struggle to fit between your desk and the filing cabinet.
There are unhelpful high-profile examples of women who work until they are close to giving birth. Nicola Horlick, the investment fund manager, made sure her maternity leave coincided with Christmas (everyone's off then, aren't they?). Cherie Blair was working as a lawyer up to a week before Leo's birth. Many ordinary women, too, want to work until term. They don't want to crochet baby hats at home, fretting about things going wrong.
But still more pregnant women have to work. Statutory maternity pay is not enough to keep a roof over most families heads. Some companies may be generous but the usual 18 weeks leave, with only the first six at 90% of full pay, isn't close to being enough. In the US, where women are entitled to a mere 12 weeks off without pay, it is the norm for women to work until the day of delivery.
Here, women are entitled to leave work 11 weeks before their baby is due. Few take their entitlement because to do so means less paid leave after the baby is born. Who wants to leave a baby when it's a couple of months old? And even if you did decide to do so, few nurseries take babies under three months, and many childminders flinch at taking such young infants.
This week's budget does well to give new fathers two weeks paternity leave, but it's a small nod to the upheaval of a birth. For the majority of women, working as long as possible becomes normal. And they increasingly work as if they aren't pregnant at all because the culture of work insists upon it.
Recent government research shows that a woman will earn £241,000 less than a man, on average, in her career. But if a woman has two children she will lose an additional £381,000 over her working life. The Maternity Alliance recently warned that, with redundancies, it's women with babies who go first. This is the way the world works, so is it any wonder that women are loathe to say they need to take things a little easier than normal at precisely the moment they are most vulnerable to their employers' prejudices?
Professor Higgins' research will not stop many pregnant women working. Most have transcended feeling guilty or fearful because they know they have no choice. But they shouldn't have to ignore their pregnancy altogether. Pregnancy may not be a disease, but it is a condition. One that consideration in the workplace can improve considerably, but that only longer - and paid - maternity leave can really alleviate.
l.dillner@bmj.com
