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Publié le 28.07.2021
In accordance with the International Labour Organization’s Maternity Protection Convention (No. 183) and European Union Directive 92/857CEE (1992), Switzerland’s Labour Law and its Maternity Protection Ordinance (OProMa) aim to protect the health of pregnant employees and their future children while enabling them to pursue their working activities. Gynaecologists-obstetricians have a key role in this legislation, particularly through the prescription of preventive leave for patients who would otherwise face dangerous or arduous tasks in the absence of an adequate risk analysis or suitable protective measures. However, international and national literature suggests that gynaecologists-obstetricians may encounter difficulties in fulfilling their role.
| Article of the legislation | Types of working conditions and activities that are considered to be dangerous or arduous for pregnant employees under the OProMa |
|---|---|
| OProMa art. 7 | Shifting heavy loads |
| OProMa art. 8 | Working in extremes of cold (below –5°C), heat (over +28°C) or very wet conditions |
| OProMa art. 9 | Movements and postures generating early fatigue (e.g., extensive stretching or bending, continuous crouching, etc.) or other tough conditions such as vibrations, shocks and bumps |
| OProMa art. 10 | Exposure to micro-organisms |
| OProMa art. 11 | Noise exposures |
| OProMa art. 12 | Ionising and non-ionising radiation |
| OProMa art. 13 | Exposure to dangerous chemicals |
| OProMa art. 14 | Constraining working-time organisation |
| OProMa art. 15 | Piecework and/or activities at a predetermined work-rate without the possibility of flexibility from the pregnant employee |
| OProMa art. 16 | Work in high pressure or in workplaces with an oxygen-reduced atmosphere |
| Activity | Detailed description | Article of the legislation if applicable |
|---|---|---|
| Determination of the aptitude for work of the pregnant or breastfeeding mother | The ob-gyn determines the aptitude for work of the pregnant or breastfeeding mother. He or she shall take account of the following: (a) the interview with the worker and her medical examination; (b) the results of the risk analysis carried out for the company by a specialist; (c) any additional information obtained during an interview with the occupational health specialist who carried out the risk analysis or with the employer. | Art. 2; al. 2 of the OProMa [19] |
| Pregnancy consultation | During pregnancy consultations, gynaecologists-obstetricians have to ask their patient about her occupational conditions and work activities that might be dangerous or arduous for their health or that of their unborn child. The OProMa describes the objective criteria and threshold values above which specialists must consider the activity or exposure as dangerous for pregnant workers. | Art. 7-16 of the OProMa [19] specify and supplement the list risks proposed by the art. 62 OLT 1 [21]. |
| The decision must also take into account the specific working conditions, such as the accumulation of several loads, the duration of exposure, the frequency of the load or hazard and other factors that may have a positive or negative influence on the risk potential to be measured. | Art. 6 of the OProMa [19]. | |
| Risk analysis | In the presence of alleged health dangers, contact the expectant mother’s employer and ask for a risk analysis to decide whether they can safely continue their work. | |
| The specialists legally entitled to carry out a risk analysis are: occupational physicians and occupational hygienists, as well as other specialists such as ergonomists who have acquired the necessary knowledge and experience in risk assessment. | Art. 17 of the OProMa [19]; art. 63, al. 1, OLT 1 [21]. | |
| Preventive leave | On the basis of the interview with the worker and her medical examination, a pregnant woman or a breastfeeding mother should not work if: (a) no risk analysis has been carried out or the one carried out is insufficient or inadequate; (b) a risk analysis has been carried out but the necessary protective measures are not implemented or are not respected within the company; (c) a risk analysis has been carried out and protective measures are taken but these are not sufficiently effective; or (d) There are indications of a risk to the worker or her child. In these scenarios, the ob-gyn should prescribe preventive leave in accordance with the precautionary principle. | Art. 2, al.3 of the OProMa [19]. |
| Other resources | The guide provided by the State Secretariat for Economic Affairs (SECO) designed explicitly for attending physicians on the protection of pregnant workers. The DSTE specialised occupational medicine consultation for pregnant workers. The DSTE training on OProMa, pregnant workers’ rights and the role of relevant stakeholders within legislation. | - |
| Sick leave | Preventive leave | |
|---|---|---|
| Cause | Pathologies both linked and not linked to the pregnancy. | In the following scenarios, the ob-gyn should prescribe preventive leave in accordance with the precautionary principle: (a) no risk analysis has been carried out or the one carried out is insufficient or inadequate; (b) a risk analysis has been carried out but the necessary protective measures are not implemented or are not respected within the company; (c) a risk analysis has been carried out and protective measures are taken but these are not sufficiently effective; or (d) There are indications of a risk to the worker or her child. |
| Remuneration | 100% for a period depending on the length of employment; or 80% for two years (in case of a loss of earnings insurance). | 80% of salary throughout the entire period of preventive leave. |
| Cost coverage | Employer or employer’s loss of earnings insurance. | Employer. |
| Costs of pregnancy consultations resulting in | National health insurance scheme (LAMal). | Employer. |
| Variables | Description | Type of variable |
|---|---|---|
| The most common risky activities encountered by gynaecologists-obstetricians during pregnancy consultations | The questionnaires proposed a list of risky activities as detailed in the OProMa and in the Federal Labour Law, which can be dangerous for pregnant workers. As psychosocial risks the items “Detrimental psychological atmosphere” and “Stressful job” were also added in the list proposed to gynaecologists-obstetricians. We asked participants to select the five risky activities most commonly encountered during their pregnancy consultations. The item, “Strenuous postures or movements”, was only proposed in 2017. | Binary variables |
| Frequency with which gynaecologists-obstetricians asked questions concerning their patients’ profession, potential occupational risks, working conditions and job satisfaction during pregnancy consultations | Participants had to evaluate how often they asked questions about their patients’ profession, potential occupational risks, working conditions and job satisfaction during pregnancy consultations. The rating scale was, “never/rarely, sometimes, often, and always”. | Ordinal variable |
| Contact with the employer of a patient whose work poses a risk to pregnancy | Participants were asked if they had ever initiated contact with the employer of a patient whose work posed a risk to their pregnancy. | Binary variable |
| Reasons for not contacting employers in cases involving a suspected occupational risk and the absence of a risk analysis | Among the items proposed in the questionnaire, participants were asked to select one or more reasons why they might choose not to contact their patient’s employer. The only reasons given in both surveys were: (1) time constraints, and (2) the maintenance of medical secrecy. In 2017, participants could select four extra items: (1) refusal by the patient; (2) gynaecologists-obstetricians’ self-perceived lack of experience or competence; (3) it is the occupational health physician’s responsibility; and (4) I have never thought about it. | Binary variables |
| Difficulties in contacting the employer | Participants were asked if they had ever encountered difficulties when trying to contact the employer of a patient whose work posed a risk to their pregnancy. | Binary variable |
| Reasons for difficulties in contacting the employer | Among the items proposed in the questionnaire, participants were asked to select one or more difficulties encountered when trying to contact the employer. In both surveys, participants could select one or more of these items: (1) time constraints; (2) lack of cooperation from the employer; and (3) the maintenance of medical secrecy. | Binary variables |
| Frequency of prescription of preventive leave during non-pathological pregnancies | Participants were asked about the frequency with which they prescribed preventive leave in cases involving a non-pathological pregnancy yet a proven occupational risk. In the 2008 survey, gynaecologists-obstetricians were asked: “Since you began your clinical career, how many times have you prescribed preventive leave because of the proven or suspected occupational health risks facing a pregnant woman or her unborn child?” The possible answers were, (I have done this: 1 or 2 times; 3–5 times; 6–10 times; 11–20 times; more than 20 times). In 2017, we reformulated this question: “In cases involving a non-pathological pregnancy and strenuous and/or dangerous work activities, as per OProMa, how often do you prescribe workers preventive leave from their workstation?” The rating scale was, “never/rarely, sometimes, often, and always”. | Ordinal variable |
| To whom do you address the invoice after having prescribed preventive leave? | Participants in the 2017 survey were asked to whom they sent their invoices for the prescription of preventive leave following a pregnancy consultation. | Binary variable |
| Patients referred to occupational health physicians in cases involving suspected or proven occupational risks | Participants were asked if they referred their patients to occupational health physicians in cases involving suspected or proven occupational risks. | Binary variable |
| Reasons for not referring the patient to an occupational health physician | Among the items proposed in the questionnaire, participants were asked to select one or more items explaining non-referral to an occupational health physician. The reasons given in both surveys were: (1) I do not know any occupational health physicians; (2) I did not think about it; and (3) I can manage the situation myself. In 2017, participants had three more choices: (4) I do not have time to orient my patients; (5) the question of pregnant women’s occupational health is not a priority in my practice; and (6) I could not find any occupational health physicians available. | Binary variables |
| 2008 (n = 83) | 2017 (n = 93) | ||
|---|---|---|---|
| Age (years), mean ± SD | 52.7 ± 7.67 | 50.1 ± 9.98 | |
| % (n) | % (n) | ||
| Sex | Man | 55% (44) | 35% (31) |
| Woman | 45% (36) | 65% (57) | |
| Type of practice | Private practice | 50% (42) | 54% (50) |
| Private practice and hospital | 46% (38) | 20% (19) | |
| Hospital | 4% (3) | 26% (24) | |
| Canton of practice | Vaud | 37% (30) | 52% (48) |
| Geneva | 32% (26) | 24% (22) | |
| Fribourg | 13% (11) | 6% (6) | |
| Neuchâtel | 10% (8) | 11% (10) | |
| Valais | 4% (3) | 5% (5) | |
| Jura | 4% (3) | 2% (2) | |
| 2008 (n = 83) | 2017 (n = 93) | p-value | Odds ratio | ||
|---|---|---|---|---|---|
| Estimated percentage of patients facing an occupational risk, mean ± SD | 20 ± 16.1 | 22 ± 15.4 | 0.544* | 1.60 | |
| % (n) | % (n) | ||||
| The five most common risky activities encountered by gynaecologists-obstetricians during pregnancy consultations | Heavy loads | 81% (67) | 91% (80) | 0.067† | 2.52 |
| Standing for long periods | 87% (72) | 80% (70) | 0.084† | 0.43 | |
| Detrimental psychological atmosphere | 88% (73) | 78% (69) | 0.189† | 0.53 | |
| Strenuous postures or movements | NA | 65% (57) | - | - | |
| Stressful job | 81% (67) | 53% (47) | 0.009† | 0.37 | |
| Constrained schedule | 86% (71) | 0 | - | - | |
| Ask questions about: | Profession | 96% (78) | 99% (89) | 0.464† | 2.43 |
| Occupational risks | 71% (58) | 86% (77) | 0.028† | 2.64 | |
| Workplace conditions | 83% (67) | 84% (76) | 0.761† | 0.86 | |
| Satisfaction at work | 63% (51) | 68% (61) | 0.454† | 1.34 | |
| Contact with the employer of a patient whose work poses a risk to pregnancy | 52% (43) | 58% (50) | 0.333† | 1.40 | |
| Multiple-choice question: Reasons explaining no contact with employers in cases involving suspected occupational risk and the absence of a risk analysis | I have to maintain medical confidentiality | 73% (27) | 13% (11) | ||
| Refusal by the patient | NA | 48% (40) | |||
| Time constraints | 8% (3) | 29% (24) | |||
| Self-perceived lack of experience or competencies | NA | 26% (22) | |||
| It is the occupational health physician’s responsibility | NA | 18% (15) | |||
| I have never thought about it | NA | 14% (12) | |||
| Difficulties in contacting the employer | 67% (29) | 70% (35) | 0.106† | 0.46 | |
| Multiple-choice question: Reason explaining the difficulties in contacting the employer Gynaecologists-obstetricians in 2008: n = 29 Gynaecologists-obstetricians in 2017: n = 35 | Time constraints | 38% (11) | 71% (25) | 0.010† | 6.78 |
| Lack of cooperation from the employer | 76% (22) | 57% (20) | 0.033† | 0.20 | |
| Medical confidentiality | 45% (13) | 20% (7) | 0.037† | 0.23 | |
| Prescription of preventive leave during normal pregnancies with proven occupational risks | 72% (59) | 31% (27) | 0.000† | 0.16 | |
| Patients referred to occupational health physicians in cases involving suspected or proven occupational risks | 25% (21) | 62% (53) | 0.000† | 5.34 | |
| Multiple-choice question: Reasons explaining non-referral to an occupational health physician Gynaecologists-obstetricians 2008: n = 62 Gynaecologists-obstetricians 2017: n = 31 | I do not know any occupational health physicians | 52% (32) | 74% (23) | 0.001† | 10.69 |
| I did not think about it | 56% (35) | 35% (11) | 0.016† | 0.25 | |
| I can manage the situation myself | 29% (18) | 16% (5) | 0.072† | 0.30 | |
| I could not find any occupational health physicians available | NA | 13% (4) | – | – | |
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