Welcome to the Preparing Obstetric teams to promote equity in employment or promote clinical team member training. Sometimes she sent me home early 'cause she knew I was pregnant. They just started sending me home. That's why I said I just ended up leaving because they just keep sending me home and my checks would be just like short.

Both in our work and the lay press, there are numerous examples of likely well-meaning clinicians providing documentation that backfired resulting in lost wages or even termination. We developed this training with the goal to empower obstetric clinical team members with the basic knowledge needed to counsel patients and provide documentation when it is needed.

We know that obstetric team members have so many things to cover during each prenatal visit. And you're not a lawyer or a human resources specialist. We've designed this training to be practical and to give you basic information so that you can accurately counsel patients and you can direct them to additional resources when it's needed.

In this training that lasts about 20 minutes, we'll cover several important topics quickly. You can start, stop. Or repeat parts of the training as you need to. We'll ask some questions along the way to check for understanding, and at the end you can take a quiz and if you submit your answers and score 80% or higher, you'll get a certificate.

We'll start with the law, then move on to a review of the literature on workplace safety during pregnancy. We'll also cover dos and don'ts for providing documentation for an employer.

Let's start with the law. In section one, we'll review the federal laws that protect pregnant and postpartum workers in the United States.

While we are going to focus on the federal laws, there may be additional protections offered by state or local laws, or even by the patient's employer, so it's important to direct patients to additional resources as they're necessary. While there are several laws and statutes that may be applied based on the specifics of a case, we're going to cover the highlights of the most relevant federal legislation, the Pregnancy Discrimination Act of 1964, the Family Medical Leave Act of 1993, and the most recent legislative acts, the Pregnant Fairness Act, and Federal Labor Standards Act, or the Pump Act both enacted in 2023.

The Pregnancy Discrimination Act of 1964 prohibits discrimination based on pregnancy, childbirth, or its related medical conditions. That means there's a whole host of things that employers can't do legally to someone who is pregnant or may experience childbirth, for example, it's illegal for an employer to deny hiring promotion or to restrict work because of pregnancy or recent childbirth.

Importantly, the Pregnancy Discrimination Act also applies to people not only who are pregnant, but also to an individual who an employer thinks might get pregnant or who's had a past abortion. The Family Medical Leave Act or FMLA as most people know, it protects individuals from losing their jobs for 12 weeks when they take time off due to their own medical condition or to care for a family member.

FMLA provides up to 12 weeks of unpaid leave per year, and it can be taken all at once or as needed. Importantly, FMLA is only required to be offered by employers if the employer has 50 employees within 75 miles of the employee's website work site. And that individual employee has worked there, has worked at the company for at least 1,250 hours within the last 12 months prior to the start of leave.

As you can imagine, it can be challenging sometimes for employees to know whether or not they truly qualify for this benefit. The best thing to do is to refer a patient to check with their hr, their employee handbook, or a direct supervisor to determine their eligibility. This is also an important opportunity for them to learn about any additional protections or benefits that's offered through their individual employer.

There are several steps to requesting FMLA leave. The first step is that the patient should make the request of their employer for FMLA leave, and in general, patients are required to notify their employer at least 30 days in advance of an impending leave. They don't necessarily have to say the words FMLA or even disclose pregnancy at that moment.

However, they should provide enough information to let their employer be aware that they may have a need for leave. The second step is that the employer is obligated to notify that person whether or not they're actually eligible for FMLA leave and they're obligated to make this eligibility determination within five business days of the request.

Part of that process, the employer must provide FMLA rights and responsibilities, and they can also ask for a certification of medical condition from a licensed healthcare provider.

Next, we'll walk through a sample of what the certifying medical forms typically look like. Section one should be completed by the employer, and it includes the employee or in this situation, your patient's name, the employer's name, the date at which the medical certification is due. The employee's job title and their regular work schedule along with their essential job functions.

It's not uncommon that we receive forms when this section one has actually not been completed, and in that situation, it's best to ask the patient about their job title and regular job duties to guide completion of the rest of the form. Section two is to be completed by the healthcare provider or the healthcare provider team, and it's divided into three parts.

Part A typically asks for medical information. It will ask what time the condition will start, the best estimate of when the condition will end, and then the third question asks for more details about the specific condition. And then there's typically a box that allows the medical provider to identify that the condition is a pregnancy and to list the expected delivery date.

Part B of the healthcare provider section asks about details about the amount of leave that will be needed. In this section, the provider details, any planned medical treatments, referrals to other healthcare providers, and the estimated dates of time that the, that the individual will be unable to work or need accommodations.

Section C then asks about essential job functions and whether or not the employee is able, not able, or will not be able to perform one or more of their essential job functions. Most often requiring time off for medical visits or time away for a postpartum recovery is considered a period of time when someone cannot perform their essential job functions.

Once the employer has asked for a medical verification form, patients should return that form back to their employer within 15 calendar days after the employer's request. The employer must notify the patients of their FMLA status and if they're covered by FMLA, they must allow the person to come back to their position or an equivalent position after the F-M-L-E-F-M-L-A leave has ended.

The Pregnant Workers' Fairness Act is newer legislation that was enacted in June of 2023. Under this law, employers with greater than 15 employees are required to provide reasonable accommodations during and after pregnancy. A reasonable accommodation is a change to an individual's job that helps them keep working and does not cause undue hardship to the employer.

Reasonable accommodations will vary based on an individual's employer and their job description. Some examples are extra breaks, a sitting stool or allowing food or drinks at the workstation. You can imagine that something that's very reasonable in one job may be completely unreasonable for another unless there's an absolute medical contraindication to a specific activity.

It's important to ask your patient about their job duties. Prior to making suggestions about reasonable accommodations in general, your patients should have access to the same modifications that an employer has provided to any other employee in a similar position when they have a temporary condition that limits their activity, such as a broken leg or a sprained ankle.

Also, technically medical documentation from a provider is not ne, is not required. However, that may be very helpful to the patient. There is also federal legislation that applies to lactation. The Fair Labor Standards Act includes specific protections that are for lactation known as the Pump Act. Most employees have the right to reasonable paid break time in general.

That's about 20 minutes. And a private space to pump that is not a bathroom for up to one year. It's important to note that some specific employers are exempt. For example, railroads, airlines, and some small businesses with less than four 50 employees are exempt if a compliance would create an undue hardship.

Again, medical documentation typically isn't required. However, it can be helpful for your patients when a well-written work note is provided more to come on this. We've covered the most important federal employment laws that have implications for pregnant and postpartum workers. In summary, the Pregnancy Discrimination Act made it illegal to discriminate based on pregnancy or postpartum status.

FMLA protects a pregnant or postpartum worker's job for 12 weeks per year, but it does not protect their paycheck. The Pregnant Workers' Fairness Act mandates reasonable accommodations and the Pump Act mandates paid break time, and private space for pumping. Now, let's do a quick check for understanding the first question.

How long does FMLA provide unpaid leave for covered employees? Is it a five weeks B, 10 weeks, C 12 weeks, or D 24 weeks? If you chose C 12 weeks, you are correct, true or false? Break time for expressing milk should be paid for employees who are covered under the Pump Act. That statement is true. Break time for expressing milk should be paid for employees who are covered under the pump Act.