Kristina Box, MD: Pregnant workers deserve safe conditions
Note: On Feb. 4, the Indiana Senate amended Senate Bill 342 to delete a provision that would have expanded reasonable accommodations for pregnant workers, including allowing them to take longer breaks, do less physical work and take unpaid leave after giving birth. The amended bill designates this provision for consideration by a summer study committee.

By Kristina Box, MD, FACOG
Indiana State Health Commissioner


As an obstetrician, state health commissioner, a mother and now grandmother, my passion is to attack Indiana’s infant mortality and maternal health issues from every front. In Indiana, we are fortunate to have the support of Gov. Eric J. Holcomb, who is committed to improving the health of our moms and babies. That is the foundation of his proposed legislation that would require reasonable accommodations in the workplace to help protect pregnant women.

More than 80,000 babies are born in Indiana each year, and the majority of them are born to women who work outside the home. Women make up almost 50% of Indiana’s workforce, and of those, nearly one-third are ages 16-44, a range that includes the peak childbearing years. 

Working during pregnancy is generally safe, according to the American College of Obstetrics and Gynecology. However, for women in physically demanding occupations or those with medically complicated pregnancies, work accommodations can allow for continuous and safe employment during pregnancy, which benefits the woman, her baby and her employer.

Steps hospitals can take
Throughout my obstetrical career, I have collaborated with employers to support women who work safely well into their last month of pregnancy. I have seen hospitals adjust workflows so that pregnant providers and nurses do not have to lift patients from one bed to another. We have shifted their roles in the operating room so they did not have to stand for prolonged periods and avoided putting the pregnant caregiver at risk by caring for highly infectious patients whenever possible. 

Pregnancy accommodations are often simple, such as having water to drink at a work station, being able to sit down or take more frequent breaks, limiting the amount of weight a woman must lift repetitively, allowing a snack between meals for a pregnant woman who is diabetic, or taking steps to reduce falls as her center of gravity changes. 

Basic changes, big impact
These basic changes can have a significant impact on the health of moms and babies, including a lower risk for preterm birth, the number one cause of infant mortality in our state. They also can benefit employers by allowing women to work longer into their pregnancies. I once saw a pregnant attorney hospitalized on bed rest bill a record number of hours because she was able to continue working remotely.

More clarity needed
While the federal Occupational Safety and Health Administration has guidelines regarding workplace exposures to radiation and other toxins that can harm a developing fetus, existing federal law surrounding pregnancy accommodations is vague and ambiguous. Many employers, including those in Indiana, offer some level of accommodation. The provisions originally included in Senate Bill 342 would add clarity for employers and women without creating any undue burden on businesses. 

To date, 27 states, including Illinois and Kentucky, and Washington, D.C., have passed additional laws clearly outlining what reasonable pregnancy accommodations are expected in the workplace. I believe this legislation will help eliminate confusion and create consistency among Indiana employers and employees. 

How Indiana benefits
I am proud to be from Indiana, because as a state, we value families, children and the unborn child. 

Pregnancy is just a season in the life of a woman and her family. Supporting her during this critical time allows employers to improve morale, protect the investment they have made in training that individual, and potentially decrease the financial burdens created by absenteeism or high health care costs associated with preterm birth. 

By creating partnerships between employers, obstetrical providers and pregnant women and making reasonable accommodations during pregnancy and the newborn period, we can decrease Indiana’s high infant mortality rate, improve maternal health and ensure that our workforce remains skilled and robust.