When Johnny Met Rosie--Women in EMS Part 8: Baby On Board

"The moment a child is born, the mother is also born. She never existed before. The woman existed, but the mother, never. A mother is something absolutely new." --Rajneesh

One thing writing this series on women in EMS has done is put me in touch with remarkable people. I get letters from all over the country from women who tell me about their experiences in EMS. One letter came from Saveria Sardone, a paramedic out of Chester County, PA, who asked me what it was like to work while I was pregnant. I read the question a few times and began laughing out loud.

How could I have gone this far in a series about women working in EMS and not covered the one thing that is absolutely gender-specific? The one thing we can do that is irrefutably a woman's role? Pregnancy--that life-creating medical miracle that turns us from one of the guys into something mystical and suddenly fragile, something...feminine.

EMS is an unpredictable job; the same applies to its physical demands. You can never predict from one call to the next what will be asked of you. Will you have enough resources to assist you? What will be required to remove a patient safely from the scene? Is there the potential for violence? Is the driver operating your vehicle doing the best he or she can to get to the destination safely versus quickly? These are all risks that we enter into every single dispatch taking.

You just don't notice them quite so much until you are pregnant.

I don't know about the rest of you, but my ob-gyn hated my line of work. During my early check-ups I would get the stern "no lifting anything over 25 lbs in the first trimester" lecture, which was met by a raised eyebrow and barely suppressed scoff. There were the lectures about getting enough rest, hydration, eating right, staying off my feet and in general doing everything that I was not hardwired to do. I have always had more than one job, I suck at drinking water, and I worked nights. so nutritional needs were met when opportunity struck, not how the guidelines dictated. If putting my feet up on the dash counts, well at least I did that.

One thing that does come with pregnancy (besides water weight and an intense craving for pancakes at 2 a.m.) is the sudden and unexpected reemergence of chivalry. All of a sudden, I never seemed to lack for an extra set of hands. I would get nudged out of the way when I started to grab my fair share of equipment, sometimes not too kindly, either. My stair chair technique grew rusty, because if I even thought of picking up my usual end it was met with cries of dismay. If I was having a bad day, it was no longer met with payback, just quiet suffering. Even the dispatchers kept an ear to the ground, and my workload was as good as they could make it for me, especially toward the end before my leave.

Frankly, on some level, it irritated the crap out of me.

We work so hard for parity--to be seen as a fully functional team member--that I did not want to be viewed as weak or incapable. There was a ridiculously stubborn part of my brain that resented being told what I could or should not do. You know that everyone is being considerate and that it's not a personal insult or implication of your inability to do the work, but it still feels unnecessarily restrictive, especially if you are feeling fine physically.

And that, my dears, is because it has yet to hit you. It's not just about you anymore, is it?

No, it's about that delicate life developing inside you. The one you're exposing to all these unavoidable risks every time you go to work, whose very existence depends on you and your continued good health. Misjudging a lift, getting into an accident, the wrong fall or a kick to the stomach from a combative patient, and suddenly what would have been just an injury is now a tragedy. It's a very sobering prospect once you wrap your brain around it, and it often doesn't come until there's undeniable proof that there's another person there. You feel that tiny flutter, that little karate kick to the liver, and suddenly your entire perspective changes, and your every day routine becomes filled with new and exotic fears.

It's Mother Nature having a good giggle at the unavoidable changes that slowly but surely take away your superhero powers.

First, there's the fatigue and just general unwell feeling. You can normally push through this without drawing too much attention to yourself, unless of course there's nausea involved. So now you're tired, cranky, can't lift and the truck is filled with saltines, ginger ale and/or any other thing that keeps the cravings and stomach calm. I would like to point out, however, that this is no worse than anyone having to deal with a partner with a "man cold." As we all know, they are MUCH worse than a normal cold and are therefore resource-intensive emergencies.

The buttons on your shirt begin to groan, and you have to opt for neutral colors because the new gaps will flash that Victoria's Secret purple at anyone having a look. Your partner dons eye-shields just in case the threads give (and because he thinks he's funny). If you've lacked for curves, you now have them. Unfortunately, the process is not painless, and you go from wishing for a slow shift to an "any-shift-that-does-not-involve-driving-on-a-bumpy-road-and-why-didn't-I-take-the-junk-out-of-my-shirt-pockets" shift.

Your legendary game face begins to crack at the edges, weakened by this uncontrollable tide of hormones that take your comfort zone and accustomed environment and turn it into a sensory cheese grater. Sights and smells that would not hit your radar suddenly cause your face to crumple and your stomach to do somersaults. A good friend of mine had to endure both his partner at work and his wife at home being pregnant at the same time. He was a haggard mess by the end of any given day, just from being buffeted by the emotional storms. Admittedly, in true EMS fashion, his tour mates were less than helpful. They quickly picked up on his partner's various triggers and took great delight in laying out a hormonal minefield for him. It's all out of love, of course.

You have to pee every 10 minutes. Enough said.

You try your best and are careful doing any lifting, but eventually you simply can't, not because your arms are rubber bands, but because you have to extend them an additional foot in front of you. Third trimester makes you a flat-out ergonomic nightmare. Before either of my children ever saw the light of day, they made their living as a fulcrum for mommy so she could get down to an angle where she could still intubate in the back of a moving truck. I never went anywhere at work without a clean sheet to put on the ground, because I knew once I got there I would be there for a bit.

First the shirts go, then the belt...notch by notch, until you give up and find pants that are remotely navy blue and won't fall down. If you're really lucky, the boots may go, too, if there's any peripheral edema involved. This also garners you the added benefit of your EMS friends wanting to check your pressure every hour or so, because you might fall down and seize at any moment.

The system where I work uses status system management--posting. So now add the additional factor of having to sit in a truck for the balance of a shift. I would fall out of the truck in the morning in tears, barely able to straighten up. You find out that being on the road when pregnant is just not an easy course to navigate; not impossible, but certainly more challenging than most people expect it to be.

Don't read this as a litany of complaints, but observations. Pregnancy is life-changing for the mother in so many ways. It's the ultimate proof that no matter how hard we try, or how we are perceived, we are never truly "one of the guys." Reaffirming our gender and our roles is not a bad thing. It was a good feeling to know there were people looking out for me and my unborn child, even when I was being stubborn about it.

During my first pregnancy, my partner was also my husband. While he did insist on carrying everything, he otherwise didn't hound me too badly, but I think that was likely because he felt since he was there with me, he could keep an eye on me better than if we were apart. (Note: I normally do not recommend working with your husband, pregnant or not.) When asked, he said that his two greatest fears were my physical well-being, as in getting hit or hurt, and pathogens. The former I expected; the latter caught me off-guard. He simply feared what the baby and I might inadvertently be exposed to when we come across so much in the course of a shift. Being exposed to those invisible enemies while pregnant would complicate any treatment after the fact.

My second time, my new partner was also pregnant. She was a couple of months ahead of me, but there we were in a big shiny ambulance just loaded with hormones and salty snack goodness. We were the department's private nightmare. Now they had to fight off two of us when we had to move a patient. Ambulances raced across town just to make sure we didn't do anything foolish like...go to a call by ourselves. I am happy to report that neither her son nor my daughter suffered any injuries or deficits as a result of being balanced on like an exercise ball so we could do things like access entrapped patients or intubate in odd positions.

So Saveria, that's pretty much what it was like to work when I was pregnant. It was uncomfortable and challenging, but not impossible. The guys (and girls) I work with were awesome, and it was a true blessing to go to work with that absolute confidence that someone there had your back if you needed them.

Today's viewpoint on pregnancy is one that advocates it not as a disability, but as a temporary condition, and most OB practitioners do not put women on leave until the extreme end of their pregnancy. I fully support that for the average woman, but not for EMS or any of the emergency services. In the absence of light duty, which many places do not have, those last couple of months are too physically difficult and I believe put us at tremendous additional risk for injury. Unfortunately, many physicians do not have a full understanding of the scope of our job, so without complications to place one at risk they may not support you coming off the truck. This is a discussion you need to have with your doctor early on, and have plans in place for before and after the baby comes.

Educate the doctor. Talk to your OB in detail about what your job entails and what your concerns are. If your department does not have light duty, explain that. It took a lot of discussion for my first OB to realize what I was going through night after night. Make a plan for when they feel you should stop working.

Talk to your co-workers. Tell them when you're ready, but tell them. Make sure they understand that if you are hesitant or are asking for lift assists when they normally make you break out in hives, there is a reason for it. Brief your manager. Let him/her know that you will be out of work at some point so they can plan ahead. Get the OK to modify your uniforms as it becomes necessary. Don't forget to thank them for looking out for you.

Invest in a cooler. Start packing your lunch. Make sure you always have things on hand to eat or drink. HYDRATE. I can't say this enough. You may not want to, especially at work (see: "pees every 10 minutes"), but it's too important not to. Most women in their third trimester are mildly dehydrated most of the time, and dehydration is a leading cause of early labor. I did my time in L&D in the middle of shifts, because I would double over with contractions out of nowhere. So drink your water.

Have a financial plan. Whether you go out early or late, you will be out of work for a period of time--period. If you rely on that income, you need to prepare for the impact of reduced income. Check your benefits; find out what's covered and how your leave of absence will be handled. Sick or personal time is finite--after that it is usually disability. Disability is a government process that, just like anything else, takes time to process and will not be your full salary. How will you make up for that gap?

If you do not have disability insurance, get some; if you have it, make sure it covers pregnancy (many do not).

Don't take unnecessary risks. Just because your superhero powers are waning, it's only temporary. Don't feel that you have to prove a point, especially when it's at a critical juncture for the baby. Let people help you lift, let them stand in front of you, grit your teeth and ask for help if it means playing it safe. Believe me, I know how it feels, but it only takes a second to go from injury to tragedy.

Pregnancy is one of those unique life experiences that are almost universally met with happiness. People naturally smile when they find out, they want to share their experiences, and they want to know how you're feeling and what they can do. Yes, you will have to put up with some horror stories, bizarre advice and people with an obsessive need to rub your belly. Ultimately, it is sharing in that primal joy and sense of community that comes with a new and innocent life. The arrival of an unconditional expression of love is something we can all look forward to on some level. Besides, once the baby comes you'll have to go back to carrying your own equipment, so enjoy it while you can.

Tracey A. Loscar, NREMT-P, is the training supervisor in charge of QA at University Hospital EMS in Newark, NJ. Contact Tracey at taloscar@gmail.com.

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