In a commentary published in Obstetrics and Gynecology, five doctors and a lawyer warned that unspecific or poorly timed notes could bring harsh responses from employers.

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Women who seek accommodations from their employers during pregnancy are sometimes fired or forced into unpaid leave for a surprising reason: Their doctor’s note was not carefully worded, experts warned earlier this month.

Doctors routinely write employment notes for pregnant patients requesting a change to work duties for a health concern. But until now, few realized how those notes can backfire.

In a commentary published in Obstetrics and Gynecology, five doctors and a lawyer warned that unspecific or poorly timed notes could bring harsh responses from employers.

“We can do harm if we are not careful when writing these notes for patients,” said Dr. Rebecca Jackson, the lead author and the chief of obstetrics and gynecology at San Francisco General Hospital.

In roughly 70 percent of pregnancy-related cases investigated by the Equal Employment Opportunity Commission over the last decade, a female employee was fired. Doctors’ notes often play a pivotal role in employment conflicts, Jackson and her colleagues said.

Vague or overarching medical recommendations can exacerbate the problem because some employers seize on them to suggest a woman can’t perform her job and so must be put on unpaid leave mid-pregnancy.

“Then having exhausted all of her maternity leave, before her baby is even born, she is threatened with job loss or is fired,” said Sharon Terman, the director of the work and family program at the Legal Aid Society-Employment Law Center.

Some doctors’ notes are pre-emptive, suggesting that a pregnant patient will need accommodation before she actually does. Others seek accommodations that are impossible to grant, such as asking that a child-care worker not be exposed to children with colds.

“Truly necessary”

The authors of the new editorial recommended that doctors first learn what a patient’s essential job duties are. Doctors should then specify in the note what she can no longer do and, as important, what she can still do.

These days, some exhausted but healthy patients without medical necessity ask for a note. Some physicians comply, neither party understanding the potential fallout. Only “truly necessary” notes should be written, the authors advised.

Dr. Laura Riley, the medical director of labor and delivery at Massachusetts General Hospital, has had some patients in the often-uncomfortable third trimester ask to stop working at 38 weeks, after a few preterm contractions.

Some workplaces will accept the note and not penalize pregnant workers who take leave a week or two before delivery.

However, “many people don’t have that luxury, and they don’t know it until they take in a note,” Riley said. “Then they are denied, or worse, someone says: ‘Oh you can’t do your job? Then I don’t have a job for you.’”

In her 24 years as an employment lawyer, Sharon Gustafson says she has even seen some employers “solicit restrictions,” by asking employees to get a doctor’s note to be able to work while pregnant.

UPS case

In one prominent legal case, Peggy Young, a former employee of the United Parcel Service, was told to get a note, said Gustafson, her lawyer. Her doctor recommended that her lifting of parcels heavier than 20 pounds be restricted.

Instead, UPS placed Young on unpaid leave. She sued for discrimination; in March, the case was reinstated by the Supreme Court.

Even the best educated doctors may not understand legal ramifications. San Francisco General Hospital surveyed 83 prenatal providers and found that half thought all workers got up to three months of unpaid, job-protected leave specified under the Family and Medical Leave Act.

In fact, roughly 40 percent of workers are not eligible.

Yet two-thirds of these doctors wrote notes outlining their patients’ workplace restrictions exactly as requested by the patients. When those restrictions included essential job functions, Jackson said, the patients risked being placed on unpaid leave.

Pregnant women are often worried about lifting, for instance, and those who lift frequently – say, every 3 to 5 minutes for more than an hour straight daily – should consider limiting the weight, according to a 2013 report.

But other pregnant women probably do not qualify for a workplace restriction, according to the commentary authors.

In 2012, while Maria Yesenia Arroyo Guerrero was pregnant with her second daughter, her doctor wrote that she should avoid lifting more than 50 pounds because of back and hip pain. As a nursing home assistant, she was bathing, dressing and lifting as many as 10 patients daily.

After Arroyo, from Hayward, Calif., presented the note to her employer, she was told her duties could not be changed. Instead, she was placed on unpaid leave in her first trimester.

She also was told that if she did not return to work by July 18, 2013, she would be terminated, despite the fact that her baby was scheduled to be born via cesarean section the day before.

Her termination letter was waiting at home when she returned from the hospital. “This shouldn’t happen to any pregnant woman,” Arroyo said in an interview.