There is no doubt that the face of veterinarian medicine is changing, and bovine medicine is no exception with the increasing number of women entering food-animal practice. The American Association of Bovine Practitioners has only recently been collecting gender data on members, but its current information indicates that at least 13 percent of its U.S. members (and probably more) and at least 42 percemt of its student members are women. Likewise, the Academy of Veterinary Consultants (representing feedlot and cow-calf veterinarians) has at least 8 percent women members and 33 percent of its student membership are women.
With this demographic change also comes important safety and health considerations that are specific to women, especially those who are pregnant or in their child-bearing years. Sarah Mills, DVM, Mills Veterinary Service LLC, Chapman, Kan., was concerned about safety of veterinarians, in particular women, their unborn children and the children they may bring to work with them on occasion. She conducted a survey of large-animal practitioners in 2007 to assess the need for safety information. “The survey was a simple way to get practical input from practitioners so veterinarians and their staff could be aware of simple cautions during pregnancy and the safety of veterinarians’ children,” Mills explains.
What she found were gaps in both female and male practitioners’ knowledge of zoonotic disease risks, drug handling by pregnant (or potentially pregnant) women, and the frustrations many women practitioners had while trying to practice while pregnant. “There was a lack of practical, common-sense advice for general practitioners,” Mills says. “Pregnancy and raising children is a blessing and time to be enjoyed and respected — not feared. Women pregnant for the first time especially need practical information on how to reduce risks during pregnancy.”
Though every food-animal veterinarian can experience safety hazards on the job (see Bovine Veterinarian, January 2009) such as cattle handling and equipment-related injuries and even the risk of zoonotic diseases, some hazards in bovine medicine can be particularly dangerous to pregnant women (see Zoonosis sidebar).
Don’t risk injury
Angela Daniels, DVM, Circle H Animal Health, Dalhart, Texas, was a swine veterinarian when she was carrying her twins, and says she did not change much in her routine while pregnant. However, when she became a dairy veterinarian and was carrying her third child, things were different. “I had major concerns with my ability to work around dairy cattle and not jeopardize my pregnancy,” Daniels says. “While I was three months pregnant, I got kicked on the hand while it was down by my side by the neighboring cow to the one I was palpating. My hand was basically belly high.” Daniels stopped preg checking the following week. “I had that luxury as a practice owner and having capable associates available,” she says. “It was a risk I was not willing to take and it was a very personal decision.”
No man or woman is a match for a 1,000+ pound animal. Instead of manhandling unruly cattle in some situations, sometimes it’s easier and no doubt more safe to go with sedation. “The only thing I may do different than the guys is sedate more of the cattle than they do,” says Lisa Willis, DVM, Mid-Texas Veterinary Associates, Gustine, Texas. “I do this for the animal’s safety, as well as the people. Owners never complain and it is an extremely inexpensive option. When I have to get in back of an angry cow or bull, I do not hesitate to give an epidural (+/- sedation) either. Owners have always been very receptive to me and don’t care about ‘cowboying’ the animal as much as getting proper treatment. I also try and use the best facilities available, though that is not always feasible.”
Jessica Laurin, DVM, The Animal Center of Marion County, Marion, Kan., believes her pregnancy hormones made her a little mentally slow between months five and six of pregnancy. “I had a harder time with short term memory and factual recall,” she says. “That information is good to know ahead of the game, so when you get to that point you are ready to perform mentally slower than what you are used to. For me, it lasted about a month.”
Female veterinarians need to assess their environment within the practice as well as when working with clients. Typical procedures such as radiology can be a pregnancy danger. Leaking anesthetic gasses can harm a fetus. Poor ventilation such as in a swine barn can also be detrimental.
Veterinary drug dangers
Veterinarians who are pregnant or in their child-bearing years should pay attention to the drugs they are exposed to, handling or administering. Mills says prostaglandins, oxytocin, chemotherapy drugs, organophosphate fly tags and other prescription drugs can be dangerous.
Being careful in dispensing said items and labeling also protects pregnant clients and farm personnel, Mills adds. “Going over instructions verbally as well as having clearly written/typed precautions on the label is essential to make sure the client or staff hears the message twice.” Mills also makes a note in the medical record as to what precautions were stated. “Just as you make sure a client does not have a sulfa or penicillin allergy when you dispense horse medications, the same goes when dispensing all medications with potential to cause harm to an unborn child or nursing mother.” It’s also imperative that women working at the practice in any capacity understand the cautions of handling any of these drugs.
It’s not about “cowboying up”
Pregnancy is not a reason to get out of physical work at the veterinary practice, but in some situations, pregnant women need to know when to say when. Information from the National Pork Board says stress and strain is an area of concern for pregnant workers, which can also apply to veterinarians. Excessive strain or stress can occur during work that was routine and non-hazardous prior to pregnancy. The differences are due the changes in abdominal musculature associated with the progression of gestation and because of changes in the center of gravity associated with pregnancy. Excessive strain or stress can occur during normal work, when climbing in and out of equipment or areas, moving feed, and carrying heavy loads of any sort.
“The most important point for a pregnant veterinarian to remember is that the child’s safety is foremost,” Mills says. “Just because a colleague delivered a calf the day before she went into labor does not mean she has to do the same. Each pregnant veterinarian has to decide what is safest for her activity and exposure level. A pregnant veterinarian does not have to prove anything to anyone. She has a child to protect and care for as top priority.”
Laurin says being in good physical shape before becoming pregnant was helpful. Because she’s tall and long waisted, she could move around pretty easily while pregnant. “But, after six months, getting into alleys, behind chutes, and bending down is not the same,” Laurin says. “With my son’s pregnancy, the very last month I had a hard time squatting and bending over. Many women will have to limit the amount of large animal physical activity in those months.”
Becky Funk, DVM, Fairview Veterinary Clinic, Lexington, Neb. was pregnant with both of her children during veterinary school. “The best advice that I can give to women is to do the tasks that you are comfortable with and don’t let anyone pressure you one way or the other,” Funk suggests. “Personally, both of my pregnancies were fantastic and I worked cattle and pregged cows right up to the day that I went into labor.” In fact, on the way to the hospital Funk had to call her boss to cover for her. “But, I know not everyone is like that or comfortable with that.”
From her survey work, Mills knows of one large animal practitioner who miscarried on the job and continued with her call, and even waited before seeing a physician. “No veterinary practitioner should fear their employer so much that she would put her health and future ability of having children at risk,” Mills says.
Mills adds that women practitioners need to also communicate with their physicians. “Most physicians have no idea what large-animal veterinarians really do or what risks they are exposed to such as zoonotic diseases and veterinary drugs. Some women are able to work up to the minute their water breaks, drive home, and then head to the hospital. Others women are miserable or have complications that prohibit physical work that would threaten the unborn baby.” Mills likens it to male veterinarians who may have heart attacks, injure knees or strain backs and require time off from practice or have to modify their work load. “Pregnancy is similar in that for a few months the work load may have to be modified.”
Mills wants pregnant veterinarians to realize there is nothing wrong with a female practitioner asking for a male or non-pregnant colleague to see to the heifer prolapse out on the back 40 acres in 105°F humidity. Or, asking the client to bring the animal in to the clinic where an assistant/technician can help with the physical work. “I found clients and colleagues to be very helpful if you just ask,” she says. “When I was six months pregnant I had a client grab my arm as I reached down to wipe up a shattered bottle of oxytocin. He was looking out for me. I had reached down without thinking twice.”
Communicate with the practice
Many women food-animal veterinarians have been hesitant to talk about their future family plans or even ask a practice about their maternity policies when interviewing for positions. This is definitely the wrong approach, according to Misty Edmondson, DVM, MS, Dipl. ACT, Auburn University. “I always tell my female students that they should discuss these types of situations with their future employers. If an employer is unwilling to make reasonable adjustments to her responsibilities while pregnant, then it may not be the best place to practice while pregnant or while in child-bearing years.”
Mills agrees. “Find out if your employer values family time and respects it upfront,” she suggests. “Outline maternity/paternity leave or flex-time options before signing a contract. Visit with other veterinarians and the staff at the practice. Not every female veterinarian chooses to have children, but for those who do, they need to know how the practice values family.”
Mills says this goes for the male practitioner as well as many new fathers choose to take time off when a baby or adopted child arrives. “My survey revealed many male veterinarians were unhappy that they missed being with their kids. They had regrets they were not there for their kids — from special events to everyday life.”
“Employers have to realize that each pregnancy can be different, and the level of continued practice will be different,” adds Christine Navarre, DVM, MS, Dipl. ACVIM, Louisiana State University. “Flexibility is necessary. Female employees should not take advantage of the situation. There are ways to be a productive part of the practice even if you have to cut down on certain activities. Good communication between both parties is a must.” Navarre says when she was pregnant in practice, “Those times I did admit I needed help and asked, my colleagues and clients were falling over each other to help. Maybe I was lucky, but the men in my life looked at pregnancy as a miracle to be protected, not as a burden.”
Navarre adds, “We should be sensitive to the concerns of our colleagues and try to reassure them that we will do our best to continue to be a productive part of the practice while at the same time taking care of ourselves and our babies.”
Laurin’s practice in the Kansas Flint Hills has a lot of cow-calf clients, and she suggests if a woman is in that type of practice, she may want to do some seasonal planning. “If you can plan when you want to be pregnant, it would be smart to have your kids in the summer months, when clinic work slows down,” she explains. “It would be a lot more respectful to the practice to not be due during calving season or the busiest time of the year if it’s possible. That just adds more stress to the workplace.”
The unborn child’s safety is foremost, states Mills. “One mistake could cost the life of the child or cause lifelong disabilities. There are no second chances when it comes to your child’s health and life. Asking for assistance does not show weakness; instead you are accepting the responsibility of the life within you. Most clients will respect your decision to be cautious. That child’s life is your responsibility. That child depends on you.”
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Zoonosis and pregnancy
Veterinarians who work with cattle and other species have the potential to be exposed to zoonotic diseases. A 2005 survey conducted across AVMA members by Centers for Disease Control & Prevention veterinarians indicated that fewer than half of the large-animal respondents (both genders) reported always isolating an animal suspected of having a serious zoonotic disease or limiting human contact with it.
The Center for Food Security and Public Health at Iowa State University lists these cattle diseases that can be zoonotic: anthrax, brucellosis, cryptosporidiosis, dermatophilosis,E. coli, Giardia, leptospirosis, listeriosis, pseudocowpox, Q Fever, ringworm, Salmonella, tuberculosis and vesicular stomatitis. Other animal diseases that put veterinarians at risk are toxoplasmosis, rabies, tularemia, psititticosis, cocciomycosis immitis “Valley Fever”, toxocariasis and avian influenza H5NA.
Though these diseases can affect men and women, some of them can be especially dangerous to pregnant women. Christine Navarre, DVM, MS, Dipl. ACVIM, says she worried about calf diarrheas and parturition in small ruminants when she was pregnant. “I stayed away from kidding and lambing small ruminants, even if they had a normal pregnancy and no abortions,” she explains. “Q fever can be shed at normal parturition and can be aerosolized, so I stopped doing small ruminant C-sections/dystocias. Any aborting animal, I think, would be a risk.”
Q fever is caused by Coxiella burnetii and can cause reproduction problems in livestock and severe respiratory (lung) and liver disease in humans. People usually get Q fever by breathing contaminated barnyard dust or by direct contact with infected animals while assisting with the delivery of newborn animals.
In pregnant women, infections can cause premature delivery, abortion and infection of the placenta. Veterinarians should avoid contact with the placenta, birth tissues, fetal membranes and aborted fetuses of sheep, cattle and goats. If you are assisting the delivery of newborn animals, wear gloves, masks and eye protection. Pregnant women should be especially careful around pregnant sheep, cattle and goats.
Chlamydiosis is fairly rare to get from a mammal, but exposure is most likely to occur by ingestion, aerosol, or direct contact with mucous membranes. Severe cases of animal-associated chlamydiosis infection in pregnant women can lead to abortion. Pregnant women should avoid contact with pregnant or aborting sheep and goats, and should wash their hands thoroughly after handling animals.
Toxoplasmosis is caused by Toxoplasma gondii and severe human cases can cause abortion or birth defects in pregnant women. Pregnant women should avoid cleaning cat litter boxes if all possible, or wear mask and gloves if changed daily. The toxoplasmosis oocysts take more than 24 hours to become infected following shedding, thus the daily litter box changing will decrease the risk.
Sarah Mills, DVM, adds that the human fetus is affected most severely when the pregnant female becomes infected in the first half of gestation. Should a non-infected woman acquire T. gondii infection during pregnancy, there is a 20–50 percent probability that her fetus will be infected. Most infected children do not have obvious clinical signs at birth, but can have manifestations later in life such as chorioretinitis and mental retardation. Human fetal infection can result in jaundice, hepatosplenomegaly, neurologic abnormalities and hearing or vision loss.
Mills says to keep T. gondii in mind when early embryonic death (or open females), mummies, sick kids, abortion and stillbirths occur in goats, with goats especially infected by grazing cat feces-infected grass and hay.
Listeriosis from Listeria monocytogenes can be shed by infected animals in the feces, milk and uterine discharges. It is also found in aborted fetuses and occasionally in the nasal discharges and urine of symptomatic animals. Listeria can spread via ingestion, inhalation or direct contact. Mills says 2500 people annually are affected with the disease, resulting in 500 deaths, of which one-third are pregnant women. A majority of the cases are due to specific populations consuming unpasteurized milk but direct contact with an infected animal can spread the disease.
Infections are transmitted either transplacentally or from an infected birth canal. Humans can also be infected by direct contact with infected animals during calving, lambing or necropsies. Cases have been reported after contact with sick birds or the carcasses of asymptomatic poultry. Pregnant women may experience either a mild, flu-like syndrome with fever, chills, headache, slight dizziness or gastrointestinal signs, or an asymptomatic infection. This may be followed in a few days to weeks by abortion, stillbirth, premature birth or septicemia in the newborn. Abortions usually occur during the second half of pregnancy and are most frequent in the third trimester.
Newborns may be infected either in in utero or from bacteria found in the vagina during delivery. These infants can develop septicemia, disseminated granulomatosis, respiratory disease or meningitis; symptoms may be present at birth or develop within a few days to several weeks. Hydrocephalus is often a sequela of meningitis in newborns. Many of these infections are fatal. Sanitation, proper personal protected gear and hygiene during deliveries in ruminants and necropsies can decrease the risk of cutaneous disease in veterinarians and others who are occupationally exposed.
Leptospirosis caused by Leptospira interrogans can occur in a large number of animals, including cattle, sheep, goats, pigs, horses, and dogs. Leptospirosis is spread through the urine of infected animals and can survive in water and soil for months. Humans acquire leptospirosis through direct contact, ingestion, or inhalation of the bacteria. Avoid water, such as ponds, where animals congregate and urinate, and wear gloves when handling reproductive fluids or when being exposed to urine.