Helping Patients Deal with Pregnancy-Related Limitations and Restrictions at Work Under the ADA

If a patient's pregnancy begins to interfere with their job, under federal laws they may have the right to obtain work adjustments, known as accommodations, that allow them to remain employed, without jeopardizing their health. This document briefly explains how you, the health care provider, can help your patient obtain accommodations of pregnancy-related conditions under the Americans with Disabilities Act (ADA).

Importantly, the Pregnant Workers Fairness Act (PWFA), which took effect on June 27, 2023, expands the rights of workers affected by pregnancy, childbirth, or related medical conditions to receive accommodations. The PWFA applies to some pregnancy-related situations where the ADA may not. Thus, if your patient is seeking an accommodation due to pregnancy, childbirth, or related medical conditions, please first consult Helping Patients Deal with Pregnancy- and Childbirth– Related Limitations and Restrictions at Work Under the Pregnant Workers Fairness Act, which explains how to help patients obtain these accommodations under the PWFA.

1. What if my patient is having a problem doing their job because of pregnancy or a condition related to pregnancy?
   
   Your patient may be able to get an accommodation that allows them to do their job.  Examples of accommodations include permission to sit or stand, ergonomic office furniture, shift changes, elimination of marginal job functions, permission to work from home, and altered break and work schedules (such as breaks to drink water, eat, rest or use the restroom). Your patient also might be able to get a reduced workload or a temporary assignment.      
   
   Your patient may be able to get an accommodation under the ADA if the source of the problem at work is a pregnancy-related condition that meets the ADA definition of "disability."  Examples of pregnancy-related conditions that may meet the ADA definition of disability include cervical insufficiency, anemia, sciatica, preeclampsia, gestational diabetes, and depression. Physical or mental conditions exacerbated by pregnancy also may meet the definition of disability.
   
   If the employer asks if your patient has a “disability,” note that a condition does not have to be permanent or severe, or result in a high degree of functional limitation, to be "substantially limiting." It may qualify by, for example, making activities more difficult, uncomfortable, or time-consuming to perform compared to the way that most people perform them. Further, if symptoms come and go, what matters is how limiting they would be when present. A condition would meet the ADA’s definition of disability if it would, when left untreated, "substantially limit" one or more major life activities (e.g., lifting, standing, sitting, walking, reaching, bending, eating, sleeping, or concentrating) or major bodily functions (e.g., digestive, genitourinary, bowel, bladder, neurological, circulatory, or cardiovascular functions).
   
   If your patient needs an accommodation to do their regular job because of a disability, the employer must give them one, without reducing their pay, unless doing so would involve significant difficulty or expense.
   
   Your patient may also be able to get an accommodation for a pregnancy-related condition under the PWFA whether or not it meets the ADA definition of a disability.
    
2. How can I help my patient who needs an accommodation because of an impairment related to their pregnancy?
   
   Your patient may ask you to provide information or a note stating that the patient is pregnant, and describing pregnancy-related impairments, restrictions or limitations. Sometimes an employer will ask for additional information. Your feedback to the employer is most likely to help your patient get an ADA accommodation if it explains, using plain language, the following:
    
   • Your job title and professional qualifications. A brief statement is sufficient.
   • The nature of the patient's condition. State the patient's pregnancy-related medical condition.
   • The patient's functional limitations in the absence of treatment. Describe the extent to which the medical condition would limit a major life activity (e.g., lifting, bending, or concentrating), or a major bodily function (e.g., bowel or circulatory functions), in the absence of treatment or any accommodation. If the symptoms of the condition come and go or are in remission, describe the limitations during an active episode. It is sufficient to establish the substantial limitation of one major life activity or major bodily function.
   • The need for an accommodation. Explain how the patient's medical condition makes changes at work necessary. For example, if the patient needs an accommodation to perform a particular job function, you should explain how the patient's symptoms-as they actually are, with treatment-make performing the function more difficult. If necessary, ask the patient for a description of job duties. Also explain to the employer why the patient may need an accommodation such as a schedule change (e.g., to attend medical appointments during the workday.)  Limit your discussion to the specific problems stemming from the medical condition that may be helped by an accommodation.
   • Suggested accommodation(s). If you are aware of an accommodation that you believe would be effective, you may suggest it. Do not overstate the need for a particular accommodation in case an alternative is necessary.     
3. What will happen after I provide the information or documentation?
   
   The employer, perhaps in consultation with a health care professional, will use the information to determine whether a work adjustment is required under the ADA. The employer also may contact you to ask for clarification of what you have written, or to provide you with additional information to consider. For example, you may be asked whether a different work adjustment would be effective if the requested accommodation would be too difficult or costly to provide.
    
4. Am I permitted to disclose my patient's medical information?
   
   The ADA does not alter a health provider's ethical or legal obligations. Employers are required to keep all medical information related to an accommodation request confidential.
    
5. What if my patient cannot work at all?
   
   If your patient cannot work for a period of time due to a pregnancy-related impairment and has no paid leave, the patient still may be entitled to unpaid leave as an accommodation. An employee may also qualify for unpaid leave for up to 12 weeks under the Family and Medical Leave Act (FMLA). More information about this law can be found at the U.S. Department of Labor’s FMLA home page. Some states and localities have passed laws that provide additional protections. 
    
6. Could an employer discriminate against my patient because of the information I provide?
   
   The ADA prohibits employers from engaging in discrimination and harassment based on disability, including when it is related to pregnancy, and from retaliating against employees because they have asked for or used an ADA accommodation. 

Further Information

More information about pregnancy discrimination and accommodations can be found in Helping Patients Deal with Pregnancy– and Childbirth– related Limitations and Restrictions at Work Under the Pregnant Workers Fairness Act, the EEOC publication Legal Rights of Pregnant Workers under Federal Law, and on the Equal Employment Opportunity Commission’s (EEOC's) website.  

The EEOC can be contacted by phone at 1-800-669-4000 (voice), 1-800-669-6820 (TTY for Deaf/Hard of Hearing callers only), 1-844-234-5122 (ASL Video Phone for Deaf/Hard of Hearing callers only), or by email at: info@eeoc.gov.