Helping Patients Deal with Pregnancy– and Childbirth– related Limitations and Restrictions at Work Under the Pregnant Workers Fairness Act

Your patient may have rights under the Pregnant Workers Fairness Act (PWFA) to accommodations—adjustments or changes to the way things are normally done at work—for limitations they experience due to pregnancy, childbirth, or related medical conditions. This document briefly explains how you, as the health care provider, can help your patient obtain an accommodation.

1.  What is the PWFA?

The PWFA is a federal law enforced by the Equal Employment Opportunity Commission (EEOC) that requires employers to make reasonable accommodations to a qualified employee’s (or applicant’s) known physical or mental conditions related to, affected by, or arising out of pregnancy, childbirth, or related medical conditions.

2.  What is a reasonable accommodation under the PWFA?

A reasonable accommodation is a change in the work environment or in the way things are usually done that enables an applicant or employee to apply for a job, perform their job, or enjoy access to the same benefits and privileges of employment as other employees. (See Question 5 for examples.)

3.  How can I help my patient get a reasonable accommodation under the PWFA?

First, some of your patients may not know about the PWFA. You can tell them that they may be able to get an accommodation. You also can refer them to EEOC resources, such as What You Should Know About the Pregnant Workers Fairness Act, and share these tips for asking for a reasonable accommodation.

Second, if your patient is seeking an accommodation, under certain circumstances, their employer may ask them to provide supporting documentation from a health care provider. However, the PWFA does not require that an employer seek supporting documentation and in many instances providing supporting documentation will be unnecessary.

4.  When can my patient get a reasonable accommodation under the PWFA?

If your patient has a physical or mental condition related to, affected by, or arising out of pregnancy, childbirth, or related medical conditions that interferes with their work, your patient may be able to get a reasonable accommodation under the PWFA.

The physical or mental condition can be:

• A problem or impediment that is minor, modest, or episodic, including those that arise during an uncomplicated pregnancy—for example, vomiting, edema, lifting restrictions, need to use the bathroom more frequently, need to drink water, need to sit, anxiety, nursing or pumping, or fatigue.
• A more serious problem—for example, placenta previa.
• A need related to maintaining the patient’s health or the health of their pregnancy—for example, attending health care appointments.
• A need related to alleviating increased pain or risk—for example, avoiding extreme temperatures, certain chemicals, or standing for certain periods of time.
• Conditions also covered by the Americans with Disabilities Act (ADA) or the Family and Medical Leave Act (FMLA). However, patients may still be entitled to accommodations under the PWFA even if their condition does not meet the definition of disability specified in the ADA and even if they do not qualify for leave under the FMLA.

Whether in a specific situation something is a physical or mental condition related to, affected by, or arising out of pregnancy, childbirth, or related medical conditions depends upon the specifics of your patient’s condition and your judgment and expertise as a health care provider.

The physical or mental condition must be related to, affected by, or arising out of pregnancy, childbirth, or related medical conditions. Pregnancy, childbirth, or related medical conditions do not have to be the sole cause, major cause, or even a substantial cause of the physical or mental condition, as long as the condition is “related to, affected by, or arising out of” pregnancy, childbirth, or related medical conditions.  

The PWFA does not contain any specific requirements that the “physical or mental condition” or the “related medical condition” has to happen within a certain time of the pregnancy or childbirth to qualify.

5.  What kind of reasonable accommodation can my patient get under the PWFA?

The PWFA does not restrict what your patient can ask for as a reasonable accommodation.

The type of accommodation your patient will need and can get will depend on their individual circumstances and the ability of the employer to provide the accommodation.

Some common examples of accommodations include:

• Additional, longer, or more flexible breaks to drink water, eat, rest, or use the restroom;
• Changing the employer’s usual food or drink policies to allow for eating or drinking on the job;
• Accommodations related to nursing, including time and a place to pump breastmilk or nurse during work hours;
• Changing equipment, devices, or workstations, such as providing a stool to sit on, or a way to work while standing;
• Changing a uniform or dress code or providing safety equipment that fits;
• Changing a work schedule, such as providing shorter hours, part-time work, or a later start time;
• Telework;
• Temporary reassignment;
• Light duty or help with lifting or other manual labor;
• Leave, for example, to attend health care appointments or to recover from childbirth. (Leave under the PWFA is usually unpaid unless an employer’s policy provides otherwise.)

Additionally, the PWFA provides that the temporary suspension of a main job duty (or “essential function”) can be a reasonable accommodation. If your patient is temporarily unable to do one or more main job functions even with an accommodation, your patient might be able to get those job functions suspended while the limitation persists. For example, if a main duty of your patient’s job is lifting, and they have a lifting restriction because of pregnancy, they may be able to get that function temporarily excused.

The employer does not have to provide the particular accommodation that your patient requests. Rather, the employer can provide a different accommodation as long as it is effective.

6.  If my patient asks me for documentation, what type of documentation is most likely to support my patient’s request for an accommodation?

If your patient is seeking an accommodation under the PWFA, their employer may, under certain circumstances, ask them to provide supporting documentation from a health care provider.

Documentation is most likely to support your patient’s request for accommodation if, using plain language, it does the following:

• Explains your professional qualifications and why you can provide the necessary information for this patient. A brief statement is sufficient. You do not need to be treating the condition at issue, as long are you are familiar enough with the patient’s circumstances to provide the information set out below. Under the PWFA, health care professionals include, but are not limited to: doctors, nurses, nurse practitioners, physician assistants, midwives, physical therapists, and licensed mental health professionals. The health care provider may be a telehealth provider.
• Confirms that your patient has a physical or mental condition. Because the PWFA covers a wide range of physical or mental conditions, you do not need to include a diagnosis; a simple statement of the patient’s physical or mental condition is sufficient. The problem or impairment may be minor, modest, or episodic (like fatigue, vomiting, or swelling); a need to attend health care appointments; or maintaining the patient’s health or the health of their pregnancy (like avoiding extreme heat or limiting exposure to chemicals).
• Confirms that the physical or mental condition is related to, affected by, or arising out of pregnancy, childbirth, or related medical conditions. Keep in mind that pregnancy, childbirth, or related medical conditions do not need to be the sole, original, or substantial cause of the physical or mental condition.
• Describes the adjustment or change that is needed at work due to the limitation, including the expected duration of the accommodation. If the change is the temporary suspension of a main job duty, make clear that the suspension will be temporary and that your patient could perform the job duty after the pregnancy or in the near future (and provide an estimate of when that will be).

If you are recommending a particular accommodation, the type of accommodation to suggest will depend on the individual circumstances of your patient and your judgment and expertise as a health care provider. Consider:

• Speaking with your patient about their job duties, their workplace, and what they believe would be an effective and available accommodation.
• Consulting the Job Accommodation Network, which offers free, expert, confidential advice on job accommodations.

It may help not to overstate the need for a particular accommodation in case an alternative is necessary.

You should not simply provide your patient’s medical records, because they will likely contain information that is unnecessary for the employer to have.

Your patient may seek further assistance from you if their employer asks them for clarification, different information, or submits additional information for you to consider. For example, your patient may be asked to get your views on whether an alternative accommodation would be effective.

These links contain examples of the types of information that may be helpful if, for instance, your patient has a lifting restriction or needs bed rest.

7.  What if my patient’s employer wants me to fill in an ADA or FMLA form for a PWFA reasonable accommodation?

Generally, employers cannot require a specific form be used for the supporting documentation for a PWFA accommodation, especially one that asks for unnecessary information.

PWFA physical or mental conditions can, but do not have to be, disabilities covered by the ADA or serious health conditions covered by the FMLA. Thus, some questions on an ADA or FMLA form may not be relevant and may seek disclosure of more information than is necessary for your patient’s PWFA request. Of course, there may be situations where your patient also is seeking an ADA accommodation or FMLA leave; in those cases, the information may be relevant.

If the employer provides a form with questions that seek more information than is necessary for a PWFA accommodation request, you and your patient can decide how best to respond to the employer. For instance, you may provide a note that contains the information set out in Question 6 instead or answer “not applicable” to some questions.

8.  Can I disclose my patient’s medical information?

The PWFA does not alter a health care provider’s ethical or legal obligations regarding the disclosure of patient information. 

Employers are required to keep all medical information related to an accommodation request confidential.

9.  Are there limits on the number or length of reasonable accommodations under the PWFA?

There are no hard limits regarding how many accommodations your patient can receive or how long the accommodations can last. Given the nature of pregnancy, childbirth, or related medical conditions, the accommodations your patient may need can change over time.

10.  What else do I need to know about the PWFA to help my patients?

The employer does not have to provide a specific accommodation if it causes an “undue hardship”— meaning significant difficulty or expense. Employers may have other legal grounds for why they are not required to provide an accommodation, such as whether the employee asked for an accommodation, whether the employee is qualified, and religious defenses.

The PWFA prohibits employers from discriminating or retaliating against an employee because they requested or used a reasonable accommodation.  

The Pregnancy Discrimination Act (PDA) prohibits employers from discriminating against,  harassing, or retaliating against an employee due to pregnancy, childbirth, or related medical conditions.

Your patient can contact the EEOC if they are facing discrimination, harassment, or retaliation.

Additional Information

More information about PWFA reasonable accommodations can be found in the EEOC publication What You Should Know About the Pregnant Workers Fairness Act and on the EEOC’s website (https://www.eeoc.gov).

In addition to the PWFA, your patient may be able to receive accommodations under other laws that the EEOC also enforces, which have different requirements.

• Under the Americans with Disabilities Act (ADA), your patient also may be able to get an accommodation if the source of their problem at work is a pregnancy-related condition that meets the ADA definition of “disability.”
• Under the Pregnancy Discrimination Act (PDA), your patient may be able to get a change at work if the employer provides such changes to other employees, who are not affected by pregnancy, childbirth, or related medical conditions, but who are similar in their ability or inability to work.

Other federal laws—enforced by other federal agencies—also may provide protection for your patients: specifically, the FMLA, which provides up to 12 weeks of unpaid, job-protected leave in a leave year for family and medical reasons to eligible workers; and the Providing Urgent Maternal Protections for Nursing Mothers Act (PUMP Act), which requires employers to provide time and a private place to pump at work for most nursing employees for one year after the birth of the employee’s child.

Some states also have laws that protect workers affected by pregnancy, childbirth, or related medical conditions.

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.