Re: Declared Pregnant Worker Question

[westbrookjl@ornl.gov (Janet L. Westbrook)]

To Greg Krause:

As the radiological fetal protection coordinator for my DOE site, I talk with many pregnant women, some of whom are both chemists and rad workers. The rad workers are mostly not fearful of the possibility of past intakes because they believe that their work procedures are rigorous enough and their health physics coverage careful enough to prevent to prevent those. However, they usually choose to cut back on their work, either avoiding handling radioactivity or reducing the amount they work with. We are fortunate to be able to allow a woman to do no rad work during her pregnancy if she chooses.

I advise a three-pronged approach in your discussion with your concerned worker: information, limitation, and cooperation.

First, you need to prepare to give her all the information you can about past and future uptakes. [Those more knowledgeable than I on this, please correct me if I am wrong!] You need to find out where she is on the pregancy time scale. As you know, while it was once thought that the first month or two were the worst for the fetus, at least in terms of external dose, now we know that the period of approximately 8 to 15 weeks is the worst. This is because it is the period of organogenesis. Because I-131 concentrates in the thyroid -- but the thyroid isn't really formed in the first two months -- one would not expect an "extra" hazard due to iodine in the first two months. Thus if bioassay shows that there have not been any significant uptakes of iodine to date, the woman can be assured that little risk should have been incurred so far; even if bioassay shows a minor uptake(s), this conclusion should still be true. But you need to find out what the hazard is to the relatively undifferentiated tissue of the embryo-fetus during this period and also to the fetal thyroid tissue so that you can discuss this with her.

Second, you need to determine what dose the fetus might actually incur from a given intake by the mother. You (or a knowledgeable dosimetrist) can do a bounding calculation of what an uptake might be: assume a nominal amount of I-131, a reasonably conservative release-and-intake scenario, and the resulting dose to the fetus. I think there is some guidance on this. You could then limit the amount of I-131 that the woman works with at one time, if that is possible, to that amount which, if the scenario came true, would result in an "acceptable" dose to the fetus (i.e., a dose that would be unlikely to result in signficant adverse effects). You would need to verify that this limit is workable before you proposed it to the woman. As part of any agreement by her to continue to work with the I-131, but in reduced amounts, you should offer more frequent and/or more prompt bioassay, if that is appropriate.

Third, if there is a minimum amount that has to be worked with at one time, but the minimum is higher than the limit, then you would have to consider how much her peace of mind is worth. That is, the facility should consider hiring part-time help to do the labeling when the present other workers have left. You would of course need to get permission with the powers that be before you talked about this with the woman. It might be that one of the researchers or doctors could help out for a few months or lend some time of a technician in another lab. If the people in charge and the researchers make feeble excuses not to do get some help for her, remind them that somebody has to have the babies and that when a person works, there seldom is a convenient time to be pregnant.

If the worker has to continue to handle the work at least part of the time, she may be anxious even with a limitation on how much she works with. So you have to pay attention to her mental state. If your worker is to continue to work safely, she needs to be reassured so that her anxiety does not affect her work (or cause her to quit suddenly, which would surely disrupt the work of the facility). So even if you can sincerely and confidently say that the chances of a significant uptake are remote in her mode of work pre-pregnancy, it is important for everybody -- the workplace village, so to speak -- to pitch in and help keep her emotionally and physically supported so that she is as much as possible the same worker that she was pre-pregnancy and thus preserve the low probability of a mistake. I have noticed at our site that when even the pregnant non-rad-worker sees the rad protection organization, her management, and her co-workers as cooperative and protective, she seems to be pretty sanguine about e.g., the hot cask moving down the street outside her window. So you will soon need to get her coworkers and management on board with you if you seek to assure her that she can still work safely and that her work conditions will be kept careful track of by her management and the rad protection people.

I hope my remarks are helpful.

Janet Westbrook

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