office of the chief of naval operations ... 6000.1c.pdfassignments 1-8 105. waivers 1-12 106....

DEPARTMENT OF THE NAVYOFFICE OF THE CHIEF OF NAVAL OPERATiONS

2000 NAVY PENTAGONWASHINGTON, D.C. 20350..2000

OPNAVINST 6000.1CN134W/M33214 Jun 07

OPNAV INSTRUCTION 6000.1C

From: Chief of Naval Operations

Subj: NAVY GUIDELINES CONCERNING PREGNANCY AND PARENTHOOD

Ref:

Encl:

(a) SECNAVINST 1000.10A(b) OPNAVINST 5354.1E(c) NAVMEDCOMINST 6320.3B(d) NAVPERS 15560D, Naval Military Personnel Manual

(MILPERSMAN)(e) DOD Instruction 1342.19 of 13 Jul 92(f) OPNAVINST 5100.23G(g) OPNAVINST 6110.1H(h) DOD 4165.63-M of Sep 93(i) OPNAVINST 3710.7T(j) NAVMED P-5055, Radiation Health Protection Manual(k) BUMEDINST 1300.2A(1) BUMED1NST 6320.72(m) TRICARE Operations Manual, Section 3, 3.12A, Ch. 18(n) Manual of the Medical Department (MANMED) , Ch. 18(0) BUMEDINST 6300.16(p) NAVPERS 156651, U.S. Navy Uniform Regulations(q) BUMEDINST 6000.14(r) NEHC-6260-TM-01, Reproductive/Developmental Hazards(s) 10 U.S. Code, Section 701, subsection (i)(t) DOD Memo of 10 Mar 2006 (NOTAL)(u) DOD Instruction 1315.18 of 12 Jan 05(v) ASD (HA) Memo of 26 Nov 2002 (NOTAL)(w) DOD Directive 1010.10 of 22 Aug 03

(1) Guidelines for Pregnancy and Parenthood

1. Purpose. To revise Navy administrative guidance concerningpregnant naval personnel (hereafter identified as servicewomen)assigned to Navy units regarding the assignment, retention,separation, standards of conduct, and medical management ofnormal pregnancies per references (a) through (w). This policyaddresses parenthood issues to include the adoption of aninfant/child and single male servicemen as parents. Theseguidelines pertain to Active and Reserve Components. Thisinstruction is a complete revision and should be reviewed in itsentirety.

OPNAVINST 6000.lC14 Jun 07

2. Cancellation. OPNAVINST 6000.lB.

3. Background

a. As indicated ln reference (a), pregnancy and parenthoodare natural events that occur in the lives of navalservicemembers and can be compatible with a successful navalcareer. There are responsibilities that come with parenthood,and for those in uniform, these responsibilities requireconsideration and planning due to military commitments. Navalservicemembers are expected to balance the demands of a navalcareer with their family plans and responsibilities.

b. The overriding concern for commanding officers (COs),supervisory personnel, and Health Care Professionals (HCPs)responsible for pregnant servicewomen is to provide for thehealth and safety of the servicewoman and her unborn child whilemaintaining optimum job and career performance. Policy andprocedures are developed to provide administrative support andensure the health and welfare of pregnant servicewomen, whileminimizing the impact pregnancy and parenthood have onoperational readiness. Pregnancy status will not adverselyaffect the career patterns of naval servicewomen. Additionally,pregnancy should not restrict tasks normally assigned toservicewomen, but may impact their ability to perform routinetasks associated with their current Navy Enlisted Classification(NEe) code and/or billet and may require temporary reassignmentas appropriate.

c. The establishment and maintenance of work sites thatallow servicewomen to perform their assigned tasks, withoutadverse job-associated consequences, are primaryresponsibilities of the command. Included is the elimination ofdetectable hazards and the prevention of occupational illnessand injury.

4. Policy

a. Pregnancy and parenthood status must be made known todesignated command officials while ensuring the servicemember'sprivacy.

2

OPNAVINST 6000.1C14 Jun 07

b. Enclosure (1) provides a single source document for themanagement of pregnancy and servicemember issues associated withparenthood in the first year.

5. Action. All Navy COs, supervisory personnel, HCPs, andservicemembers will be made aware of this instruction in itsentirety.

6. Forms

a. DD 689 (Mar 63), Individual Sick Slip is availableonline at website: http://forms.daps.dla.mil/order/.

b. SF 513 (Rev. 4-98), Medical Record Consultation Sheet isavailable online at website: http://hydra.gsa.gov/forms/.

c. NAVPERS 1740/6 (4-96), Department of the Navy FamilyCare Plan Certificate is available online (download at no cost)at website: http://forms.daps.dla.mil/order/.

d. NAVPERS 1740/7 (4-96), Family Care Plan Arrangements isavailable online (download at no cost) at website:http://forms.daps.dla.mil/order/.

e. NAVPERS 1070/613 (10-81), Administrative Remarks isavailable online (download at no cost) at website:http://forms.daps.dla.mil/order/.

f. NAVMED 6260/8 (12-2002), Occupational Exposures ofReproductive or Developmental Concern - Supervisor's Statementand NAVMED 6260/9 (12-2002), Occupational Exposures ofReproductive or Developmental Concern - Worker's Statement areavailable at website:http://navymedicine.med.navy.mil/default.cfm?selTab=Directives.

OperationsTraining

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Distribution:Electronic only via Department of the Navy Issuances Web sitehttp://doni.daps.dla.mil/

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GUIDELINES CONCERNINGPREGNANCY AND PARENTHOOD

Enclosure (1)


TABLE OF CONTENTS

Page

FOREWARD i

CHAPTER 1 - Pregnancy

101. Responsibilities 1-1

102. Workplace Assignment and Medical WorkplaceConsiderations 1-5

103. General Limitations 1-6

104. Assignments 1-8

105. Waivers 1-12

106. Evacuation of Pregnant Servicewomen 1-13

107. Provision of Healthcare 1-14

108. Exercise 1-16

109. Disposition of Complicated/High RiskPregnancies 1-16

110. Termination of Pregnancy 1-18

111. Surrogacy 1-19

112. Uniforms 1-19

113. Billeting 1-20

114. Pregnant Brig Prisoners 1-20

115. Separation from Service 1-20

CHAPTER 2 - Parenthood

201. Responsibilities 2-1

T-1 Enclosure (1)


202. Adoption 2-4

203. Leave and Convalescent Leave 2-4

204. Shaken Baby Syndrome Prevention (SBS) 2-5

205. Postpartum Exercise 2-6

206. Postpartum Depression 2-7

207. In-Vitro Fertilization (IVF) 2-7

208. Immunization Considerations 2-8

209. Workplace Support of BreastfeedingServicewomen 2 - 8

APPENDIX A - Sample Pregnancy Notification toCommanding Officer/Officer in Charge(CO/ 0 I C) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A - 1

APPENDIX B - NAVMED 6260/9 (12-02), OccupationalExposures of Reproductive orDevelopmental Concern - Worker'sStatement B-1

APPENDIX C - NAVMED 6260/8 (12-02), OccupationalExposures of Reproductive orDevelopmental Concern - Supervisor'sStatement C-l

APPENDIX D - Sample Pregnancy Counseling Form D-l

T-2 Enclosure (1)


FOREWORD

1. Users of this instruction are encouraged to submitrecommended changes and comments to improve the publication.Comments should be keyed to the specific page, paragraph, andline of the text in which the change is recommended. Reasonsfor recommendations should be provided for each comment.Comments should be directed by letter to the Chief of NavalOperations (NI34W) Washington, DC 20350-2000. Recommendedchanges regarding health care issues should be directed toBureau of Medicine and Surgery (M332) Washington DC 20372-5300.

1 Enclosure (1)


CHAPTER 1PREGNANCY

101. Responsibilities

a. Commanding Officers (COs)

(1) Shall make every effort to ensure that pregnantservicewomen are not subjected to harassment, imposition ofpersonal opinions, or infringement of legal rights per reference(b) .

(2) Shall ensure servicewomen receive counseling oncepregnancy has been confirmed. Counseling will includediscussions on military entitlements to obstetrical (OB) carewhile on active duty per references (c) and (d), and Navy policyon worldwide assignability. Single parents and dual militaryservicemembers are required to sign NAVPERS 1740/6, Departmentof the Navy Family Care Plan Certificate and NAVPERS 1740/7,Family Care Plan Arrangements to appoint a guardian for theirchild(ren) per reference (e). Sample Pregnancy Counseling Form,appendix D, provided. Command counseling will be documented andrecorded by service record entries. Servicemembers ordered tooverseas duty should be counseled concerning a command'sdecision to sponsor or not sponsor their family member(s) perreference (d), article 1740-010.

(3) Shall advise servicewomen that requests forseparation due to pregnancy will not normally be approved. Inthose cases where extenuating circumstances exist, requests forseparation should be submitted with adequate lead-time, prior tothe 20th week of pregnancy, to allow appropriate separationdates to be determined per reference (d), article 1910-112.Pregnant servicewomen requesting separation will be counseled onthe limited medical benefits available after separation as perreference (d), articles 1740-030 and 1910-112.

(4) Shall ensure all pregnant servicewomen are affordedthe opportunity for counseling by an occupational HCP, ifrequested, per reference (f).

(5) Shall ensure that pregnant servicewomen are notadversely evaluated or receive adverse fitness reports/evaluations as a consequence of pregnancy. Additionally, no

1-1 Enclosure (1)


comment on the pregnancy shall be made in the comments section.Weight standards exceeded during pregnancy through 6 monthspostpartum are not cause for adverse fitness reports/evaluations. Pregnant servicewomen who have recently delivered,who are otherwise fully qualified for and desire reenlistment,but who exceed acceptable weight standards per reference (g)will be extended for the maximum of up to 6 months afterdelivery.

(6) Shall authorize, if requested, a pregnantservicewoman to occupy off-base housing and be paid BasicAllowance for Housing (BAH) up to her 20th week of pregnancy,per reference (h). From the 20th week onward the host commandermust approve a request to occupy off-base housing.

b. Health Care Professionals (HCPs)

(1) Are responsible for ensuring the privacy of theservicewoman while at the same time safeguarding both herwelfare and that of the unborn child.

(2) Will provide written notification (appendix A) tothe servicewoman's CO, upon confirmation of a pregnancy.

(3) Should be familiar with and utilize the Departmentof Defense/Veteran's Administration (DOD/VA) UncomplicatedPregnancy Clinical Practice Guideline (DOD/VA UPCPG) (availableat http://www.guideline.gov/) to provide the best evidence-basedperinatal care to servicewomen.

(4) Should be familiar with the administrative andcommand requirements relating to pregnant servicewomen.

(5) Shall monitor the health of a servicewoman todetermine if modifications to duty (i.e., Sick in Quarters (SIQ) ,Obstetrical (OB) Quarters, Convalescent Leave (CONLV)) arewarranted.

(6) will provide timely guidance on work restrictionsand the most effective job utilization of a pregnantservicewoman in order not to cause undue stress on her or herunborn child. The HCP should refer to occupational healthprofessionals when there is a concern about exposure to chemicalor toxic agents, environmental hazards, positive responses on

1-2 Enclosure (1)


the mandatory questionnaires (appendices B and C), or whenclinically indicated.

c. Occupational Health Professionals. will support COs infulfillment of their responsibilities to provide a safe andhealthy workplace for pregnant servicewomen. Depending on thecircumstances and information required, the appropriateoccupational health professional might be an occupationalmedicine physician, industrial hygienist, occupational healthnurse, lactation consultant, audiologist, radiation healthofficer, toxicologist, or environmental health officer.

d. Patient Administration. Shall counsel separatingpregnant servicewomen about their options available for OB careand document this counseling on the servicewoman's NAVPERS1070/613, Administrative Remarks, page 13.

e. Servicewomen

(1) Are expected to plan a pregnancy in order tosuccessfully balance the demands of family responsibilities andmilitary obligations.

(2) Shall seek confirmation of pregnancy by a militaryHCP or civilian HCP in cases of inaccessibility to a militarytreatment facility (MTF).

(3) Shall notify their CO or officer in charge (OIC) ofa pregnancy as soon as possible, but no later than two weeksafter diagnosis. This will facilitate planning a replacementrequisition if the servicewoman is in a seagoing/deployablebillet.

(4) Shall report as soon as possible to the supportingMTF to establish a prenatal care program.

(5) Are expected to perform military duties within thelimits established by their condition.

(6) Will comply with work site and task-related safetyand health recommendations made by appropriate occupationalhealth professionals, including the use of personal protectiveequipment.

1-3 Enclosure (1)


(7) Have the same rights and responsibilities and aresubject to the same administrative and disciplinary actions asall other naval personnel. A servicewoman under court-martialcharges or sentence of court-martial, who is certified aspregnant by a military HCP, may be discharged only with thewritten consent of the officer exercising general court-martialjurisdiction over her.

(8) In the Reserve Component (RC) , those who receiveorders must provide documentation of approval by their OB HCPprior to participation in active duty functions.

f. Navy Environmental Health Center (NAVENVIRHLTHCEN)will maintain a current list of potential reproductive hazardsbased on professional review of the literature and analysis ofavailable data, per reference (f). NAVENVIRHLTHCEN will provideguidance to medical departments on criteria for requestingoccupational health consultation and will also providereproductive hazard guidance on request or when indicated.

g. Medical Treatment Facility (MTF)/Fleet IndustrialHygienists. At the time of a baseline industrial hygiene sitesurvey, and during any survey updates, the presence of possiblereproductive and lactation hazards will be evaluated, includingpotential exposure to agents on the NAVENVHLTHCEN list. Anypositive findings will be brought to the attention of the CO orSafety Officer and Senior Medical Department Representative(SMDR) .

h. Type Commander (TYCOM)/Afloat Industrial Hygiene Officer(IHO). IHOs having cognizance over ships billeted withservicewomen will evaluate the presence of shipboardreproductive hazards periodically and make recommendations tothe CO and the SMDR. The SMDR should request an evaluation wheninterpretation of individual and group exposure data involvingpregnant servicewomen is needed.

i. Commander, Naval Air Forces will ensure that proceduresfor managing requests for flight waivers are disseminatedthroughout the aviation community per reference (i).

j. Bureau of Medicine and Surgery (BUMED) will develop,maintain, and promulgate policy regarding the medical management

1-4 Enclosure (1)


and medically related administrative issues concerning pregnantservicewomen.

k. Chief of Chaplains of the Navy/Director of ReligiousMinistries (CNO (N097)) will ensure that the Chaplains Schoolcurriculum includes subject matter to prepare chaplains toprovide counsel and advice from a spiritual perspectiveconcerning issues of faith and character, parentalresponsibilities, personal decisions, and care values perreference (a).

1. Office of the Judge Advocate General (Code 13) willcoordinate to ensure that appropriate judge advocates providelegal assistance relating to options in establishing paternity,obtaining child support, and adoption.

m. Naval Education and Training Command (NETC) will ensuretraining in sexually responsible behavior is conducted forofficer and enlisted accessions. Additionally, NETC will ensurethis topic is included in the General Military Training (GMT)plan.

102. Workplace Assignment and Medical Considerations

a. Few restrictions are required in an uncomplicatedpregnancy of a physically fit servicewoman working in a safeenvironment. The servicewoman shall not be assigned to dutieswhere she is a hazard to self or others. A pregnantservicewoman's duties/occupation may cause or exacerbatesymptoms such as lightheadedness or nausea. In consultationwith the appropriate HCP, the CO shall determine medical andwork assignment limitations. Results of the industrial hygienesite survey, evaluation of the occupational HCP, orrecommendations of the OB HCP may indicate the need forreassignment or work restriction(s) per reference (f).

b. The command should ascertain whether the work site hashad an industrial hygiene site survey. If the setting has nothad a recent industrial hygiene site survey, temporary removalof the pregnant servicewoman from an industrial setting may beindicated; consult with an occupational HCP for evaluation ofthe site survey.

1-5 Enclosure (1)


c. The Occupational Exposures of Reproductive orDevelopmental Concern questionnaires as required by reference (f)(appendices B and C) shall be completed by the pregnantservicewoman and command supervisory personnel knowledgeable ofthe servicewoman's workplace. If potential for exposure to adevelopmental hazard is present in the workplace, or if navalactivities have not determined the possibility of such potential,the command shall arrange for an occupational HCP to evaluatethe servicewoman as soon as possible. If the most recentindustrial hygiene site survey documents that no potential forexposure to a developmental hazard exists in the workplace, anoccupational medicine evaluation should occur if either thepregnant servicewoman or the CO requests it. A copy of theappropriate sections of the completed evaluations should beplaced in the servicewoman's medical record and in theservicewoman's command safety office. Additional limitationswill require the judgment of the CO in consultation with the HCPand the occupational health professional.

d. The pregnant servicewoman may be allowed to work shifts.

103. General Limitations

a. General limitations fall into the following categories:

(1) Medical. After confirmation of pregnancy, apregnant servicewoman shall be exempt from:

(a) The physical readiness program (PRP) duringpregnancy and for 6 months following delivery. (Refer toExercise sections 108 and 205) .

(b) All routine immunizations except as indicated insection 107c of this instruction.

(2) Ergonomic. An ergonomic restriction would applywhen a pregnant servicewoman's physical configuration/abilitiespreclude her from continuing with specific activities. Thesafety office can be requested to provide an ergonomicassessment of the pregnant servicewoman's workplace, if thereare any concerns. Pregnant servicewomen shall be exempt from:

(a) Standing at parade rest or attention for longerthan 15 minutes.

1-6 Enclosure (1)


(b) Lying in the prone position for a prolongedperiod.

(c) Participating in weapons training, swimmingqualifications, drown-proofing, diving, and any other physicaltraining requirements that may adversely affect the health ofthe servicewoman/fetus (refer to Exercise, section 108) .

(d) Lifting greater than 25 pounds.

(e) Working ~n one position for prolonged periods.

(f) Performing prolonged work at heights (such as onladders and step stools) .

(g) Exposure to excessive heat or vibration.

b. An OB HCP may recommend light duty to the CO any timethat it ~s determined to be medically necessary. Pregnantservicewomen may be placed in a light duty status at the 36thweek of pregnancy until term, unless clinical circumstancesindicate otherwise. Additionally, light duty may be prescribedfor a maximum of 2 weeks for those servicewomen having completedCONLV, who are ready to report to the command, but can work onlypart-time.

c.beyond)

During the last 3 months of pregnancy (weeks 28 andthe servicewoman shall be:

(1) Allowed to rest 20 minutes every 4 hours (sitting ina chair with feet up is acceptable) .

(2) Limited to a 40-hour work-week. The 40 hours may bedistributed among any 7-day period. Pregnancy does not precludewatch standing responsibilities, but all hours shall count aspart of the 40 hour per week limitation. In instances where theunit work week/watch standing requirements exceed 40 hours, theCO, in consultation with the HCP, must be informed and approve,on a case by case basis, extension of the servicewoman's workweek beyond 40 hours. The servicewoman may request a waiver toextend her hours beyond the stated 40 hour week, if she isphysically capable and her OB HCP concurs with the request.

1-7 Enclosure (1)


(3) Environmental. The work environment may presentpotential health hazards. The occupational HCP will determineappropriate restrictions as detailed in section 101.

(a) The pregnant servicewoman may be exposed toapplicable Permissible Exposure Limits (PELs) to Radio Frequency(RF) Radiation in the range of 3 kilohertz to 300 Gigahertz perreference (f). No special RF exposure limits or additionalrestrictions are imposed in the case of pregnancy.

(b) The pregnant servicewoman may be occupationallyexposed to ionizing radiation, but this exposure shall be as lowas reasonably achievable. Navy specific procedures for managingdeclared pregnant radiation workers are provided in reference(j), chapter (5).

(c) Exposure to chemical or toxicagents/environmental hazards that are determined unsafe by theoccupational health professional or the OB HCP should be avoided.Areas with other questionably harmful effects such as chemical,biological, radiological, and nuclear effects (CBRNE) trainingshould also be avoided.

104. Assignments

a. Transfer. All transfer (permanent change of station(PCS) , temporary additional duty (TEMADD), etc.) assignments aredeferred for a period of 12 months following delivery unless theservicewoman requests earlier rotation, in which case a waiveris required (refer to Waiver, section 105). Earlier assignmentto a non-deployable unit is acceptable. if the billet is a "hotfill." The purpose for the delay is to allow the servicewomantime to regain her physical strength and stamina in order toperform the duties commensurate with her rate/rank. The 6-monthwaiver from PRP participation will remain in effect.

b. Continental United States (CONUS) Assignment. Pregnantservicewomen may be assigned in CONUS without restrictionprovided they do not have to fly after the 36 t h week of pregnancy.

1-8 Enclosure (1)


c. Outside Continental United States (OCONUS) Assignment

(1) Navy Personnel Command (NAVPERSCOM) shall limitoverseas assignment as feasible, consistent with manning andreadiness considerations. No servicewoman may be assignedoverseas or travel overseas after the completion of the 28 t h weekof pregnancy. Suitability screening for overseas duty, ifproperly conducted under procedures outlined in reference (k),ensures that the assignment and transfer of pregnantservicewomen conform with the following guideline: Pregnantservicewomen in a shore billet in the 48 contiguous states, andassigned to an overseas duty station/geographically isolatedduty station who have not reached their 28 t h week of pregnancy,may be assigned for duty at an overseas installation except whenany of the following conditions exist:

(a) Adequate civilian/military medical facilitieswith OB capabilities (equivalent to American College ofObstetricians and Gynecologists (ACOG) Guidelines) to providecare as required by reference (1) are not available.

(b) The servicewoman intends to place the infantfor adoption. In these cases the servicewoman will not beeligible for overseas/isolated duty until after CONLV andadoption requirements are completed.

(c) Base or alternate civilian housing is notavailable.

(2) Pregnant servicewomen will not be assigned to unitsthat are deploying during the period from the 20 t h week ofpregnancy through 12 months after the servicewoman's expecteddate of delivery and any additional deferment time as determinedby HCP.

(3) Servicewomen who are pregnant at the time oftransfer will not be assigned to mandatory unaccompaniedoverseas duty stations or geographic locations that require theuse of government quarters, or areas that have inadequate OB/GYNfacilities. Pregnant servicewomen will be deferred fromoverseas duty if they are in an advanced stage of pregnancygreater than 28 weeks.

1-9 Enclosure (1)


(4) Servicewomen deferred from overseas transfer due topregnancy will have their projected rotation date (PRD) adjustedto remain at their current duty station until 12 monthsfollowing delivery. If conditions exist at their current dutystation which preclude this extension, the servicewomen will beassigned temporary duty to another command for the same timeperiod. They will be assigned per the normal sea/shore rotationpattern at their adjusted PRD.

(5) Pregnant servicewomen stationed at an overseas dutystation with adequate OB care and available housing (governmentor community) will remain at their current duty station.Pregnant servicewomen stationed at an overseas duty stationwithout available housing (government or civilian) or adequateOB care, will be reassigned prior to the 20 t h week of pregnancy.

e. Specific Assignments

(1) Initial Training. Servicewomen with pregnanciesthat existed prior to entrance (EPTE) or certified duringinitial training (e.g., recruit training or officer candidateschool (OCS)) shall be denied entrance or discharged asunqualified for military service per reference (d), article1740-020. When certified as EPTE, the members shall bedischarged without maternity benefits. The initial permanentduty station has the authority to discharge pregnantservicewomen when it is medically determined that they becamepregnant during initial training. Discharged servicewomen shallnot be prohibited from applying for reenlistment per currentdirectives.

(2) Shipboard

(a) Pregnant servicewomen may remain onboard up tothe 20 t h week of pregnancy.

(b) A pregnant servicewoman shall remain onboard ifthe time for medical evacuation to a treatment facility capableof evaluating and stabilizing OB emergencies is less than 6hours. The 6-hour rule is not intended to allow pregnant womento operate routinely at sea, but rather to provide the COflexibility during short underway periods (i.e., localoperations such as changes in ship's berth, ammunitionanchorages, and transits to and from local shipyards).

1-10 Enclosure (1)


(c) For enlisted servicewomen, cas shall ensure theenlisted availability report includes the date the pregnantservicewoman will be in her 20th week of pregnancy, the datereplacement required, and in the case of deploying units, thedate of deployment. For officers, cas should notify the commandplacement officer as soon as possible for relief and transfer ofthe officer.

(3) Aviation Squadron

(a) Reference (i) discusses the considerations andrequirements in regard to pregnant flight personnel.

!. Pregnancy is considered disqualifying fordesignated flight status personnel. However, waivers may berequested up to the beginning of the third trimester (28 t h week)Flight personnel may be waived to permit flight in transport,maritime, or helo type aircraft with a cabin altitude of lessthan 10,000 feet. No solo flight or ejection seat flight willbe considered for waiver. Designated Naval Aviators (DNA) arewaived to service group III (SG III) only. Pregnancy must beuncomplicated.

2. Close flight surgeon follow-up is mandatory.Ergonomic factors must be observed and flight status altered ifthe member cannot safely perform her duties due to the confinesof the aircraft.

(b) cas should ensure an enlisted availabilityreport is submitted indicating the requested detachment date forenlisted servicewomen who become pregnant while assigned to seaduty aviation squadrons due for deployment. For officers, casshould notify the command's placement officer for relief andtransfer of the officer.

(4) Reporting or Assigned as a Student

(a) Assignment of a pregnant servicewoman will behandled on a case-by-case basis. Consideration must be made forthe course content and the limitations discussed in sections101c through 102.

(b) If a servicewoman becomes pregnant duringtraining, the CO of the training command will determine if she

1-11 Enclosure (1)


can complete her training, as per section 104.e. (4) (a) Whendisenrollment is required, it will be necessary to determinewhen training can be terminated. If possible, training will beterminated at a point academically feasible for the servicemember to reenter the training at a later date, without havingto complete previously completed portions of training. Based onthis information and the projected delivery date, the CO of thetraining command will determine the disenrollment date.

(c) If disenrolled, the pregnant servicewoman willbe returned to her parent command until fully recovered, ifTEMADD. If under pes orders, final disposition will bedetermined by NAVPERseOM (PERS-4).

(d) After returning to full duty, a servicewomandisenrolled for pregnancy will be afforded the opportunity tocomplete her training, consistent with manning and readinessconditions. NETC will determine if enrollment will be necessaryfor the entire course of instruction or only for the portionlost as a result of disenrollment for pregnancy.

105. Waivers

a. General_. A waiver procedure has been established foruse in unique circumstances. If the circumstances warrant, aservicewoman's CO may request a waiver on her behalf.

b. Assignment Waiver Request. Requests for a waiver ofpregnancy policy assignment restrictions shall be submittedpromptly to NAVPERSeOM (PERS-4) for officers and rated personnel,or Personal Readiness and Support Branch (PERS-4013) in the caseof non-designated Seaman/Airman/Fireman (SN/AN/FN). Theappropriate Detailing Branch Head will screen the request andmake the final determination regarding assignment eligibility.A medical waiver request should contain all information requiredby NAVPERSeOM (PERS-4 or PERS-4013), along with the followinginformation:

(1) Narrative of condition including number of weeks ofgestation, present condition, special treatment requirements andany anticipated future requirements other than normal delivery.

(2) Results of specialty consultation that include themedical officer's estimate of the servicewoman's ability to

1-12 Enclosure (1)


perform assigned duties, and when such duties should beterminated prior to the expected date of delivery.

(3) If the member is due to be stationed overseas, theavailability of medical care must be determined. This wouldinclude the facility's ability to manage the servicewoman'sprenatal care, delivery, postnatal care, and care of the infant.

c. Aviation Waiver. Waiver requests should be submittedper the procedures defined in Navy Aeromedical Reference andWaiver Guide to Chief of Naval Operations (N88) and NAVPERSCOM(PERS 43B) via Naval Operational Medicine Institute Detachment,Naval Aerospace Medical Institute (NAVOPMEDINST DETNAVAEROMEDINST), Pensacola, FL (Code 42). Additionally,NAVOPMEDINST DET NAVAEROMEDINST (Code 42) will be notified upontermination of pregnancy.

d. Postpartum Deferment Waiver. Postpartum defermentwaiver requests should be signed by the attending OB HCP andforwarded from the servicewoman's CO to NAVPERSCOM per section105 (b) .

106. Evacuation of Pregnant Servicewomen

a. If noncombatant evacuation is ordered in any area, allpregnant servicewomen who have reached the 20 t h week of pregnancywill be evacuated as noncombatants.

b. The area commander will make the decision whether toevacuate servicewomen in the earlier (less than 20 weeks) stagesof pregnancy. The area commander will consult with availablemedical authority and base a decision on:

(1) Ability of the pregnant servicewoman to perform inher specialty.

(2) Capability of field medical (or other support unit)to perform emergency OB care.

(3) Requirement for duties.

(4) Nearness of the hostilities.

(5) Welfare of the unborn child.

1-13 Enclosure (1)


c. Medical evacuation methods will not be used for pregnantservicewomen unless directed by a medical officer.

d. Pregnant servicewomen who are evacuated will be reportedto and reassigned by NAVPERSCOM (PERS-4).

107. Provision of Healthcare

a. OB Care

(1) In Vicinity of Servicewomen's Commands. Whenpregnant servicewomen remain at their duty stations, OB carewill be provided at the designated MTF, provided it has OB carecapability and the servicewomen reside in the facility'scatchment area. If that MTF does not have OB care capabilityand there is no other MTF with this capability serving thecatchment area, servicewomen may choose a TRICARE networkprovider, if available. If no network providers are available,then servicewornen may choose any TRICARE authorized provider todeliver in a civilian hospital closer to their residence, ortravel to the nearest or most accessible MTF for delivery. Seereferences (c), (j), and (1) for procedures relative to receiptof payment for civilian care. Following delivery and upondischarge from either the military or civilian inpatientfacility, the servicewomen will be granted CONLV based onspecific medical indications. Reference (d), article 1050-180and section 107 of this instruction provide guidance for thegranting of convalescent leave.

(2) While in a Leave Status. If servicewomen request tohave the delivery or other OB care at a location outside of theMTF catchment area or away from the network provider or TRICAREauthorized provider while in a leave status, there must first bea referral and authorization from the member's Primary CareManager (PCM) , even if the intention is to utilize another MTF.The PCM's referral and authorization are required for theTRICARE Managed Care Support Contractor to pay for authorizedcivilian healthcare services.

(a) Prior to approving such leave, theservicewoman's CO shall ensure that the servicewoman hasreceived counseling, which may include the local BeneficiaryCounseling and Assistance Coordinator (BCAC) with regard toprenatal and postnatal care available in her leave area or

1-14 Enclosure (1)


TRICARE Managed Care Support Contractor's Health BenefitsAdvisor. Leave status can be terminated only when determinedmedically necessary by a military HCP. Normally, this shouldoccur at the time of admission for delivery.

(b) When a servicewoman has been granted leave tocover the period of an imminent delivery, the servicewomanshould request a copy of her complete prenatal care records fromthe OB HCP. The OB HCP should note in the record whether theservicewoman is medically cleared to travel. The servicewomanwill obtain a statement bearing the name of the MTF (may be aMilitary Medical Support Office (MMSO)) having medicalresponsibility for the geographic area of the patient's leaveaddress from the Patient Administration Department. If theservicewoman is receiving prenatal care from other than a MTF,she should avail herself of the services of the nearest BCAC orTRICARE Managed Care Support Contractor's Health BenefitsAdvisor to affect the forestalled services. This statementshould be attached to the approved leave request. The commandshould determine if the requested MTF can provide treatmentprior to approval.

(3) Civilian OB care for the servicewoman includes allcharges for the servicewoman and the newborn as long as themother remains hospitalized. If the infant must remain in or istransferred to a civilian hospital after discharge of the mother,the infant's admission or transfer costs shall be cost sharedunder TRICARE, per reference (m). The servicewoman should usethe services of the nearest BCAC or TRICARE Managed Care SupportContractor's Health Benefits Advisor for detailed informationregarding health benefits for the infant(s).

(4) Upon discharge from the civilian hospital followingdelivery, the mother will be granted CONLV by the MTF listed onthe statement attached to her leave request or by the cognizantMMSO per section 107. The period, if any, between expiration ofCONLV and the servicewoman's return to her parent organizationis chargeable as regular leave.

b. Hospitalization. When it becomes necessary tohospitalize a pregnant servicewoman because of complications orthe onset of labor, the MTF or MMSO will notify theservicewoman's command, citing the medical indication which

1-15 Enclosure (1)


warranted her hospitalization per reference (c) for notificationrequirements.

c. Immunizations. The benefits of immunizing women usuallyoutweigh the potential risks when the likelihood of diseaseexposure is high and when infection would pose a risk to themother or fetus. Pregnant servicewomen may routinely receivetetanus-diphtheria toxoid, polyvalent influenza vaccine,hepatitis B vaccine, and meningococcal vaccine. For othervaccines, immunize according to the Centers for Disease Controland Prevention (CDC) General Recommendations on Immunization(available at www.cdc.gov/nip/publications/preg_guide.htm) andin consultation with the servicewoman's OB HCP.

108. Exercise .. Per ACOG and the DOD/VA Uncomplicated PregnancyClinical Practice Guideline (DOD/VA UPCPG), servicewomen withuncomplicated pregnancies should continue to perform anindividualized exercise program that incorporates regular mildto moderate exercise in sessions of 30 minutes duration, threeor more times per week during the pregnancy. The exerciseprogram should be based on pre-pregnancy activity level and beapproved by the OB HCP. Pregnant servicewomen should notparticipate in push-ups or sit-ups. Pregnant servicewomenshould not engage in scuba diving, high-altitude (>10,000 feetabove sea level) activities, contact sports, or activities thatcarry increased risk of falling or risk for abdominal traumaduring pregnancy.

109. Disposition of Complicated/High Risk Pregnancies. Somepregnant servicewomen require significant amounts of time awayfrom the work environment (i.e., past history of multi-problempregnancy, bleeding or threatened abortions). In theseinstances, it is not unusual for the OB HCP to order theservicewoman to bed rest for extended periods, or until delivery.If this impacts the command adversely, the following dispositionalternatives may be utilized:

a. Medical Holding Company (MHC). MHCs may be utilized forthose requiring extraordinary time in an OB-Quarters status.Placement on temporary duty (TEMDU) in a MHC by a MTF enablesthe parent command to request a relief. Time limitations forremaining in a MHC are waived for pregnant servicewomen. Onceadmitted to a MHC, the servicewoman should be assigned duties

1-16 Enclosure (1)


commensurate with the physical limitations directed by her OBHCP per reference (n).

b. Referral to Medical Evaluation Board (MEB)/Limited Duty(LIMDU) Convening a MEB for the purpose of placing aservicewoman in a LIMDU status is rarely indicated for pregnancy.Only when a medical condition arises that would otherwise promptreferral to an MEB in a non-pregnant servicewoman (i.e.,ruptured anterior cruciate ligament) should the case be referredto an MEB.

c. OB-Quarters Status Policy. Pregnant servicewomenrequiring extended bed rest who do not reside in the barracksmust be seen by their OB HCP at least weekly and may be placedin OB-Quarters status at home. The OB HCP must certifyspecifically that OB-Quarters is prescribed. A pregnantservicewoman will not be placed in an OB-Quarters status solelyon the basis of pregnancy (i.e., no complications or extenuatingcircumstances).. The medical condition of the servicewoman mustdictate the length of time she should be allowed to remain inOB-Quarters status. Accordingly, the normal 72-hour time limitfor SIQ patients is waived for OB-Quarters patients. Thisstatus should be reserved for those instances when, in theopinion of the OB HCP:

(1) The servicewoman has become disabled (unable toperform assigned duties) .

(2) There are complications present that would precludeany type of duty responsibilities or delivery is imminent.

(3) There are complications or conditions caused by, ordirectly related to the pregnancy (i.e., excessive vomiting,hypertension, or multiple pregnancy), which could potentiallylead to an adverse OB outcome.

d. Admission to MTF. In those instances deemed appropriateand in keeping with utilization review standards, a servicewomanliving in the barracks who requires extended bed rest may beadmitted to an MTF.

e. Procedures. To place a patient in OB-Quarters status,the OB HCP shall record on the DD 689, Individual Sick Slip, theexpected duration of OB-Quarters Status. If the period will

1-17 Enclosure (1)

OPNAVINST GOOO.1C14 Jun 07

exceed 72 hours, the OB RCP must notify the member's co and mustbe noted in her OB medical record. Civilian OB providerrecommendations for duty limitations will require approval by anMTF RCP.

110. Termination of Pregnancy

a. Spontaneous Abortions. Following a spontaneous abortion(i.e., miscarriage), the servicewoman's RCP may recommend aperiod of convalescent leave when clinically indicated. The RCPmay also waive participation from the PRP (PFA and BCA) asclinically indicated.

b. Abortions

(1) Reference (0), provides guidance on the use of DODappropriated funds (including MTF supplemental care funds andTRICARE) for performing abortions. DOD policy prohibits the useof DOD appropriated funds, except under the followingcircumstances:

(a) CONUS. Abortions may be performed in naval MTFswithin CONUS when the life of the mother would be endangered ifthe fetus were carried to term. Abortions shall not beconducted in CONUS naval MTFs when the pregnancy is a result ofrape or incest.

(b) OCONUS.feasible and consistentmembers and active dutyhave access to abortionbeneficiaries in CONUS.

It is DOD health policy, to the extentwith legal obligations, that active dutyfamily members stationed OCONUS shallservices comparable to those same

1. Abortions may be performed on active dutymembers and active duty family members in naval MTFs OCONUS whenthe life of the mother would be endangered if the fetus werecarried to term.

2. Abortions may be performed on active dutymembers and active duty family members in naval MTFs OCONUS on apre-paid basis when the pregnancy is the result of rape orincest. Charges for abortions under these circumstances shallbe based on the full reimbursement rate for same-day surgerybased upon patient category.

1-18 Enclosure (1)


(2) Servicewomen are highly encouraged to consult with amilitary HCP for information prior to obtaining an abortion.Every provision will be made to maintain the sensitivity andconfidentiality of the consultation. During this time,information will be provided to servicewomen concerning theprocedure so that, should they experience any difficulties, theywill seek medical attention for appropriate treatment.Servicewomen should consult with an MTF HCP following theprocedure for the purpose of follow up care, including anynecessary medications, appropriate short term duty restrictions,scheduling of follow up examinations/laboratory studies, anddocumentation in the health record.

(3) Civilian facilities will be used at theservicewoman's expense. Annual leave will be used in order tohave the procedure accomplished. Any subsequent treatment orhospitalization required as a result of an abortion at acivilian facility will be managed as any other illness ordisability under references (c) or (m), as appropriate. An MTFHCP shall determine the requirement for convalescent leave.

Ill. Surrogacy:. Per reference (a), servicewomen are notauthorized to provide surrogate pregnancy services. Forpurposes of this instruction, surrogate pregnancy is a voluntaryarrangement by which a woman agrees, whether or not forcompensation, to carry a pregnancy to term for the purpose ofsurrendering the child to the sole custody of another person orpersons.

112. Uniforms. The proper wearing of the uniform duringpregnancy is the responsibility of the servicewoman and shall beaddressed by the unit co. The certified maternity uniform ismandatory for all pregnant servicewomen in the Navy when auniform is prescribed and regular uniforms no longer fit. Theouter garments (sweater, raincoat, overcoat, peacoat, and reefer)may be worn unbuttoned when the garment no longer fits properlybuttoned. The servicewoman is expected to wear regular uniformsupon returning from CONLVi however, COs may approve the wear ofmaternity uniforms up to 6 months from the date of deliverybased on medical officer diagnosis and/or recommendations.Enlisted servicewomen will be given a clothing allowance uponpresenting the pregnancy notification from the CO/OIC to thepersonnel support detachment (PERSUPPDET) per reference (p).

1-19 Enclosure (1)


113. Billeting

a. Per reference (a), a pregnant servicewoman with nofamily members may reside in bachelor quarters for her full term.If requested, the host commander may authorize a pregnantservicewoman to occupy off-base housing and be paid a BAH up toher 20th week of pregnancy. From the 20th week onward the hostcommander must approve a request to occupy off-base housing.

b. COs may authorize single pregnant servicewomen to moveinto government housing, based on availability, before the birthof the child. However, they will not be given special treatment(i.e., head of line privilege on the base housing list).

c. These policies allow single pregnant servicewomen to setup housing in preparation for the baby. Reference (h) outlinesthe policy for application to government housing and reference(a) supports this. Payment of BAH will be per applicable payand entitlement regulations.

114. Pregnant Brig Prisoners. The care and management ofpregnant servicewomen prisoners confined to a brig shall conformto the requirements of this instruction except that convalescentleave cannot be authorized. Pregnancy per se does not precludeconfinement in a brig as long as appropriate prenatal care isprovided and there is a MTF near the brig that can provide carefor labor, delivery, and the management of OB emergencies.

115. Separation from Service and Care after Separation

a. By law, neither the military departments nor TRICAREhave the authority to pay civilian maternity care expenses forformer servicewomen who separate from active duty while they arepregnant, unless qualified for the Transitional AssistanceManagement Program (TAMP) through PERSUPPDETs or ID card issuingoffices per reference (m), paragraph 199.3 e., under Eligibility.Former servicewomen lose entitlement to all civilian OB care atmilitary expense upon receipt of a discharge certificate (DD 214)unless qualified for TAMP as above or if in receipt of a MTF COauthorization for direct care. See reference (d), article 1910180, for effect.ive time of discharge. Prior to separation,servicewomen should receive counseling by a PatientAdminist.rat.ion Officer/Representative about current information

1-20 Enclosure (1)


regarding health care benefits available to separatingservicewomen.

b. The uniformed services voluntary gO-day medicalinsurance policy, also called the Continued Health Care BenefitProgram (CHCBP), is available to separating servicewomen andwill cover pre--existing conditions such as pregnancy. This mustbe purchased within 60 days of separation from Active Duty andcan be purchased in three month increments, not to exceed twoyears.

c. The Service Secretaries (under special administrativeauthority) allow former servicewomen who separate underhonorable conditions and are pregnant, to receive maternity carefor that pregnancy up to 6 weeks following delivery in MTFs on aspace available basis. The DD 214 along with a letter from theMTF HCP documenting the estimated date of confinement (EDC) maybe presented to gain access to the MTF to utilize theappropriate services until six weeks after delivery. This careis available only if:

(1) The servicewoman presents documented evidence thatreflects that a physical examination given at a MTF demonstratesthat she was pregnant prior to her separation from active duty.

(2) The MTF to which she applies for care has thecapability of providing OB care. Many MTFs cannot provide OBcare. A pregnant servicewoman who elects to leave the servicemust first consider the distance between her home and thenearest MTF that has OB care capability. She must consider thepossibilities of premature delivery or other emergency DB careneeds. These factors could unexpectedly force her to use acivilian source of care. Should that happen, neither the MTF,TRICARE, nor the VA has authority to pay civilian OB careexpenses, regardless of the circumstances necessitating use ofcivilian care for either the ex servicewoman or her newborninfant(s). The servicewoman should be made aware that if thenewborn infant(s) require(s) care beyond that, which isavailable at the MTF, it may be necessary to transfer theinfant(s) to a civilian source of care (e.g., neonatal care) andthese expenses will be the servicewoman's personal financialresponsibility. However, every effort will be made to send theinfant(s) to an MTF with the appropriate capability.

1-21 Enclosure (1)


d. Before deciding to accept a discharge or resign from theservice, pregnant servicewomen should contact the BCAC of theMTF that she plans to use, to determine if:

(1) The facility provides OB care.

(2) The facility is close enough to her planned place ofresidence to provide assurance that, barring emergencyrequirements, she can reach it expeditiously at the time ofbirth.

(3) The facility's workload will permit acceptance ofher case.

e. There are OB benefits for women veterans enrolled in theVA system. VA facilities are using enhanced sharing authorityto contract for OB services to include prenatal care, childbirth,and postpartum care. This benefit does not cover care of thenewborn. In addition, the veteran may be responsible for someof the expenses incurred.

1-22 Enclosure (1)


CHAPTER 2PARENTHOOD

201. Responsibilities

a. Commanding Officers (COs)

(1) Shall make every effort to permit new fathers totake leave in conjunction with the birth of their child. Leavewill be charged against regular leave balance and granteddependent on the unit's mission, specific operationalcircumstances, and servicemember's billet. This leave shouldcommence once the child has been born in order to assist theparent(s) in adapting to the demands of parenthood, formalizinglegal requirements, establishing a child care program, and othertasks as required.

(2) Shall maintain a command environment that promotesthe education of servicemembers concerning the enduringindividual responsibilities of family planning and parenthood.

(3) Shall ensure that a servicewoman who will become asingle parent and that dual military couples residing in a jointhousehold are counseled regarding the availability of governmenthousing (especially in high cost areas) .

(4) Shall ensure that servicemembers are afforded theopportunity to take advantage of available legal assistance foradvice regarding their options in establishing paternity.Absent a court order or other competent authority, maleservicemembers will not be compelled to have a paternity test.Department of the Navy (DON) medical facilities do not pay forpaternity testing. Paternity testing will be obtained at theservicemember'S expense.

(5) Shall develop written policies to delineate supportof servicewomen with breastfeeding infants that includesinformation such as facilities provided and time allotted forbreaks. The policies will ensure that the work environmentsupports and respects servicemembers who engage in healthybehaviors such as breast milk expression. The policies willprohibit harassment and discrimination of breastfeedingservicewomen.

2-1 Enclosure (1)

OPNAVlNST 6000.1C14 Jun 07

(6) Shall provide access to educational information fromdidactic materials and/or a lactation consultant for breast care,breast feeding education, counseling, and support during thepregnancy, after delivery, and on return to work forservicewomen and their families.

(7) Shall engage the Navy Occupational and Safety HealthProgram, as necessary, to ensure that an Occupational Exposuresof Reproductive or Developmental Concern Questionnaire has beencompleted, per reference (q), and that the current industrialhygiene site survey identifies potential environmental andoccupational hazards that may impact servicewomen with nursinginfants.

(8) Shall ensure legal, financial, religious, and otherservices are available to assist and encourage all navalservicemembers in making family life decisions that aresupportive of both service obligations and their parentalresponsibilities.

b. Health Care Professionals (HCPs)

(1) Shall provide pre-conceptual counseling forservicemembers when requested. Refer to section 207 for furtherimmunization guidance.

(2) Shall assist Fleet and shore cas and OlCs in theirefforts to support servicewomen with nursing infants perreference (r).

c. Servicemembers

(1) Are expected to plan a pregnancy and/or adoption inorder to successfully balance the demands of familyresponsibilities and military obligations.

(2) Anticipating the responsibilities associated withparenthood, are required to make arrangements for child care tocover regular working hours, duty, exercises, and combatcontingency deployment. This applies to Reserve Componentmembers on active duty/inactive duty for training uponmobilization.

2-2 Enclosure (1)


(3) All single servicemembers and dual military coupleswith eligible family members are responsible for initiating aformalized family care plan per reference (e). A completedfamily care plan will certify that family members will be caredfor during the servicemember's absence. It will also identifythe designated legal guardian of the eligible family member(s),as well as logistical, relocation, and financial arrangements.Servicemembers are advised to contact their local Fleet andFamily Service Center (FFSC) to develop a family care plan.Servicemembers may consult with Fleet and Family Support staffif needed for assistance identifying or selecting caregivers.Single, separated or divorced servicemembers with possiblecustody issues are advised to consult with their legalassistance office when designating caregiver and legal guardians.

(4) Are advised to contact their local Child and YouthPrograms Resource and Referral Office to complete DD 2606,Request for Child Care Record, to place the newborn child orsoon to be adopted child on the waiting list for childcare or toreceive referrals for community based childcare services. Thisform is available online at: http://forms.daps.dla.mil/order/.

d. Servicewomen

(1) After delivery, will participate in an exerciseprogram, as soon as medically authorized, to prepare for thephysical fitness assessment (PFA). No later than 6 months afterbeing returned to full duty by the Hep, the servicewoman isrequired to take the PFA and conform to the acceptableheight/weight standards, per reference (g). Additional time maybe recommended by the HCP and granted, if necessary, due tomedical complications.

(2) Who desire to continue breastfeeding upon return toduty will notify their chain of command at the earliest possibletime to allow the command to determine how best to support themas well as to facilitate the prompt evaluation of the workplacefor potential hazards. Questions regarding potential workplacehazard issues related to lactating servicewomen should bereferred to Navy Occupational Health Program personnel todetermine whether intervention is necessary.

e. NAVENVIRHLTHCEN. will maintain a current list ofpotential lactation hazards based on professional review of the

2-3 Enclosure (1)


literature and analysis of available data, per reference (f).NAVENVIRHLTHCEN will provide guidance to medical departments oncriteria for requesting occupational health consultation andwill also provide generic lactation hazard guidance on requestor when indicated.

f. Naval Education and Training Command (NETC) will ensuretraining is conducted for officer and enlisted accessions thatcovers the importance of family planning and responsibilities ofparenthood. Additionally, NETC will ensure these topics areincluded in the GMT plan.

202. Adoption

a. Infants Placed for Adoption. General legal advice onadoption may be obtained through the local Naval Legal ServiceOffice (NLSO). Any required legal work to place a child foradoption or to adopt a child must be provided by a civilianattorney retained by the servicewoman. Pregnant servicewomenintending to place their infant for adoption are not eligiblefor OCONUS assignment until delivery and adoption requirementsare completed.

b. Servicemembers Adopting an Infant/Child

(1) The CO shall authorize up to 21 days permissiveTEMADD for any servicemember adopting a child, dependent on theunit's mission, specific operational circumstances, and theservicemember'g billet. Adoption leave may be authorized inconjunction with ordinary leave. In the event a dual militarycouple adopts a child in a qualifying child adoption, only oneof the members shall be granted adoption leave as per references(s) and (t). A. qualifying adoption is defined as the memberbeing eligible for reimbursement of qualified adoption expensesunder Section 1052, title 10 United States Code.

(2) After placement of the infant/child, one parentshall be exempt from duty away from the home station, i.e.,TEMADD and/or deployment for 4 months per reference (e),paragraph 4.13, and reference (u), paragraph 6.10.4.

203. Leave and CONLV. The servicewoman's CO (upon advice ofthe OB RCP) , COs of the MTF, or MMSO (persons hospitalized in

2-4 Enclosure (1)


civilian facilities within their respective areas of authority),may grant convalescent leave as follows:

a. Convalescent leave will normally be for 42 days afterdischarge from the MTF following any uncomplicated delivery orcesarean section. The attending physician may recommendextension of convalescent leave beyond the standard 42 daysbased on medical complications. The servicewoman's permanentcommand must be notified of this recommendation. Theservicewoman may terminate such leave early with the OB HCP'sapproval. COs may grant regular leave following convalescentleave if appropriate, per reference (d), article 1050-180.

b. The OB HCP must certify that the patient is not fit forduty, will not need hospital treatment during the contemplatedleave period, and that such leave will not delay the finaldisposition of the patient.

c. Servicewomen awaiting disciplinary action or separationfrom the service for medical or administrative reasons may notbe granted CONLV as per reference (d), article 1050-180.

d. It is the responsibility of the servicewoman to reportany complications or medical problems that she has experiencedduring CONLV to her OB HCP. If clinically indicated, the HCPmay recommend an extension of CONLV.

204. Shaken Baby Syndrome (SBS) Prevention

a. Shaken Baby Syndrome (SBS) refers to the collection ofsigns, symptoms, and physical injuries resulting from violentshaking of an infant or small child. It is a serious form ofchild abuse. A hospital-based SBS Prevention Program, targetingparents just prior to discharge with their newborn baby canincrease awareness and decrease the incidence of SBS byproviding parents with appropriate strategies to cope with apersistently crying infant by explaining normal phases of growthand development.

b. MTFs will collaborate with local FFSC and the ArmedForces Center for Child Protection to implement and monitor anevidence-based SBS Prevention Program, providing quarterlyoutreach and incidence statistics for their regions. This SBSPrevention Program will provide education about the dangers and

2-5 Enclosure (1)


consequences of shaking infants; discussion of normal infantdevelopment, including colic; suggestions of ways to reducerisks factors associated with child abuse; and informationconcerning appropriate methods of managing the frustration andanger that cause someone to shake an infant. The SBS PreventionProgram will include postpartum parental education beforenewborn discharge, during outpatient processing, and at the timeof the first well baby appointment. Fleet operational HCPs willprovide SBS prevention education for new fathers on deploYmentbefore reunification with their new baby and family.

c. The New Parent Support Home Visitation Program willsupplement in-hospital SBS Prevention Programs by reviewingparents' knowledge of effective and safe parenting techniquesduring home visits. Home RN or New Parent Support Specialistvisits will target "at risk" families identified by a voluntaryuniversal screening tool. In addition, all single parents andfamilies with a deployed servicemernber will be offered homevisitation services.

205. Postpartum Exercise

a. An exercise program should be gradually resumed 6 weeksafter an uncomplicated vaginal delivery or cesarean section.Servicewomen who have medical or OB complications should discussand plan a modified postpartum exercise program under theguidance of their OB HCP. Postpartum servicewomen shouldgradually increase their individualized exercise program to beable to perform regular mild to moderate exercise in sessions of30 minutes duration, three or more times per week.

b. Servicewomen will be responsible for participating inthe Physical Fitness Assessment (PFA) and Body CompositionAssessment (BCA) requirements six months after delivery. Ifclinically indicated due to medical complications, sections ofthe PFA may be waived by the HCP.

c. Administrative Actions. Per reference (g),administrative actions due to Physical Fitness Assessmentfailures incurred prior to confirmation of pregnancy will remainin effect during term of pregnancy and aftercare. This includesbut is not limited to withholding of advancement, recommendationfor retention, and administrative separation processing.

2-6 Enclosure (1)

206. Postpartum Depression


a. Medical department staff shall routinely assess andscreen all pregnant servicewomen and new mothers forsigns/symptoms of depression or a history ofdepression/psychosis during the following periods of care: newobstetric care visit, transfer obstetric care visit, lasttrimester of pregnancy, 6 weeks postpartum as well ~s each ofthe well-child care visits in the first 6 months of life at aminimum as per DOD/VA Uncomplicated Pregnancy Clinical PracticeGuidelines and American College of Obstetricians andGynecologists. This is important since a history of previouspostpartum depression or major depression significantlyincreases the risk for the servicewoman developing postpartumdepression.

b. Scientifically proven screening tools, such as thePatient Health Questionnaire Two (PHQ-2) Question Screeningduring pregnancy and the Edinburgh Postnatal Depression Scale(EPDS) should be offered to women in the postpartum period aspart of a screening program for postpartum depression. Thepostpartum screening may be done in conjunction with the 6 weekpostpartum visit as well as each well-child care visit in thefirst 6 months of life at a minimum. Postpartum depressionshould be managed in the same way as depression at any othertime, but with additional considerations regarding the use ofantidepressants while breastfeeding.

207. In-Vitro Fertilization (IVF). Servicewomen undergoinginfertility treatment with IVF are required to inform theircommand with a letter from their HCP that should include theduration of the treatment, the potential dates for minorprocedures such as oocyte retrieval and embryo transfer, so thatpossible duty limitations and TAD may be anticipated. Duringthe actual IVF cycles, servicewomen will be exempt fromparticipating in the PFA and BCA to better ensure IVFsuccess. Women who participate in IVF programs are more likelyto gain weight due to numerous hormone treatments and must limitphysical activity to increase IVF success rates and preventadditional IVF treatments. When IVF treatment results in asuccessful pregnancy, the provisions of this policy willpertain. If the IVF treatment is unsuccessful, the servicewomanwill be expected to participate fully in the PFA and BCA in 30days.

2-7 Enclosure (1)

208. Immunization Considerations

OPNAVINST GOOO.lC14 Jun 07

a. It has been determined that live virus vaccines(influenza, measles-mumps-rubella (MMR) , varicella, BCG,smallpox, yellow fever) can be hazardous to an unborn child ifconception occurs within three months of vaccination. Refer toCenter for Disease Control and Prevention (CDC) GeneralRecommendations on Immunization (available atwww.cdc.gov/nip/publications/preg_guide.htm) .

b. If live virus vaccine is administered, servicewomen areto be counseled to avoid becoming pregnant for three months.This counseling will be documented in the servicewoman's healthrecord.

c. Breastfeeding does not adversely affect immunization andis not a contraindication for vaccines. Per the CDC andPrevention, neither inactivated nor live vaccines (includingvaricella vaccine) administered to a breastfeeding servicewomanaffect the safety of breast-feeding for mothers or infants.

d. Vaccinia (smallpox) vaccine is relativelycontraindicated for breastfeeding mothers as it could put aninfant in close contact with mother's vaccination site. Ifimmunization of the mother or father is essential, thevaccination site should be dressed and strict hand washingundertaken until healing of the immunization site occurs. Formore information see reference (v), Advisory Committee onImmunizations Practice (ACIP) and American Academy of FamilyPhysicians (AAFP) General Recommendations on Immunization,http://www.cdc.gov/mmwr/PDF/rr/rr5l02.pdf (see page 18)

209. Workplace Support of Breastfeeding Servicewomen

a. Background

(1) Breastfeeding offers proven health benefits forinfants and mothers. Providing accommodations for breastfeedingoffers tremendous rewards for the DOD and the Navy, in costsavings for health care, reduced absenteeism, improved moraleand servicemember retention. Challenges in the workplaceinclude lack of break time and inadequate facilities for pumpingand storing breast milk. Many of these workplace challenges canbe reduced with a small investment of time and flexibility.

2-8 Enclosure (1)


(2) DOD has directed that active and selected reservecomponent members be physically and mentally fit to carry outtheir missions and that the emphasis will be placed on theachievement of the Department of Health and Human Services'Healthy People Goals, per reference (w). Support ofservicewomen who continue breastfeeding their infant(s) uponreturn to duty aligns with DOD policy, ensures the physical andemotional well-being of servicewomen and their families, reducesabsence from work due to illness, and improves operationalreadiness. Per current professional standards, the militarymedical community advises pregnant servicewomen to exclusivelybreastfeed for the first 6 months and encourages them tocontinue to provide breast milk for the remainder of the firstyear, per reference (u).

b. Workplace Breast Milk Expression

(1) Supervisors and breastfeeding servicewomen willcollaborate to keep to a minimum the amount of time required formilk expression. The time required for breast milk expressionvaries and is highly dependent upon several factors, includingthe age of the infant, amount of milk produced, pump quality,distance of the pumping location from the workplace, andproximity to a water source. Information regarding workplacesupport of breast feeding is available at:http://www.usbreastfeeding.org/Publications.html.

(2) Servicewomen who continue to provide breast milkupon return to duty will be, at a minimum, afforded theavailability of a clean, secluded space (not a toilet space)with ready access to a water source for the purpose of pumpingbreast milk. The number of breaks needed to express breast milkis greatest when the infant is youngest, then graduallydecreases (i.e., 15-30 minutes every 3-4 hours).

(3) Commands must ensure breastfeeding servicewomen areafforded access to cool storage for expressed breast milk.Access to refrigeration is ideal, but not required forservicewomen who work up to 12 hours in any particular day.Servicewomen may keep breast milk cool in a portable coldthermal bag if refrigeration is not immediately available.Access to a freezer compartment is necessary if the workdayextends beyond 12 hours. Breast milk should be contained and

2-9 Enclosure (1)


labeled so as to avoid contamination by other items located inthe vicinity.

(4) Requests to breast feed infants during duty hoursshould be handled on a case-by-case basis. However,breastfeeding an infant is not a reason for granting excessivetime for meals or from work.

2-10 Enclosure (1)


APPENDIX ASAMPLE PREGNANCY NOTIFICATION TO

COMMANDING OFFICER/OFFICER IN CHARGE (CO/OIC)

Information to be included in Pregnancy Notification to theCO/OIC.

Date---------From:

MTF/PhysicianTo:

Commanding Officer/Officer-in-Charge

Subj :Member's Name

Ref: (a) OPNAVINST 6000.1C

1. This is to notify you that a member of your command,______________ , is pregnant. Using current dating information,her estimated date of confinement isThis would make her 20 t h week about andher 28 t h week about

2. Pregnancy is a condition that includes a range ofphysiological changes that can potentially lead to clinicalfindings that would result in your command having to modify theservicewoman's job function/working hours. In addition, certainunforeseen conditions related to the pregnancy may arise thatcould warrant specific medical interaction and further physicallimitation of the servicewoman's activities.

3. Please refer to reference (a), which provides currentadministrative guidance concerning pregnant servicewomen. Thisguidance is intended to promote uniformity in the medicaladministrative management of pregnancies for women in the Navyand Marine Corps.

Signature/Rank

A-I Appendix A toEnclosure (1)


APPENDIX B

Occupational. Bxpo.ur•• o~ R8produot:lve or D_~opaental. Concern - Work.r·.8ta~t

After your .upervJ.or ha. conpleted the NAwaD 626018, pl•••• cOtll'Jece ~IJJ. rona .nd M" It wJth you "hen you ... the h••lthcare prot'ee• .1on.l ....ho will help ,,1th· your evalu.eJon. PL~~ PRINr.

First

Phone (work)

L I ~c:y.. OJOJITIIJ___________-----J Day .Month Year

D Phone (haae) I IRank/Rate/Job Code

Age D Sex

How many years have you had your current job?

Live births DStillbirths ~

Mi.carriage. ~

Abortion. D

How lIUIJly were:

DD

DYesONO Number of previous Dpreonancies

Date last, menstrualOJOJITIIJperiod began

Day .Month Year

Are you pregnant?

~•• onJ.y

HlI.J.e. onl.y

How many children have you fathered (ever)?

All worker.

What did you do at your previous job? What doe. your spou.e or mate do at work?

Have you ever qotten sick or injured because of DNa DYes QIW.,.",oIl/IIY ')W"-".,.your job?Have any of your children had birth defects? ONO o Ye.

Do you have any illnesses you see the doctor for o No o Ye.regularly?00 you take medications regularly? DNa o Yes

Do you use any other drugs, inclUding tobacco? DNa DYes ,

How much alcohol do, you usually drink per week? 0<6 drink. 06 to 14 015 to 21 022 or JIOre

Reason for consultation What reproductive or developmental hazards are youIIIOst concerned about?

recreation, hObbie., .econd job, etc., are you expo.ed to any of the following?In your activities at hODe,(Check all that apply)

Cbem.oal Jlaenta

o Inorganic chemicals

llbyooioal Aa-nta

o Ionizing radiation

1 -

tio1.ogiaa1 av-a-o Bacteria 0 Animal danders

o Organic solvents and fuels 0 Microwave and other RF radiation 0 I!'Ungi

o Metals - lead, eadmium, etc. 0 "Noise" (Intense sound) 0 Viruses

o Endotoxins

o Enzymes and other proteins

o Thermal stress (heat or cold)

o Vibration

o Pesticides

o Pharmaceuticals/drugs

o Other hazards (specify)--------

l'hya:Loal CoDd:Ltiona

o Irregular or shift

D Strenuous work

[J None of the above

Supervisor's Signature

NAVMED 626019 112-2002)

B-1 Appendix BEnclosure

to(1 )


APPENDIX C

OacupaUona1 Expoaurea o~ a.produative or Deve1opaenl:a1 Conae%ll. - Supe%'Viaor'a Sl:a~t

To be coapleted by the .lupervl.or for any worker .,jth concern. ~.rdJtJg workplace reproductJve- or develos-ental h•••rds. rhi.foe. .lhould then be fortlarded to _A'raprJ.te IMdJc.l per.onneJ aUGb •• OCotIJMtjOlNl -.::tJ.c~,... OIIIGYN. 'etc. -Pl ..., • • ttach

uterJal ••/ety e:ut. shHts (HSDS) for any .~t.D~. to vlJ.tah th,ja worker J.. e1CPOaed.

SSH

Last First H.I.

Rank/~te/Job Code

M>rker's Telephone

o OUtdoorso Officeo Shop

Command/Shop I----;:::::===============:::._--------....:...--,

Job Duties (not job title) I ----J

CheaIt &3.1 _. that _ly

workplace: 0 Shipboard

o other (descr1l>e) 1.. ---------------I. the worker ~:

1by8:1.aa1 ~bI

o Ionizing radiation

[] M:l.crowave and other RF radiation

[] "Moise" (Intense sound)

[] Themal stress (heat or cold)

[] Vibration

[] other hazards (specify below)

1by8:1.aa1 CclDd:I.t::i....

[] Irregular or shift

[] Strenuous work

[] Other hazards (spec:l.fy below)

o Anillal danders

o Endotoxins

o Enz~s and other proteins

o other hazardll (specify below),

o Fungi

o Viruses

o protozoa

a-icaJ. 10Qente

o Inorqanic chemicals

[J Organic solvents and fuela

o Metals - lead. cada1l11D. aoercury. etc. (specify below)

o pesticides (specify below)

o Pharmaceuticals/druqs (specify below)

o other hazards (specify below)

Biological 10Qente

o Bacteria

[] No [] YesPersonal Protective Equipment required:

o None D Hearing protection [] G.loves

[] Protective clothinq [] Respirator

Is the worker in a medical surveillance proqram?

[] No 0 Yes [] Don't know

Are there Induatria~ Hyqiene sampling data forthe involved worker? [] No D Yea

Did the Industrial Hyqiene survey r.,veal reproductiveor developmental hazards? [] No [] Yes (specify)

Is the worker required to work ahift.?

If yea. which one (s)? I'-------------'Has the work.ite had an Industrial Hygiene survey inthe last two year.?

[]No[]Yes rnrnITIIJD.ly Honth Year

Has the worker reported an occupat:l.onal illness orinjury in the last year? [] No D Yes (apecify)

Io No [] Yes

Has a detailed evaluation of the worksite(s) and/orprocess{s) with which the worker 1s involved beenpert'ormed?

Supervisor·. SiqnatuxeHAWED 6260/8 [12-2002 ~

C-1 Appendix CEnclosure

to(1 )


APPENDIX DSAMPLE PREGNANCY COUNSELING FORM

Date:

RATE or RANK/NAME:

COUNSELOR RATE or RANK/NAME:

SUBJ: COUNSELING FOR PREGNANT SERVICEWOMAN

1. Pregnant servicewomen are required to read the referenceslisted below:

a. OPNAVINST 6000.1C.

b. MILPERSMAN, Articles 1910-112, 1740-020 and 1740-030.

c. NAVPERS 1740/6, Department of the Navy Family Care PlanCertificate.

2. If any environmental hazards or toxins exist in aservicewoman's work center, as identified by medical and oroccupational health, the servicewoman will be reassigned orduties modified.

3. Pregnant servicewomen are exempt from the following:

a. Physical Readiness Program until 6 months after delivery.

b. Deployment until 12 months after delivery.

c. Participation in weapons training, swimmingqualifications, drown-proofing, or other physical requirements.

d. Exposure to chemical or toxic agents/environmentalhazards.

e. Standing at parade rest or attention for longer than 15minutes.

D-1 Appendix D toEnclosure (1)


APPENDIX D (CONT' D)SAMPLE PREGNANCY COUNSELING FORM

4. During the last 3 months (week 28 and beyond), servicewomenare allowed to rest 20 minutes every 4 hours and are limited toa 40-hour workweek, including watches.

5. Maternity uniforms are mandatory when regular uniforms nolonger fit. Enlisted servicewomen will be given a clothingallowance upon presentation of pregnancy notification toPERSUPPDET.

6. Servicewomen with uncomplicated pregnancies should continueto perform an individualized exercise program based on prepregnancy activity level and be approved by the OB HCP if thereare any known medical or OB complications. Pregnantservicewomen should not participate in push-ups or sit-ups.

7. Pregnancy is considered disqualifying for designated flightstatus personnel; however, a waiver may be requested up to thebeginning of the third trimester (28 t h week) .

8. Pregnant servicewomen (less than 20 weeks pregnant) assignedshipboard shall not remain onboard ship if it is estimated thatit will take greater than 6 hours to transport a servicewoman toa medical treatment facility capable of evaluating andstabilizing OB emergencies. Servicewomen assigned shipboardshall not remain onboard beyond the 20th week of pregnancy.

9. Servicewomen may not travel overseas after the beginning ofthe 28 t h week of pregnancy.

10. Post-delivery convalescent leave of 6 weeks (42 days) willnormally be granted by the CO upon advice of the attendingphysician.

11. Servicewomen who desire to continue breastfeeding uponreturn to duty will notify their chain of command at theearliest possible time to allow the command to determine howbest to support them as well as to facilitate the promptevaluation of the workplace for potential hazards. Questionsregarding potential workplace hazard issues that are related tobreast feeding servicewomen should be referred to Navy

D-2 Appendix D toEnclosure (1)


APPENDIX D (CONT' D)SAMPLE PREGNANCY COUNSELING FORM

Occupational Health Program personnel to determine whetherintervention is necessary. When possible, COs shall ensure theavailability of a clean, secluded space (not a toilet space)with ready access to running water for the purpose of pumpingbreast milk. The number of breaks needed to express breast milkis greatest when the infant is youngest, then graduallydecreases (i.e., 15-30 minutes every 3-4 hours). Requests tobreast feed infants at work during duty hours should be handledon a case-by-case basis; however, breastfeeding an infant is nota reason for granting excessive time for meals or from work.

12. Servicemembers with children are required to makearrangements for childcare to cover regular working hours, duty,exercises, war, and combat contingency deploYment.

13. Legal counsel, if necessary, may be obtained from NavyLegal Service Office (NLSO) per SECNAVINST 1000.IOA.

14. After delivery, servicewomen will participate in anexercise program, as soon as medically authorized, to preparefor the physical fitness assessment (PFA). No later than 6months after being returned to full duty by the HCP,servicewomen are required to take the PFA and conform to theacceptable height/weight standards, per OPNAVINST 6110.1H.Additional time may be recommended by the HCP and granted, ifnecessary, due to medical complications.

Servicewoman Signature/Date

D-3

Counselor Signature/Date

Appendix D toEnclosure (1)

office of the chief of naval operations ... 6000.1c.pdfassignments 1-8 105. waivers 1-12 106....

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