Employer Guide to Pregnancy Sickness & HG

Why This Guide Matters

Pregnancy sickness affects up to 80% of pregnant women to some degree, and around 1-3% experience hyperemesis gravidarum (HG), the most severe form, which can require hospitalisation. In the UK workforce, where women make up nearly half of all employees, pregnancy sickness has a significant impact on businesses, teams, and individuals.

The cost to UK businesses is substantial. Research estimates that pregnancy-related sickness absence costs employers hundreds of millions of pounds annually in lost productivity, temporary cover, and recruitment costs when women are forced out of their roles. But these financial losses are largely preventable. Employers who respond with understanding and make reasonable adjustments retain skilled employees, avoid costly tribunal claims, and build a workplace culture that attracts and keeps talent.

Beyond the business case, there is a human one. Women suffering from pregnancy sickness frequently report that how their employer responded was one of the most significant factors in their overall experience. Supportive employers reduce stress, which can itself lessen symptom severity. Unsupportive employers compound an already distressing condition, sometimes with lasting consequences for mental health and career progression.

Understanding Pregnancy Sickness from an Employer Perspective

The first thing to understand is that the term "morning sickness" is profoundly misleading. Pregnancy sickness can occur at any time of day or night, and for many women it is a constant, unrelenting condition. It is not a minor inconvenience and it is not caused by a lack of willpower, poor diet, or insufficient effort. It is a physiological response to pregnancy hormones, primarily human chorionic gonadotropin (hCG), and it varies enormously from person to person and from pregnancy to pregnancy.

Key facts employers should understand:

• Pregnancy sickness typically begins around week 6 and peaks between weeks 8 and 12, but it can start earlier and last much longer. For some women, it continues throughout the entire pregnancy.
• Symptoms are not limited to vomiting. Persistent, debilitating nausea without vomiting can be equally disabling. Fatigue, food aversions, heightened sense of smell, excess saliva, and inability to concentrate are all common.
• Triggers in the workplace can include fluorescent lighting, computer screen glare, colleagues' perfumes or food smells, cleaning products, air conditioning, and the motion of commuting.
• The condition is unpredictable. An employee may feel relatively well one day and be unable to function the next. This inconsistency is a feature of the condition, not evidence of exaggeration.
• Pregnancy sickness can cause or worsen anxiety and depression. The psychological burden of being unwell while trying to maintain professional responsibilities should not be underestimated.

The Severity Spectrum

Pregnancy sickness exists on a spectrum, and understanding this helps employers respond proportionately. The severity of an employee's condition will determine the level of support required.

Mild Pregnancy Sickness

Intermittent nausea, occasional vomiting, and food aversions. The employee can usually continue working with minor adjustments such as flexible start times, access to snacks, and permission to take short breaks. Symptoms may be worse at certain times of day.

Moderate Pregnancy Sickness

Frequent nausea and vomiting that significantly affects daily functioning. The employee may struggle with a full working day and may need more substantial adjustments including reduced hours, working from home, or modified duties. There may be periods of absence.

Severe Pregnancy Sickness (Hyperemesis Gravidarum)

Persistent, excessive vomiting leading to dehydration, weight loss, and potential hospitalisation. The employee may be unable to work for extended periods. HG is a serious medical condition that can be life-threatening if untreated. Employees with HG require significant support and understanding, and extended absence should be anticipated.

Legal Obligations: The Equality Act 2010

Pregnancy and maternity are protected characteristics under the Equality Act 2010. This means employers have specific legal duties when an employee is pregnant or suffering from pregnancy-related illness. Failure to comply can result in claims of pregnancy discrimination, which do not require a qualifying period of employment and have no cap on compensation.

Pregnancy-Related Absence Must Not Trigger Absence Procedures

This is the single most important legal obligation for employers to understand. If your organisation uses absence management procedures — Bradford Factor scoring, return-to-work trigger points, formal warnings after a set number of days — pregnancy-related sickness absence must be excluded entirely. You must record pregnancy-related absence separately and it must not count towards any threshold or trigger.

This means you cannot:

• Issue a written warning because an employee has been absent due to pregnancy sickness
• Include pregnancy-related days in a Bradford Factor calculation
• Use pregnancy-related absence as a factor in redundancy selection criteria
• Reference pregnancy-related absence in a performance review
• Withhold a bonus or pay increment because of pregnancy-related absence

Protection from Unfavourable Treatment

Beyond absence management, you must not treat an employee unfavourably because of pregnancy or pregnancy-related illness. Examples of unlawful treatment include:

• Passing the employee over for promotion or training opportunities
• Removing responsibilities or interesting work
• Making negative comments about attendance or commitment
• Pressuring the employee to start maternity leave early
• Failing to carry out a risk assessment
• Refusing reasonable requests for adjustments
• Dismissing or selecting for redundancy because of pregnancy-related absence

Health and Safety Obligations

Under the Management of Health and Safety at Work Regulations 1999, employers have a specific duty to assess workplace risks to new and expectant mothers. This duty is triggered when you are notified in writing that an employee is pregnant.

Risk Assessment Requirements

You must carry out an individual risk assessment for each pregnant employee. For employees with pregnancy sickness, the assessment should consider:

• Environmental triggers: Smells, fumes, chemicals, cleaning products, food odours, temperature, ventilation, and lighting
• Physical demands: Standing for long periods, heavy lifting, bending, repetitive movements
• Welfare facilities: Proximity to toilets, availability of a rest area, access to fresh water and food storage
• Working patterns: Shift work, early starts, long hours, unpredictable schedules
• Travel: Commuting requirements, business travel, driving duties
• Stress factors: Workload, deadlines, customer-facing demands, emotional labour

What You Must Do After the Assessment

If the assessment identifies risks, you must take the following steps in order:

1. Adjust working conditions or hours to remove or reduce the risk
2. If adjustment is not reasonable or sufficient, offer suitable alternative work on the same terms and conditions
3. If no suitable alternative is available, suspend the employee on full pay for as long as necessary

You cannot simply tell the employee to go on sick leave instead of carrying out a risk assessment. You cannot ignore risks because adjustments would be inconvenient. Failure to conduct a risk assessment is itself a breach of health and safety law and can also constitute pregnancy discrimination.

Reasonable Adjustments

The following table outlines common adjustments that can support employees with pregnancy sickness. Most are low-cost and straightforward to implement, yet they can make the difference between an employee being able to continue working and being forced into extended absence.

Adjustment	Cost	Ease of Implementation	Impact on Employee
Flexible working hours — later starts, earlier finishes, compressed hours	Nil	Easy	High — allows employee to work around peak symptom times
Remote working — full or partial home working	Low (equipment may be needed)	Easy to moderate	High — eliminates commute triggers and provides access to own facilities
Modified duties — removing tasks involving triggers	Nil	Moderate	High — prevents direct exposure to nausea triggers
Frequent rest breaks — short breaks for fresh air, snacks, or managing symptoms	Nil	Easy	Moderate to high — helps manage symptoms throughout the day
Proximity to toilets — desk relocation or priority access	Nil to low	Easy	High — reduces anxiety and practical difficulty when vomiting
Reduced travel — limiting commuting days or removing business travel	Nil	Easy	High — travel is a major trigger for many women
Scent-free workspace — asking nearby colleagues to avoid perfumes and strong-smelling food	Nil	Easy (requires team cooperation)	Moderate to high — heightened smell sensitivity is a primary trigger
Adjusted start times — avoiding rush hour commuting	Nil	Easy	Moderate — reduces nausea from crowded, hot transport
Access to food and drink at workstation — allowing snacking at desk	Nil	Easy	Moderate — empty stomach worsens nausea for many women
Private rest area — quiet room for lying down during severe episodes	Low	Moderate (space dependent)	High — allows recovery without having to go home

The key principle is proportionality. An employee with mild nausea may only need a later start time and permission to snack at her desk. An employee with moderate sickness may need a combination of home working and reduced hours. An employee with HG may need extended leave with a supportive, phased return plan. The adjustments should be reviewed regularly as symptoms change.

Sick Leave and Pay

When pregnancy sickness prevents an employee from working, understanding the sick pay framework is essential for both employer and employee.

Statutory Sick Pay (SSP)

Employees who are unable to work due to pregnancy sickness are entitled to Statutory Sick Pay, provided they meet the standard eligibility criteria: they must be classed as an employee, have been ill for at least four consecutive days (including non-working days), and earn at least the lower earnings limit for National Insurance. SSP is payable for up to 28 weeks.

Company Sick Pay

If your organisation offers contractual sick pay that is more generous than SSP, pregnancy-related sickness absence should be treated in the same way as any other sickness absence for pay purposes. Withholding enhanced sick pay specifically because the absence is pregnancy-related would constitute unfavourable treatment and is likely to be discriminatory.

Pregnancy-Related Absence Rights

There are specific rules about pregnancy-related absence that employers must observe:

• Pregnancy-related absence must be recorded separately from general sickness absence
• If an employee is absent with a pregnancy-related illness in the four weeks before her expected week of childbirth (from 36 weeks), you may start her maternity leave automatically — but not before this point
• You cannot force an employee to start maternity leave early because of pregnancy sickness before the 36-week point
• Pregnancy-related absence does not reduce entitlement to Statutory Maternity Pay, provided the employee meets the other qualifying conditions
• An employee on pregnancy-related sick leave continues to accrue annual leave and other contractual benefits

Common Employer Mistakes That Constitute Discrimination

The following are real errors that employers make, each of which can give rise to a successful pregnancy discrimination claim at tribunal. Understanding these mistakes is the best way to avoid them.

Mistake 1: Including Pregnancy Absence in Sickness Triggers

The most common and most costly mistake. If your HR system or absence policy does not distinguish between pregnancy-related and ordinary sickness, you are almost certainly breaking the law for any pregnant employee who has time off sick. Audit your systems immediately.

Mistake 2: Making Negative Comments

Remarks such as "You're always off," "We can't keep covering for you," "Perhaps this isn't the right time to be pregnant," or even well-meaning but dismissive comments like "My wife worked right through her pregnancy" can constitute harassment related to pregnancy. Train managers to understand this.

Mistake 3: Failing to Conduct a Risk Assessment

Once notified in writing of a pregnancy, you must carry out a risk assessment. Not doing so is a breach of health and safety regulations and can be evidence of pregnancy discrimination if the employee subsequently suffers harm or is forced to take absence that could have been prevented.

Mistake 4: Pressuring Early Maternity Leave

Suggesting or requiring an employee to start maternity leave before 36 weeks because of pregnancy sickness is unlawful. The employee has the right to remain on sick leave with appropriate pay. The decision to start maternity leave must be the employee's own choice (before the 36-week automatic trigger point).

Mistake 5: Removing Opportunities

Assuming a pregnant employee will not want or be able to handle a promotion, project, or training opportunity is discriminatory, even if well-intentioned. The employee should be offered the same opportunities as her colleagues and allowed to make her own decisions.

Mistake 6: Redundancy Selection

Using pregnancy-related absence as a factor in redundancy scoring is direct discrimination. If an employee is selected for redundancy during pregnancy, you must be able to demonstrate that the selection was entirely unrelated to pregnancy or pregnancy-related absence.

How to Have Supportive Conversations

The way a manager responds when an employee discloses pregnancy sickness sets the tone for the entire experience. A single dismissive comment can cause lasting damage to trust and to the employment relationship. Here is guidance on having these conversations well.

When an Employee First Discloses

• Listen without judgement. Do not compare her experience to anyone else's pregnancy. Do not minimise or dismiss her symptoms.
• Express support. A simple "Thank you for telling me. I want to make sure we support you properly" goes a long way.
• Ask what she needs. She knows her condition best. Ask "What would help you?" rather than making assumptions.
• Explain her rights. Many employees do not know that pregnancy-related absence is treated differently. Proactively sharing this information demonstrates good faith.
• Discuss confidentiality. Ask who she would like to know and respect her wishes about when and how the news is shared with colleagues.
• Arrange a follow-up. Symptoms change over time. Schedule a check-in to review how things are going and whether adjustments need to be modified.

Phrases to Use

• "What can we do to support you?"
• "Your health comes first. Let's work out what we can adjust."
• "Pregnancy-related absence won't count against you in any absence procedures."
• "Let's review the risk assessment together."
• "You don't need to apologise for being unwell."

Phrases to Avoid

• "It's just morning sickness, isn't it?"
• "Can't you just push through?"
• "This is putting a lot of pressure on the team."
• "Have you thought about starting maternity leave early?"
• "My partner/sister/wife didn't have any problems."

Creating a Pregnancy Sickness Policy

A dedicated pregnancy sickness policy demonstrates your organisation's commitment to supporting pregnant employees and provides a clear framework for managers. Your policy should include the following elements:

Policy Template Outline

1. Policy statement: A clear commitment to supporting employees experiencing pregnancy sickness, recognising it as a legitimate medical condition
2. Scope: All employees from day one of employment, including those on probation, fixed-term contracts, and agency workers
3. Notification: How employees should notify the company of pregnancy and pregnancy-related sickness, with assurance of confidentiality
4. Risk assessment: The process for conducting and reviewing individual risk assessments, including timescales
5. Reasonable adjustments: A non-exhaustive list of adjustments the organisation will consider, and the process for requesting and reviewing them
6. Absence recording: Explicit confirmation that pregnancy-related absence is recorded separately and excluded from absence management triggers
7. Sick pay: Entitlements during pregnancy-related absence, including any enhanced company sick pay
8. Communication: How the organisation will maintain contact during absence, respecting the employee's preferences
9. Return to work: The process for supporting a phased return, including temporary adjustments
10. Complaints: How to raise concerns if the employee feels unsupported or discriminated against
11. Manager responsibilities: Clear obligations for line managers, including training requirements
12. Review: Commitment to reviewing the policy regularly and in response to legal or organisational changes

Return to Work After Extended Absence

For employees who have been absent for an extended period due to severe pregnancy sickness or HG, the return to work requires careful planning. A poorly managed return can result in the employee becoming unwell again or feeling unable to continue, leading to further absence.

Phased Return Guidance

• Plan before the return date. Contact the employee (with her consent) before her expected return to discuss what support she needs. Do not wait until she walks through the door.
• Start with reduced hours. A phased return over two to four weeks allows the employee to rebuild stamina. Start with half-days or three days a week and increase gradually.
• Maintain adjustments. Any adjustments that were in place before the absence (flexible hours, home working, desk location) should continue and be reviewed as the employee settles back in.
• Be prepared for setbacks. Pregnancy sickness can fluctuate. If the employee needs to reduce hours again or take further time off, respond with understanding rather than frustration.
• Protect from overload. Do not pile up accumulated work. Redistribute tasks that built up during the absence and set realistic expectations for the return period.
• Schedule regular check-ins. Weekly catch-ups during the first month of return allow you to adjust the plan as needed.

Keep in Touch Days

If the employee is on maternity leave (whether started voluntarily or triggered at 36 weeks), she can work up to ten "Keeping in Touch" (KIT) days without affecting her maternity pay or leave. These can be useful for attending team meetings, training, or gradually reintegrating. KIT days are voluntary — the employee cannot be required to work them, and you cannot penalise her for declining.

Supporting the Wider Team

When a colleague is absent due to pregnancy sickness, the remaining team members may face increased workload and pressure. Managing this well is important both for team morale and for the absent employee's return.

What Managers Should Do

• Redistribute work fairly. Do not place the entire additional burden on one person. Spread tasks across the team or bring in temporary support.
• Be transparent (within limits). You cannot share medical details without the employee's consent, but you can acknowledge that a team member is unwell and outline how work will be managed.
• Prevent resentment. If team members express frustration, acknowledge their feelings while making clear that the absence is a medical matter and that the organisation supports all employees when they are unwell.
• Consider temporary cover. For extended absences, hiring a temporary worker or redistributing work across a wider group is more sustainable than overburdening the existing team.
• Recognise extra effort. If team members are taking on additional responsibilities, acknowledge this formally — in performance reviews, through additional time off in lieu, or other recognition.

Case Studies: Best Practice Employers

Case Study 1: Technology Company (150 employees)

When a senior developer disclosed that she was experiencing severe pregnancy sickness, her manager immediately offered full remote working and flexible hours. The team used asynchronous communication tools to accommodate her unpredictable availability. When she needed three weeks off during her worst period, the company brought in a contractor and ensured a smooth handover. She returned to work with a phased schedule and was promoted six months after her maternity leave. The total cost of temporary cover was significantly less than the cost of recruiting and training a replacement developer.

Case Study 2: NHS Trust

A large NHS Trust implemented a pregnancy sickness protocol after an employment tribunal claim highlighted gaps in their approach. The protocol included automatic risk assessment triggers when pregnancy was disclosed, a menu of standard adjustments available without management approval, separate absence recording in the HR system, and mandatory training for all line managers. In the two years following implementation, pregnancy-related grievances dropped by 80%, and staff survey scores on supportiveness improved significantly.

Case Study 3: Retail Chain

A national retailer with a predominantly female workforce developed a "pregnancy passport" — a document held by the employee that recorded agreed adjustments and could be shown to any manager or supervisor. This was particularly useful in retail where employees might work with different managers on different shifts. The passport included the employee's preferred adjustments, emergency contact details, and a reminder that pregnancy-related absence must not be included in absence triggers. Staff feedback described it as "the single most helpful thing" the company had done for pregnant employees.

ACAS Guidance and Further Resources

The following organisations provide detailed guidance for employers dealing with pregnancy sickness in the workplace.

Resource	What It Covers	Contact / Link
ACAS	Comprehensive guidance on pregnancy and maternity rights, managing absence, and avoiding discrimination	0300 123 1100 / acas.org.uk
Health and Safety Executive (HSE)	Risk assessment guidance for new and expectant mothers, workplace hazards	hse.gov.uk/mothers
Equality and Human Rights Commission (EHRC)	Guidance on the Equality Act 2010, pregnancy discrimination, and employer obligations	equalityhumanrights.com
Maternity Action	Specialist advice on maternity rights at work, guides for employers	maternityaction.org.uk
CIPD	HR best practice guides, policy templates, and research on pregnancy and work	cipd.org
Pregnancy Sickness Support	Information for employers about pregnancy sickness and HG, awareness resources	024 7569 0504 / pregnancysicknesssuport.org.uk
Gov.uk	Official guidance on maternity leave, statutory pay, and employment law	gov.uk/employers-maternity-pay-leave

Checklist for Managers

When an employee reports pregnancy sickness, work through the following checklist to ensure you are meeting your obligations and providing appropriate support.

Immediate Actions (Within 24-48 Hours)

• Acknowledge the disclosure with support and empathy
• Confirm confidentiality arrangements — who the employee is happy for you to tell
• Ensure the employee knows that pregnancy-related absence will not count against her in absence procedures
• Schedule an individual risk assessment
• Ask the employee what adjustments she thinks would help
• Notify HR so that absence recording is set up correctly

Within One Week

• Complete the risk assessment and document findings
• Implement agreed adjustments and confirm them in writing
• Check that the HR system is recording pregnancy-related absence separately
• Review the employee's workload and make temporary adjustments if needed
• Provide written confirmation of the adjustments agreed

Ongoing

• Hold regular check-ins (fortnightly or as agreed) to review how adjustments are working
• Be flexible — symptoms change and adjustments may need to change too
• Keep records of all discussions and agreements
• Review the risk assessment at regular intervals and when circumstances change
• If the employee is absent, maintain supportive contact at an agreed frequency
• Plan for any extended absence — temporary cover, work redistribution

If the Employee Takes Extended Leave

• Agree a communication plan — how often you will be in touch and by what method
• Ensure the employee continues to receive information about workplace developments, training opportunities, and vacancies
• Plan the return to work in advance, with a phased return schedule
• Ensure adjustments are in place before the employee returns
• Brief the team appropriately and ensure a welcoming return