Doctor’s Orders: Dive In

Doctor’s Orders: Dive In Experts say women divers face minimal additional health risks

SOME MYTHS DIE HARD, BUT when it comes to the one about women divers being more prone to decompression sickness than men, leading medical experts are ready to put the final nail in the coffin.

There is no significant difference in the rates of decompression sickness among men and women, according to doctors who specialize in diving medicine. And further, unless a woman diver is pregnant or trying to become pregnant, her job poses almost no additional health risks, medical experts say.

“The primary concerns for female commercial divers in a predominately male environment are more social in nature than medical,” said Dr. Nick Bird, the chief medical officer for Divers Alert Network, a not-for-profit organization that provides emergency medical advice and assistance to divers. “As far as we know, there are no significant gender differences in the way our bodies respond to pressure. There is no data to support an assertion that there is a genderspecific propensity for ill health.”

The decades-old myth about women getting decompression sickness more often than men stemmed from the fact that women typically have a higher body-fat percentage than men, and fat tissue takes longer to offgas after a dive. But by that logic, male divers who have a little extra body fat also should be more prone to decompression sickness, and that isn’t the case.

“Over the years there has been a lot of interest in whether females are at greater or lesser risk of diving-related decompression illness than males,” said Dr. Richard Moon, the medical director at Duke University’s Center for Hyperbaric Medicine and Environmental Physiology. “The data do not support a major difference between the genders. Women are not at greater risk of decompression sickness, arterial gas embolism, oxygen toxicity or diving-related death.”

The good news for women divers is that there is no medical evidence that says they shouldn’t be in the water. But the bad news is that on the issues of diving while pregnant or while taking oral contraceptives, there’s very little medical evidence, period.

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Dr. Maida Beth Taylor, a DAN consultant and a clinical professor at the University of California- San Francisco, said that diving’s effect on a fetus is not known, so the general rule is that women who are pregnant or trying to become pregnant should not dive. Doctors say a fetus shouldn’t be inadvertently exposed to high partial pressures of oxygen or altered mixed-breathing gases.

Since organogenesis, the formation of organs and limbs, begins during the first few weeks of pregnancy, in theory, a woman diving even in the early stages of pregnancy – when she’s not even aware that she’s pregnant – could be putting her unborn child at risk. But since there are very few studies on the subject, doctors can’t be certain that it’s either safe or unsafe.

“There’s no evidence that diving causes a higher rate of birth defects in women who dived in early pregnancy, but the number of cases that are available

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for scrutiny is so small that you can’t really compute valid statistics,” Taylor said. “Having said that, a woman who suspects that she’s pregnant or becomes pregnant should stop diving immediately.”

In an article entitled “DAN Explores Fitness and Diving Issues for Women,” written for DAN by Taylor, Moon and Dr. Donna M. Uguccioni, the authors say that studies of decompression sickness in animals suggest a higher rate of heart-related birth defects. Therefore, they say women who dive before pregnancy is diagnosed should get a secondtrimester ultrasound focusing on limb and spinal development along with key circulatory structures such as the heart, aorta and pulmonary arteries.

“It is a purely theoretical projection of risk to the fetus,” Taylor said. “We used to get several calls a year from divers who got pregnant asking what they should do. The general recommendation is no diving while pregnant. No chambers anywhere allow inside attendants who are pregnant. If you are pregnant, you are no longer an inside tender.”

Dr. Tony Alleman, who began a fellowship in hyperbaric medicine at Louisiana State University this year and has advised the ADCI on diving medicine, said diving companies should make sure women divers know that they shouldn’t dive while pregnant.

“There aren’t any studies with pregnant divers, and we don’t want to have a study of one, so to speak,” he said. “The ADCI and every reputable diving textbook I’ve ever read say pregnancy is a contrary indication to diving, and I don’t know of any physician who would ever qualify a pregnant diver.”

The authors of the DAN article also said there is no risk to infants being breast-fed by mothers who dive.

Aside from pregnancy, there are several other minor health concerns for women divers. Moon said that because women are smaller in size than men, they could be at a greater risk of hypothermia if they dive with inadequate thermal protection. And menstruation can be a concern for some women divers.

Alleman said women who experience painful menstruation might have a problem differentiating that from the symptoms of decompression sickness, which could be a cause for concern. And Taylor said that while women are no more prone to decompression sickness than men, women who experience decompression sickness often do so early in their menstrual cycle.

“There is some clustering of accidents in t he menstrua l and early phase of the cycle,” she said. “If you’re a woman who’s menstruating, just dive a little bit more conservatively than you otherwise would. This has shown up in the literature repeatedly that events in women tend to cluster earlier in their cycle, and why that is, nobody really knows.”

According to the DAN article, a study of 956 women divers with decompression sickness found that 38 percent were menstruating at the time of their injury.

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Taylor said medical experts also have speculated that since women who take birth-control pills are somewhat more prone to blood clots, they would have a higher rate of decompression sickness, but there hasn’t been enough data collected to make a determination.

“There’s a theoretical concern about hormonal contraception and the fact that it causes a relative hypercoagulative state – it makes women relatively more prone to blood clots, and the implication there is, will that increase the likelihood of a decompression event? And in the event that a bubble occurs, will there be a higher probability of propagation of a vascular cascade and clotting and an obstruction of blood flow, and will it be harder to treat?”

But Taylor said this is a minimal risk, especially since many women taking birth-control pills are relatively young and have less of a risk of clotting than older women.

Alleman said it’s important that commercial diving companies have their divers – male or female – examined by qualified medical diving experts, who are the only ones capable of determining whether a diver is physically qualified to dive.

But once qualified by a doctor, women divers should be allowed to perform all the tasks of their male counterparts.

“The issues pertinent to the safety of male divers are of equal importance for females,” Moon said. “In addition, the workplace environment should encompass a culture based on performance so that both male and female divers can feel comfortable doing those jobs for which they are particularly skilled.”

“Basically, there’s really no difference in men and women divers other than size and peak power, peak strength,” Taylor said. “Women, because they’re smaller, at the peak of both aerobic and strength training, do not achieve the same output that men do. But trained women vs. untrained men or women of virtually comparable to size to men basically can do anything that a man can do. Given that dictum, they’re far more similar than they are different.”

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