by Sally Maitlis and Gianpiero Petriglieri
Nothing is more full of life, potential, and possibility than the experience of expecting a child, of carrying new life and waiting to bring it into the world. Birth is all beginning, the furthest we will ever be, in life, from death.
Except when it isn’t.
About one in four women experiences pregnancy loss through miscarriage, stillbirth, or very early death of a newborn. Miscarriage, the natural loss of a fetus in the first 20 weeks of pregnancy, occurs in around 25% of pregnancies, with 1% of women experiencing recurrent — three or more — miscarriages. Stillbirth, the natural loss of a fetus after 20 weeks of pregnancy, occurs in 1% of pregnancies. Despite the frequency of these losses and their impact on those who experience them, however, they are rarely talked about — and that burden of silence is especially heavy as the parents return to work. There, in addition to the upheaval that grief creates within them, they must confront colleagues who know nothing of their suffering, or who know just enough to make interactions painful.
In this article we attempt to give voice to the experience of those returning to work after a pregnancy loss, highlight ways to make it if not less difficult, then at least no harder than it needs to be, and offer some suggestions of how managers and coworkers can help.
The Experience of Pregnancy Loss
The impact of losing a baby in pregnancy, birth, or shortly after is immense. That pain can impair day-to-day functioning and lead to social withdrawal, intrusive thoughts, and feelings of numbness. Research has found that pregnancy loss is associated with post-traumatic stress, depression, anxiety, and sleeping disorders. Although such symptoms usually diminish over the first year, some parents will experience an extended state of heightened mourning known as “complicated grief.” This is often accompanied by feelings of guilt, envy of others who have children, and ongoing distress due to the unexpected and sudden nature of the death. (And if the loss is of one’s first child, some may find it hard to claim the identity of parent, adding confusion to the intense pain of grief.)
The birth mother’s emotional anguish after a miscarriage or stillbirth is often compounded by physical pain, which, depending on the circumstances and the medical procedures involved, might last weeks. The follow-up treatments and medical check-ups, when necessary, are vivid reminders of the loss. At the same time, her partner’s suffering is frequently overlooked. Coworkers might have no way of knowing that the person has suffered a major loss. For men in particular, research finds that they are often seen primarily as the main source of support for their partners after the loss of a pregnancy, leaving little room for their own grief and mourning, and prompting few offers of support for them.
On returning to the workplace, those bereaved through pregnancy loss must not only cope with their own grief, which can come in unexpected waves triggered by small things, but also other people’s awkwardness with them at work. One bereaved father we spoke to shared how he saw a pregnant woman take a step when he entered an elevator “as if to say, ‘I want to get out,’ you know, as if stillbirth might be catching.” Although she may have been trying to spare his feelings, he did not experience it that way.
While researching our recent article about how people experience, and deal with, death in the workplace, we often heard that the Western taboo around death is amplified in professional settings. That silence, we learned, is loudest and most upsetting when it comes to child bereavement in general, and the loss of unborn children in particular. Beyond the trauma itself, the loss is often further complicated by its invisibility — if, for example, the pregnancy is lost before many others know about it. As a result, those experiencing the loss are often left coping alone.
Alternatively, the bereaved may have to tolerate their deeply private ordeal being known publicly. With a stillbirth, colleagues may have last seen their coworker late in pregnancy, perhaps at a baby shower. In these situations, the bereaved may not know what to say to their colleagues, and colleagues are frequently unsure how to behave around the bereaved.
Returning to Work
Support from others is one of the most important factors helping bereaved parents to cope and has a major impact on how they experience returning to work, and to their lives, after pregnancy loss. As a mother who lost her baby explained in research conducted by SANDS (a British stillbirth and neonatal death charity), “The thought of going back to work was actually worse than being there. It did feel strange at first but everyone was so warm and welcoming and this really helped me to settle back in.”
As with any bereavement, people who have had a pregnancy loss differ in how soon they feel able, want, or need to return to work. There will be differences in how individuals are affected physically and emotionally, and in how the loss affects their perspective on work. Some may find it helpful to get back into their old routines and find work a helpful distraction. Others will be unable to carry out their job tasks and feel daunted at the prospect of being around other people who can’t understand what they have been through. Many simply must return to work for financial reasons.
Furthermore, parental leave policies vary considerably, including how they are applied to those who have had a miscarriage or stillbirth. For example, while women in the UK who have a stillbirth after the 24th week of pregnancy are entitled to the same parental leave and benefits as those who have a live birth, the situation is different in the US, where there is considerable variation by state and organization and no statutory Family and Medical Leave after a stillbirth.
If you are a bereaved parent returning to work, decide what you want colleagues to know, if anything, about your loss. If coworkers were unaware of the pregnancy, you may choose to keep it that way, but it can be helpful to let your boss know, in confidence. You may experience further physical or emotional symptoms after returning to work, and it will be easier for your boss to support you if he or she knows your situation.
If people at work knew that you were pregnant, it can make your and everyone else’s life easier if you send a note to your manager or a trusted coworker, letting them know what happened and what you would find helpful on your return, including whether you want to talk about your loss at work. Ask them to share the contents of your note with others on your team.
Even if you have expressed a wish not to discuss your loss at work, it may still come up, especially from someone outside your immediate work circle. Research on pregnancy loss finds this is one of the most difficult and emotional situations parents encounter when returning to work. Consider in advance how you will respond to certain questions you may be asked. Try to prepare yourself for the common question of “How is your baby?,” a well-meaning inquiry that has the potential to disturb many bereaved parents. Simply responding, “I lost the baby,” should suffice. You are under no obligation to explain further, or to reassure the other person that you are “ok.” Conversely, if the person is someone you wish to open up to, let them know that you’d love to talk more about it, and where and when that would suit you best.
Particularly in the early days following a pregnancy loss, it can be hard to be around coworkers who are expecting or who have recently had a baby. If they know of your loss, they should understand your need to excuse yourself. Regardless, you should not feel obligated to attend a baby shower or spend time in settings which trigger painful feelings about your loss.
Other difficult times may be significant dates, such as the original due date or the anniversary of the miscarriage or baby’s death. Anticipate these and consider booking a day off work.
Managing a Bereaved Parent
As a manager, you can make a big difference in a bereaved parent’s return to work. If the individual writes or calls to let you know what has happened, offer your condolences and ask how you can support them. Ask whether and what they would like you to tell others at work. If they want you to inform their coworkers, you might suggest that they send you a note that you could circulate among their immediate colleagues, including any details they feel comfortable sharing about their loss. This saves the bereaved from having to tell their story repeatedly on their return.
Where possible, be flexible about the employee’s return to work, offering a graduated return or adjusted schedule. Once the employee is back, be prepared to calibrate your expectations, as for any recently bereaved worker, and let the individual know that you realize they may not feel like themselves over the coming weeks. At the same time, don’t assume that they don’t want to be challenged by their work at this time. Involve them in any decisions that affect them. They are bereaved, not incapacitated, and work is often one domain that helps people draw a line between the two.
Don’t avoid spending time with your bereaved colleague. In addition to having normal work-related conversations, check in to see how they are doing and don’t be afraid to offer a simple acknowledgement of their loss or to ask what they need. (It is not helpful, however, to say things like, “It was meant to be” or “At least you (can) have other children.” Such comments can diminish the person’s experience of loss and leave them feeling worse.)
Whether being back at work sharpens the pain or offers temporary respite depends, in significant part, on the ability of those around the bereaved, and especially their managers, to acknowledge parents’ loss and be with them in their grief. Recognizing and respecting the ending that those parents have experienced, and will mourn and carry with them, will help them, in due course, move towards new beginnings.