Perinatal loss and the workplace: What every employee deserves

As a Clinical Psychologist and someone with lived experience of baby loss, I have both personal and professional understanding of navigating loss in the workplace. My first, a ruptured ectopic pregnancy, happened when I was in the office and I vividly remember calling my GP from the bathroom overwhelmed with pain and anxiety, unsure of what was happening and what to do. When my daughter was stillborn the following year, my manager was one of the first people I messaged, explaining that I would not be in work that day, nor would I be back for the foreseeable future. These memories are imprinted as significant parts of my loss stories.

I was lucky because, overall, I felt supported both at the time and later in my return to work. With the ectopic pregnancy, I was able to take leave and then worked from home as a phased return. Following my daughter’s stillbirth, I was entitled to maternity leave, which gave me the time, space and financial security I desperately needed.

But I know that sadly not everyone has this experience.

It is estimated that one in four pregnancies in the UK will end in loss and given that the majority of these will occur in people of working age, baby loss is a huge workplace issue. Research consistently demonstrates that women experience high levels of post-traumatic stress, anxiety, and depression after pregnancy loss, and these symptoms can remain clinically significant many months, or even years, later (Farren et al, 2019; Gravensteen et al., 2013). We also know that those who experience the loss of a baby are at greater risk of developing complicated grief, which includes intense emotional distress and difficulty with day-to-day functioning which can be long lasting (Kersting and Wagner, 2012).

Concerns that I often hear from clients and those in the loss community are:

·       A lack of understanding and empathy for what they have been through, and the mental health impact of grief.

·       Limited understanding from their managers about the physical and emotional pain and recovery in both the short and long term.

·       Fear of disclosing their loss as they do not want their workplace to know that they are trying to begin or grow their family.

·       Not being allowed time off to recover and process what they have been through.

·       Being expected to return to work without any reasonable adjustments (e.g. a graded return).

·       Their loss being totally ignored by their manager and colleagues.

·       A lack of understanding or empathy about how their grief and trauma manifests (e.g. triggers in the workplace such as pregnancy announcements and baby showers or anniversaries).

·       Poor understanding of the intense stress and anxiety of a pregnancy following loss.

Whilst some people find comfort in the routine of work, we know that often people return sooner than they would like to, which can significantly impact their ability to work effectively, particularly in the early stages of grieving (Ogwulu, et al, 2015; Quenby et al, 2021). Presenteeism (being present at work but not able to function at an optimum level due to things such as illness, mental health difficulties or grief) costs workplaces roughly three‐and‐a‐half times more than people taking time away from work, so it is beneficial for everyone to ensure that appropriate leave is available to staff.

 Without the right policies or training in place for managers, workplaces can cause further distress at an already traumatic time. In 2022, the CIPD found that 24% of people surveyed had considered leaving their job because of how they were treated following their pregnancy loss.

So how can workplaces do better?

 2022 CIPD report recommended that workplaces should:

 1.      Raise awareness across the organisation about the need for pregnancy and baby loss to be recognised as an important workplace wellbeing issue.

2.      Create an open, inclusive and supportive culture.

3.      Develop an organisational framework to support employees experiencing pregnancy or baby loss.

4.      Manage absence and leave with understanding and flexibility.

5.      Equip line managers to support people with empathy and understanding.

 This is consistent with what we hear from the loss community.

Examples of good practice include…

Compassion. When an organisation is informed and educated on all aspects of baby loss, trauma and grief, they can develop compassion for the realities of what their employees are going through.

Time. Allowing time away from work to recover, time to attend health appointments and an understanding that grief has no set timeframe. People need empathy and support in the long term not just immediately after their loss (Heazell et al, 2016).

Flexibility. Not only when returning to work, but also when navigating anniversaries, difficult triggering events such as pregnancy announcements and trying to conceive / pregnancy after loss.

Clarity. Having a clear and thorough policy in place helps both employers and employees to feel contained. This should cover leave from work, what financial support someone is entitled to, as well as clear suggestions for returning to the workplace.

Communication. Employers should be trained to understand the best language to use when talking about pregnancy and baby loss. They should also have clear ideas of how to keep in touch with their staff without adding undue pressure to return. Employees also appreciate being asked what they would like to be communicated to their colleagues.

Include partners. The father or non-birthing parent often returns to work sooner and is less likely to be offered support and understanding. Workplaces need to ensure that they are considering the whole family.

Signpost to support. Those who experience loss are often not offered ongoing support or follow up. Workplace Employee Assistance Programmes or private healthcare can make a huge difference for someone who may be struggling alone.

Losing a baby is a life changing and devastating experience. Workplaces play such an important role in a family’s recovery, and small, meaningful changes can and do benefit everyone.

References:

CIPD (2020). Workplace support for employees experiencing pregnancy or baby loss: CIPD Survey Report.

Farren et al (2019). Posttraumatic stress, anxiety and depression following miscarriage and ectopic pregnancy: a multicenter, prospective, cohort study. Am J Obstet Gynecol. 222:367.

Gravensteen et al. (2013). Women's experiences in relation to stillbirth and risk factors for long-term post-traumatic stress symptoms: a retrospective study. BMJ, 22:3(10).

Heazell, et al. (2016) Stillbirths: Economic and Psychosocial Consequences. The Lancet, 387, 604-616.

Kersting, A and Wagner, B. (2012). Complicated grief after perinatal loss. Dialogues in Clinical Neuroscience, 14(2), 187-194.

Ogwulu et al. (2015). Exploring the intangible economic costs of stillbirth. BMC Pregnancy and Childbirth, 15.

Quenby et al. (2021). Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss. The Lancet, 397, 1658-67.