Miscarriage and pregnancy loss is a difficult topic to discuss, steeped with feelings of anguish, shame, and uncertainty. Although miscarriage in the first trimester occurs in about 10 to 15 percent of known pregnancies and in approximately 20% of all pregnancies, it’s rarely talked about or discussed in society at large. Women who experience miscarriage are at higher risk for anxiety and depression: one study found that four in ten women reported symptoms of PTSD three months after pregnancy loss.
With the introduction of Sen. Tammy Duckworth and Rep Ayanna Pressley’s new bill, the Support Through Loss Act, conversations about pregnancy loss have vaulted to the national stage. Employers, having placed a renewed emphasis on mental health and women’s health in response to the COVID-19 pandemic, are paying close attention to the developments of the bill.
How does pregnancy loss impact mental and physical health?
Pregnancy loss can be extremely traumatic, whether it’s classified as a miscarriage or a stillbirth. It can significantly impact the mental and physical wellness of a family. Physically, women experience bleeding and cramps that can last up to two weeks, and it can take up to six weeks for their menstrual cycle to return to normal.
Psychologically, however, the symptoms can last much longer. According to a 2015 study, “nearly 20% of women who experience a miscarriage become symptomatic for depression and/or anxiety; in a majority of those affected, symptoms persist for 1 to 3 years, impacting quality of life and subsequent pregnancies.” Depression and anxiety can affect physical health, fertility, and interpersonal relationships, and can manifest in different ways throughout the grieving process.
“For loss like a miscarriage, oftentimes people don’t know that there was a pregnancy to lose,” says Sarah Gugluizza, a Licensed Clinical Social Worker and Maven provider specializing in grief counseling and pregnancy loss. “They’re often grieving their loss in silence while having to go about day-to-day tasks and responsibilities. It becomes a secret weight the woman has to bear as she goes through physical, hormonal, and emotional changes.”
Stigma creates obstacles to seeking help
Stigma plays a large role in the way women grieve and cope with pregnancy loss. Traditionally, pregnancy isn’t publicly announced until after the second trimester begins 一 or after 12 weeks 一 meaning that if loss occurs before then, many women likely haven’t told friends, family, or coworkers they were expecting. On the other hand, women who experience stillbirths have to address the reality of expectations held by friends, family, and coworkers. These losses are difficult to discuss, and are rarely adequately addressed or acknowledged in social settings, whether among friends or at work.
Social support is crucial during the grieving process, and due to the nature of miscarriage, women are often deprived of the empathy and understanding they need to cope effectively. If a woman hasn’t told anyone about her pregnancy, it’s that much harder to tell their support system that they’ve lost it, too. Likewise, if the people she told were expecting good news, it can be extraordinarily difficult to share the reality with them.
The impact on partners
Partners, especially fathers, also tend to struggle coping with pregnancy loss. Gendered expectations, as well as a lack of institutional support, can create a confused and distressed emotional state “to the extent that such males might feel it necessary to deny their own feelings of grief in a double-bind situation.” The reality is that the grieving process for an unborn child is innately complex: parents grieve the dreams and the possibilities of the future of which they were deprived as much as they grieve the loss itself. And although they never had the chance to meet or learn about their child, parents experience a complicated mix of grief, anger, jealousy, and even relief.
“Many partners have the additional stress or confusion related to wanting to help and support their partner and make sure they are protected and taken care of as they go through this difficult thing that they don't always acknowledge their own emotions,” says Gugluizza.
Pregnancy loss in the workplace
If the result of pregnancy loss is so often mental health challenges, the consequences cannot be understated. Untreated maternal mental health issues cost the U.S. over $14 billion in losses annually in 2017, and that number is likely on the rise. Postpartum care is in many ways insufficient for mothers, and is almost nonexistent for mothers who endure pregnancy loss. Treatments can be excessively expensive, and serve as grim reminders of what the family just endured. Returning to work without support, and often without ever having spoken of the pregnancy in the first place, can often result in prolonged mental health issues. This can have profound effects on performance, productivity, and ultimately retention.
“Coping with this type of loss can cause distractibility, difficulty concentrating, irritability towards workload, coworkers and superiors, feelings of jealousy, feeling burnt out, loss of motivation to attend work and/or complete tasks,” says Gugluizza. And, because pregnancy loss is often mired by shame and secrecy, employees may find it difficult to share with coworkers or managers the nature of their struggles, and might go to great lengths to obscure their grief.
According to Dr. Emily Porschitz at Keene State College School of Management,, “the combination of secrecy and grief that is layered on top of a difficult physical experience makes miscarriage a unique experience that, to date, has mostly been ignored in management literature and practice.”
What can employers do?
The bill put forward by Senator Duckworth and Representative Pressley would mandate bereavement leave for pregnancy loss, to allow families the time they need to grieve away from the expectations of work. However, there are other practical ways to address pregnancy loss beyond leave: providing access to mental healthcare specialized for women and families can significantly improve outcomes for mothers who have experienced pregnancy loss. Making leave available is a good starting point, but pregnancy loss affects people in different ways — in other words, time away from work may not be enough.
Telehealth can provide flexible support for grieving families
Of the many gaps in family healthcare, pregnancy loss support, much like postpartum support, is a glaring hole in the traditional maternity journey. Although physicians are advised to screen for symptoms of depression and anxiety following loss, access to mental healthcare, and the prevalence of stigma in the workplace and in society at large, complicate things.
One way to fill this gap is to offer telehealth access to care for pregnancy loss and perinatal mood disorders. Generic mental health services can help, but giving employees with access to practitioners who understand the complexities of their journey, and can provide culturally humble care, can drive outcomes further for parents in your workplace.
Telemental healthcare (TMH) is believed “to perform these functions (monitoring, surveillance, mental health promotion, mental illness prevention, and biopsychosocial treatment programs) more efficiently and as well as or more effectively than in-person care.” Likewise, specifically for perinatal and postpartum mood disorders, TMH was found to have “significantly decreased postpartum depression symptoms.”
Maven, the world’s largest virtual care clinic for women’s and family health, offers continuous support for women throughout their maternity journey, from prenatal planning and fertility, to postpartum and parenting. Maven’s pregnancy loss track features relevant content, as well as 24/7 access to mental health providers, career coaches, nutritionists, and more, who can help aggrieved families cope and find balance among the pain.
To find out how Maven can help your organization plan benefits for women and families, request a demo today.
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