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Today’s post is a bit different – today I wanted to do a “research spotlight” focused on a book chapter that my colleagues and I published last summer entitled “Invisible Grief: An Examination of Miscarriage in the Workplace.” In this chapter we explore what women are going through as they return to work after a pregnancy loss and the different factors that can make this even more difficult and the factors that could be helpful. If you are a leader in an organization, I hope this post gives you some food for thought. If you have experienced a pregnancy loss, I hope that this post is encouraging and helps you to know that you’re not alone.

I have always enjoyed working on research projects that are based on my own personal experiences. My choice to specialize in the work-family interface was based on growing up in a large family, watching my mother juggle work and family. I wrote my dissertation on the impact of job stress on mother and baby health after giving birth to my son during one of the most stressful times of my life – a PhD program. This book chapter, and the continuing work we are doing in this area is no different. In fact, it is a very special project for me. You see, between my pregnancies with my son and daughter, I experienced two miscarriages, which is the loss of a pregnancy before the 20th week of gestation (ACOG Committee on Obstetric Practice, 2018). These were two of the most difficult times in my life. It was particularly difficult to navigate going back to work each time.

Aside from a personal motivation, there are a few other reasons that we wanted to examine miscarriage and the workplace. Management literature has only recently seen increased scholarly attention to the experiences of pregnant employees. However, it has remained silent about a major part of many employees’ pregnancy experiences – miscarriage. Roughly 15-20% of recognized pregnancies end in miscarriage (Everett, 1997; Griebel et al., 2005; Wilcox et al., 1988). In fact, it is the most common pregnancy complication.

Not only is miscarriage more common than most probably realize, but there are also several reasons it is relevant to the workplace (Porschitz & Siler, 2017):

1)      It might occur at work.

2)      It may cause women to miss time from work.

3)      It has organizational consequences due to the significant grief that women experience.

The big question that we dig into in this book chapter is…

“How do women navigate returning to work after a miscarriage?”

Pushing On Theory of Perinatal Bereavement

One of the theories we use in this chapter is called the Pushing on Theory of Perinatal Bereavement (Wright, 2010; 2015). As suggested by the name, the core idea of this theory is “pushing on” which describes how women suffering pregnancy loss move beyond their grief and eventually incorporate their pregnancy loss into their lives. Under this umbrella idea of “pushing on”, there are six different stages that women move through. As I discuss these six stages below, it’s important to remember a few things. First, women’s experiences within each stage may look different for each of them. Second, this theory presents the stages as thought they are chronological, and they may be for some women, but often life is much messier and less organized than that.

Stage 1: Experiencing the Pregnancy

The first stage is experiencing the pregnancy. In this stage, pregnancy goes from a possibility to a reality. It’s that moment when we see the two pink lines on a pregnancy test and feel all the emotions that go along with it. Now, a woman’s reaction to the news that she is pregnant will be impacted by numerous factors but once she commits to continuing the pregnancy she begins envisioning the pregnancy ending with a live birth and starts to form an emotional attachment to her anticipated baby.

Stage 2: Losing the Baby

The second stage is losing the baby. In the moment of finding out that the pregnancy is no longer viable, women may experience shock, numbness, and detachment. Yet, these blunted emotions don’t last forever and women are forced into the third stage.

Stage 3: Bearing the Burden

In this stage, women must bear the emotional and physical burden of their pregnancy loss. These emotional burdens can include depression, anxiety, insomnia, anger, complicated grief, and increased fear of death. On top of feeling all of those things, women are also faced with the burden to make decisions such as whether to miscarry naturally or undergo a dilation and curettage (a surgical procedure often performed after a first-trimester miscarriage) and how or whether to share the news of the loss with others.

Finally, there are physical burdens women must also bear including physical healing itself and experiencing symptoms such as phantom kicks, arms aching to hold a baby, and lactation. The amount of time it takes women to move beyond the worst of the pain varies, but eventually women recognize that they need to make an active effort to work through the pain – the fourth stage in the POT.

Stage 4: Working it Through

This stage involves actively working through the pain and grief of the loss, which takes time and effort. Women working it through are often searching for answers, reflecting, and seeking help.

Stage 5: Coming to Terms

Slowly, and in their own time, women move into the fifth stage which involves coming to terms with their pregnancy loss. At this point, they have learned how to integrate their pregnancy loss into their lives. Yet, even here the pain associated with the loss can emerge from time to time and particularly on days that hold special meaning (e.g., Mother’s Day, the due date, and the anniversary of the loss).

Stage 6: Living a Changed Life

The final stage is living a changed life. As you can imagine, or maybe even have experienced it yourself, having a pregnancy loss and then “pushing on” through the first five stages that we just discussed has a major impact on a woman and how she views herself, her family, and the world around her.

Miscarriage in the Workplace

The very fact that most of the stages we just discussed can, and often do, take place at work means that pregnancy loss is a topic of concern for managers, leaders, and organizations. I wanted to introduce these six stages for a few reasons. First, they provide an excellent glimpse into what women are working through in their personal lives as they return to work after a miscarriage. If you’ve listened to this show for long, you know that work and family experiences don’t occur in a vacuum. Instead, they spillover and impact each other. We cannot expect women to arrive at work and leave their grief at the door. Second, having experienced two miscarriages and feeling like there was something wrong with me, like I wasn’t grieving the “right” way, these stages provided so much validation to my experiences and I pray that they do the same for you.

So, keeping those six stages as a backdrop, let’s move into a discussion of the workplace and the factors that can make things even worse (i.e., societal norms, organizational norms, and job demands) and the factors that can make things more bearable (i.e., resilience resources).

The presence of dysfunctional societal and organizational norms surrounding miscarriage only makes things worse.

Dysfunctional Norm # 1:

In our society, there tends to be a shroud of secrecy and silence surrounding the topic of miscarriage. In fact, many of us are advised to not share the news of our pregnancies with others until after the 12th week of gestation when the risk of miscarriage is greatly reduced.

Dysfunctional Norm # 2:

In the workplace, miscarriage is often seen as a taboo topic because it involves physicality, sexuality, and emotionality (Gatenby & Humphries, 1999).

Dysfunctional Norm # 3:

Out of shame or fear of discrimination, many women do not share their miscarriage with their employer or coworkers. Previous research has shown that women may face discrimination in the workplace if they are perceived as trying to conceive or pregnant (Morgan, Walker, Hebl, & King, 2013) and women are well-aware of these perceptions (Gatrell, 2011). In the case of a miscarriage, women may feel like they are doubly failing. Not only are they not able to live up to the “ideal worker” by being pregnant, but they’re also failing because they lost the pregnancy (Porschitz & Siler, 2017).

Dysfunctional Norm # 4:

The grief of women who have experienced pregnancy loss is doubly disenfranchised at work. Disenfranchised grief is grief that is incurred by a loss not openly acknowledged, publicly mourned, or socially recognized (Doka, 1989). Not only is grief, in general, stifled in the workplace but also the pregnancy loss is often perceived as minimal because it is assumed that the mother did not have time to develop a relationship with the child.

The presence of these dysfunctional norms is going to make it that much harder for women to navigate returning to work after their pregnancy loss; especially considering that connection and support are necessary for healing and coping (Hazen, 2003) and that allowing women to tell their story can be a pathway towards resolving the disenfranchised grief (Gerber-Epstein et al., 2008). And that’s one of the main drivers behind this research. I want us to be able to tell our stories. In fact, after my first miscarriage I decided that I would tell others about my second pregnancy before 12 weeks because walking though that loss and that grief without others knowing and without being able to talk about it only made things harder.

Normal job demands may be more stressful upon returning to work after a pregnancy loss.

Another factor that leaders need to consider is that a woman’s normal job demands may seem more stressful to her upon returning to work after a pregnancy loss. Not only do leaders need to consider this, but we need to remember this and have grace with ourselves. Returning to work inevitably means we are returning to our normal responsibilities associated with our job. Yet, you may return to work only to find that you are unable to perform at the same level that you did prior to your loss. This won’t last forever, but research has shown that women may have difficulty completing tasks that require high emotional labor or concentration (Porschitz & Siler, 2017). These are normal effects of grief and if we think about it, they can likely be tied to the amount of effort, time, and energy that women are devoting toward actively pushing themselves through those six stages we discussed earlier. I believe that this highlights the need for us to not only learn more about returning to work after a miscarriage but also the need for us to create space for pregnancy loss discussions and support in the workplace.

Speaking of support…

Having access to resilience resources (e.g., social support, organizational accommodations) will help to protect women from dysfunctional work and personal outcomes.

Up to this point, we have established that a miscarriage can be a stressful and even traumatic event for women. We have also examined some factors that can make this experience even more stressful (i.e., societal norms, organizational norms, and job demands), leading to dysfunctional personal and work outcomes. The good news is that having access to some resilience resources can help women push through this difficult time. When we talk about resilience, we are referring to the ability to continue functioning when faced with difficulties. Women’s ability to be resilient during a pregnancy loss will depend greatly on their access to resources.

Resource # 1: Social support

Like I mentioned earlier, connection and support are necessary for healing and coping with grief and allowing women to tell their story can be a way to resolve disenfranchised grief. Support could look different in each situation. Perhaps you’re a leader and you support your employees by helping them manage the overwhelming workload. Maybe you’re a coworker and you just need to be present and listen. Some women may not want to share with their supervisors or coworkers, but would greatly appreciate the ability to have personal conversations with their family or friends while at work, as needed. The best way to provide social support to a woman who is grieving? Ask her how she wants to be supported. And for those of you who get asked? Answer honestly.

Resource # 2: Organizational Accommodations

Organizational accommodations could be immensely supportive in helping women navigate the return to work after a miscarriage. Unfortunately, there is currently no federal law that requires the employer to provide bereavement leave. This coupled with the fact that the death of a baby while still in the woman’s womb is hardly recognized (Lang et al., 2011), means that there is a lot of improvement that could be done in this area. As it stands now, it is entirely up to the employer to determine whether any time off is allowed for the employee to grieve over her miscarriage. Another type of accommodation that might be helpful is an Employee Assistance Program that provides resources such as counseling. If you’re in a leadership position, I highly encourage you to consider what could be done to fully support women experiencing pregnancy loss. When organizations provide the necessary time, flexibility, and resources that women need to “push on” through their pregnancy loss, we will likely see less severe dysfunctional outcomes for her, both personally and at work.

If you’ve stuck with me this far, I’m so glad that you’re here. This project is so important to me and I’m excited to share what I’m learning with you.

We are continuing our work on pregnancy loss in the workplace and are actually getting ready to start a new data collection. If you work full-time and have experienced a pregnancy loss within the last year, I want to invite you to share your story with us. We hope to learn more about the transition back to work after a pregnancy loss and make an impact on how organizations and leaders support their female employees. If you’re interested you can register for the study here or if you know someone who may be interested, please share this with them!

Interested in reading the full chapter?

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References

ACOG Committee on Obstetric Practice. (2018). Employment considerations during pregnancy and the postpartum period. Obstetrics & Gynecology, 131(4), e115 – e123.

Doka, K. J. (1989). Disenfranchised grief: Recognizing hidden sorrow. Lexington, MA: Lexington Books/DC Heath and Com.

Everett, C. (1997). Incidence and outcome of bleeding before the 20th week of pregnancy: prospective study from general practice. BMJ, 315(7099), 32-34.

Gatenby, B., & Humphries, M. (1999). Exploring gender, management education and careers: speaking in the silences. Gender and Education, 11(3), 281-294.

Gerber-Epstein, P., Leichtentritt, R. D., & Benyamini, Y. (2008). The experience of miscarriage in first pregnancy: the women's voices. Death Studies, 33(1), 1-29.

Griebel, C. P., Halvorsen, J., Golemon, T. B., & Day, A. A. (2005). Management of spontaneous abortion. American Family Physician, 72(7), 1243-1250.

Hackney, K. J., Wu, C., & Nuner, J. (2020). Invisible Grief: An Examination of Miscarriage in the Workplace. In A. M. Rossi, J. Meurs, & P. Perrewé (Eds.), Stress and Quality of Working Life, Vol. 7. Information Age Publishing.

Hazen, M. A. (2003). Societal and workplace responses to perinatal loss: Disenfranchised grief or healing connection. Human Relations, 56(2), 147-166.

Lang, A., Fleiszer, A. R., Duhamel, F., Sword, W., Gilbert, K. R., & Corsini-Munt, S. (2011). Perinatal loss and parental grief: The challenge of ambiguity and disenfranchised grief. Omega, 63(2), 183–196.

Morgan, W. B., Walker, S. S., Hebl, M. M. R., & King, E. B. (2013). A field experiment: Reducing interpersonal discrimination toward pregnant job applicants. Journal of Applied Psychology, 98(5), 799-809.

Porschitz, E. T., & Siler, E. A. (2017). Miscarriage in the workplace: An authoethnography. Gender, Work & Organization, 24(6), 565-578.

Wilcox, A. J., Weinberg, C. R., O'Connor, J. F., Baird, D. D., Schlatterer, J. P., Canfield, R. E., Armstrong, G. & Nisula, B. C. (1988). Incidence of early loss of pregnancy. New England Journal of Medicine, 319(4), 189-194.

Wright, P. M. (2010). Pushing on: A grounded theory study of maternal perinatal bereavement (Doctoral dissertation). Loyola University Chicago, Chicago, IL, USA.

 Wright, P. M. (2015). The pushing on theory of maternal perinatal bereavement. In B. P. Black, P. M. Wright, & R. Limbo (Eds.) Perinatal and pediatric bereavement in nursing and other health professions (71-96). New York, NY: Springer.

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