The choice to remain silent after a miscarriage can perpetuate a sense of shame and stigma
I had been working for six months on a psychiatric Mother and Baby Unit when I became pregnant. I had been working there nine months when I had a miscarriage. On the morning of my 12 week scan I had been sitting with a patient helping them make sense of a past traumatic experience of pregnancy loss. It seemed ironic that only a couple of hours later, in the upstairs antenatal department, a lovely ultrasonographer would be comforting me after failing to find my own baby’s heartbeat. How fragile and deceptive the boundaries between patient and doctor are.
I was lucky to have excellent care at my maternity unit, but having an ERPC (Evacuation of Retained Products of Conception) procedure in the same building as your place of work presents its own difficulties. The sadness and anxiety about a traumatic procedure—I will never be dismissive of a patient’s fear of a general anaesthetic again—were matched by the dread of bumping into a colleague as I was wheeled down the corridor from theatre in an inappropriately elated, shouty opioid daze.
Once the opioids had worn off, it was a little harder to get my head around the prospect of returning to work. I loved my job working as a core psychiatry trainee, with new and expectant mothers and their babies, on a specialist inpatient mental health unit. Everyone is different and some people might find returning to work a useful distraction. But the prospect of being faced so starkly with my loss on a daily basis seemed too painful a distraction at first—both the daily contact with pregnant mums and babies, as well as the fact it felt like returning to the scene of the crime. All healthcare professionals develop the ability to put their own personal worries to one side and focus on the patient in front of them. But there are times when this becomes too difficult and the connection between personal and professional life can feel just a little too close to the bone.
I went to a brilliant talk recently by the breast consultant Liz O’Riordan, who spoke movingly about her experience of being diagnosed with breast cancer in the same unit where she had worked as a surgeon for many years. This very particular type of medical occupational hazard, where the personal and professional lives of doctors collide, can’t be that uncommon. Whether that is being a patient in your own department, or struggling with the very health issues the patient in front of you is facing. Yet when it happened I felt totally unprepared for how I should behave and how I could navigate returning to work.
I had an understanding consultant, which helped. She encouraged me to take the time I needed and not rush back to work. I took two weeks off and returned fragile, but knowing she would be supportive and encourage me to take more time if I needed. She checked in with me regularly for the rest of my placement and was never afraid to bring it up. What didn’t help was a rather unsympathetic interaction with HR when cancelling a set of night shifts–I was told off for not giving enough notice (I gave eight days). It may have been because I used the slightly mysterious euphemism of “emergency gynaecological procedure.” Perhaps there would have been a more sympathetic response if I’d spelled it out.
And why didn’t I just say I’d had a miscarriage? Looking back, I think this was the most difficult part about returning to work. I told my consultant and registrars but, for some reason, I didn’t share what had happened with anyone else at work. I really wish I had. The miscarriage was so present in my mind. Being surrounded by people who weren’t aware that I was struggling left me feeling isolated and unseen over the weeks that it took me to recover.
The reluctance to share mental health compared to physical health issues with colleagues is well recognised. Miscarriage clearly affects both psychological and physical wellbeing, yet seems to share more of the stigma and silence afforded to mental health. The visibility of a broken bone entitles you to the sympathy and adjustments needed during the weeks it takes to heal. It was precisely having nothing to show for a lost pregnancy that made the silence so hard—I knew something was missing but no one else did.
Did I want to spare my colleagues the awkwardness, the difficulty of having to deal with me? Did I not want to be treated differently? Was I worried someone might say something insensitive? Logically, I believe we can have faith in highly trained colleagues to deal with us with the same care and sensitivity that they show patients. Often the reality of loss is you would rather someone said something, anything, than nothing at all. It also affords your colleagues, particularly pregnant ones, the opportunity to tread a little more sensitively around you.
A recent article in the Guardian unpicks how the stigma around miscarriage—the sense of failure of your body, your fertility, your womanhood compared to societal expectations—can determine women’s ability to share the news of both an early pregnancy and of a miscarriage. Yet the choice to remain silent can perpetuate this sense of shame.
What might have helped me be more open about my miscarriage at work? Rather straightforwardly, I think the logistics of informing colleagues can prove an obstacle. You don’t exactly want to stand up and announce it in a meeting on your first day back. You don’t necessarily ever find “the right moment” or indeed want to spend all day everyday explaining to colleagues what’s been going on. If you don’t tell people straight away, as time goes on, you feel silly saying anything. A couple of colleagues did ask if I was pregnant due to a tiny residual bump (something that is associated with it’s own difficulties), but the honest answer felt too stark to give.
Personally I would have been happy for someone else to sensitively tell my colleagues when I wasn’t there or in a no-fuss email. I know some people couldn’t think of anything worse. For me, there would be something comforting in that communal solidarity and knowledge—even had no one said anything to me afterwards. I wonder if there is a role for a more formal HR support system to talk about these sensitive returning to work issues—whether its miscarriage or another health issue that might make returning to the work environment particularly hard. A system could offer focussed support, advice about informing colleagues, guidance on graded returns, perhaps even advice for partners—who are often forgotten following a miscarriage. Of course, it might have been available to me if I had told them what had happened in the first place!
Ultimately it was a relief to move on from the mother and baby unit for a while. Unsurprisingly pregnancy and babies are not a daily talking point on my new acute male inpatient psychiatric ward. I was lucky to have the opportunity to work elsewhere as a trainee that still rotates and I’m conscious that not everyone does. But I wonder if the more transient relationship trainees have with ward colleagues also makes it more difficult to seek support when struggling with issues in our personal lives.
I’m also lucky to be pregnant again—although I’m tentative and know there are no guarantees—I refuse to fall into the trap that sharing this news might act as some sort of jinx. I’ve deliberately been much more open so far—it was a relief to tell my colleagues about my previous miscarriage and how it has made me feel more anxious and worried both in work and about the pregnancy. It’s helped me be more proactive about coming off the on-call rota and steering away from stressful situations (although the guilt towards my fellow trainees is still real). I’ve had nothing but support from my colleagues, and it confirms my suspicions that being more open and honest might have helped me feel less isolated and alone in the aftermath of my miscarriage.