Returning to work after pregnancy loss: what to say, to whom, and how to get through the first weeks

Monday, ten past eight. Two colleagues are standing by the coffee machine, talking about the weekend. One of them turns round: “Oh, you’re back! Were you ill? You look a bit pale.” And in that moment you have half a second to choose: say “yes, some virus” and smile, or tell the truth — a truth in which nothing from the last two weeks belongs in this corridor. The scan with no heartbeat, the hospital, the silence in the flat, the box of medical reports in a drawer.

Most people choose the virus. Then they go to their desk, switch on the computer and try to be as much like their self of a month ago as they can. Some manage it for a few hours, some for a few days. Very few manage longer without something along the way catching them off guard.

I have written about pregnancy loss as a form of grief in Pregnancy loss: the grief others don’t acknowledge. Here I want to turn to something more everyday and, at the same time, surprisingly hard: the day you go back to work, and the weeks that follow. This applies to those who lost a pregnancy early or late, through miscarriage or after a decision made for medical reasons — and it applies to partners too, who usually go back to work first, and about whom least is said.

Why going back is harder than you expect

Many people expect returning to work to be a relief. And often it partly is: a routine, tasks, people who know nothing and therefore don’t look at you with that look. But at the same time, work is a place where you have to keep yourself together all day. At home you can cry when it hits you. In the office, the shop, on the production line or in the classroom, that is expected only after hours.

Research shows that what is happening inside you is not an overreaction. Jessica Farren and colleagues followed women after early pregnancy loss — miscarriage or ectopic pregnancy — in a large prospective study in London. One month after the loss, almost a third had symptoms of post-traumatic stress: intrusive memories, avoidance, constant alertness. For some of the women, the symptoms were still there nine months later. That is precisely the period when most have long been back at work and when those around them think it is “over by now”.

A month is not long. It is often exactly when people return to work. Which means that many people sit in meetings, answer emails and serve customers with a nervous system that is still on high alert. No wonder it is harder to concentrate, that you forget things, that small things make you angry, or that by evening you are as exhausted as if you had been carrying stones all day.

Two different stories: when they knew and when they didn’t

What going back looks like depends a great deal on whether people at work knew about the pregnancy.

If they knew, something you cannot control is waiting for you: people will ask, stare, avoid you, or say the wrong thing. Perhaps someone had already talked about your maternity leave, perhaps cover for your work had already been arranged. The return is then also public — the loss happens in front of an audience.

If they didn’t know, the problem is the reverse. Nobody knows, so nobody makes it easier. Nobody understands why you were off, why you leave a meeting, why you don’t go to a colleague’s birthday drinks. You carry something big, and you carry it alone. Kenneth Doka introduced a term for this kind of grief: disenfranchised grief — a loss that those around you don’t see or don’t count as a real loss. I write about this more broadly in The grief nobody acknowledges: miscarriage, divorce, losing a job.

Pregnancy loss is not rare. In a review in The Lancet, Siobhan Quenby and colleagues estimated that around 15 per cent of recognised pregnancies end in miscarriage. In almost every larger team, then, there is someone who knows this from their own life or their partner’s. It’s just that almost nobody talks about it at work, so everyone who returns feels as though they are the only one.

How true this is was shown by an American survey carried out by Jonah Bardos and colleagues. Many respondents wrongly believed that miscarriage is rare and that it is often caused by stress or lifting heavy things. Those who had experienced a loss frequently reported guilt and feeling alone. When well-known people spoke publicly about their own loss, many found it eased that sense of isolation. One experience spoken aloud makes room for others.

What to say, and to whom

One of the most practical questions before going back is simply: what will I say when they ask? It helps to prepare the answer in advance, before you are standing in the middle of the corridor.

The answer doesn’t have to be the same for everyone. It helps to picture three circles of people:

• One person you trust. A colleague who knows more. This person can warn you before someone innocently asks when your maternity leave starts, or quietly steer a conversation elsewhere when needed.
• Your manager. Your manager doesn’t need the details, but does need enough to organise the work. Often this is enough: “I had a pregnancy loss. For the first few weeks I may need some adjustments.” It can also be said by email, before you return, so that the first conversation isn’t face to face.
• The team. Here one sentence is enough, or nothing at all. “I’ve had a difficult time, I’m back now” is a perfect answer. You are under no obligation to explain what.

One thing people often forget: you can ask someone else to tell people for you. Your manager or a trusted colleague can let the team know, before you return, that you have had a loss and don’t wish to talk about it. That way you don’t have to repeat the same thing ten times. For some people this is a huge relief; for others it is too much disclosure. There is no right choice, only yours.

Triggers nobody else can see

At work it is often not the big things that hit you, but the small ones. A colleague announcing she is pregnant. A collection for a baby gift. A photo of a newborn in the team chat. A customer asking, “Do you have children?” The due date in your calendar that you once entered yourself. A meeting scheduled for the week you would have started maternity leave.

A trigger like this brings everything back in an instant: your body tightens, your throat closes, your thoughts run off. For everyone else it is an ordinary moment; for you it is as if someone has opened a door you worked very hard to close.

You can’t avoid every trigger. But you can anticipate some. It helps to remove or rename pregnancy-related dates in your calendar, to mute notifications in chat groups where photos are shared, and to know where you can go for five minutes when it hits: the toilets, the stairwell, the car park, a walk round the block.

And if you ever cry in front of others — it happens. It is not a sign that you weren’t ready to come back. I have written about why we are so afraid of crying at work in Crying at work: why we fear it so much and what it really means.

Your body isn’t where the calendar is

After a pregnancy loss, the body needs its own time. Bleeding, tiredness, hormonal changes, milk that sometimes comes in after a later loss, pain — all of this can drag on after you are formally well and back at your desk. What is normal for your body and when you need to see a doctor is something your gynaecologist should tell you; it is not a question for a blog.

What I can say is this: grief happens in the body too. Poorer sleep, headaches, more frequent colds and a sense that you can’t concentrate are common among the bereaved. I write more about this in Grief and the body: why we fall ill more often after a loss.

At work, this means it is realistic to expect less. Not because you are less capable, but because part of your energy is busy elsewhere. If you manage half of what you did before, that is not failure; it is a very realistic estimate of what a person can do in a period like this. Psychologists sometimes talk about the window of tolerance — the zone in which we can think, feel and work at the same time. After a loss, that window is narrower. The days when you get thrown out of it will be easier to get through if you know they are part of the road.

When work helps — and why

Now the other side. For many people, work is one of the few things in this period that still has a shape. You have to get up in the morning, get dressed and go somewhere. Someone needs you for something that has nothing to do with the loss. For a few hours a day you can be someone who knows how and is able.

Margaret Stroebe and Henk Schut described how healthy grieving is not constant immersion in pain. It is an oscillation: between periods when we engage with the loss, feel it and talk about it, and periods when we turn towards everyday life, tasks and obligations. Both directions are needed. Someone who only ever confronts the loss can get stuck in it. Someone who always avoids it carries it locked away somewhere inside.

Work can be one of the places a grieving person retreats to from the pain — and that is healthy, as long as it isn’t the only one. That is why it matters that, alongside work, there is the other pole too: time in the evening, at the weekend, with your partner or a friend, when the loss is allowed to show.

(a composite dialogue, not a real person)
“Everyone thinks I’m fine because I’m working like before. Even more than before.”
“And how is it really?”
“At work it’s fine. Then I get in the car and cry there for twenty minutes before I go home. So my partner doesn’t see.”
“What do you think would happen if he saw?”
“That he’d have to be sad too. And everything would be open again.”

There is a great deal in this short exchange that happens often. Work becomes the place where it is possible to be “fine”, and the car the only place where it is allowed not to be. And the couple don’t meet — each protects the other and both end up alone. In relational family therapy, in which I am training, this is a familiar pattern: protection meant as love creates a distance nobody wanted.

When it is your partner going back

Partners most often go back to work sooner, sometimes the very next day. Many are not even told “I’m sorry”, because colleagues didn’t know there was a pregnancy. If they do know, they often ask, “How is she?” — and nobody asks how he, or she, is doing.

Partners who did not carry the pregnancy often feel they have no right to sadness. Their job is to be strong, to organise, drive, make the calls. At work they then carry on as if nothing has happened, and they expect that of themselves too. But the sadness comes later, sometimes as irritability, tiredness, withdrawal or working more than ever.

If you are the partner going back, there is room for you too. You can tell your manager. You can take a day. You can be sad without taking anything away from your partner. And if you sometimes wonder whether you could have done something differently, you may find Guilt after a loss: “I could have done more” helpful — guilt after pregnancy loss is common in both partners, even though it is rarely based on anything anyone could really have changed.

Exercise: a plan for the first week

This exercise isn’t meant to make the first week a “success”. It is meant to help you get through it with fewer surprises. Take a sheet of paper or a note on your phone and give yourself fifteen minutes, ideally a day or two before you go back.

1. Write your sentence. One sentence for the team and one for your manager. For example: “I’ve had a difficult time, thank you for asking. I’m back now.” Say it out loud once or twice so you won’t be searching for it in the corridor.
2. Choose one person. Who at work is someone you can tell more? If there is such a person, send them a message before you arrive. If there isn’t, that is important information too — it means your support lies outside work.
3. Go through your calendar and chats. Remove or rename pregnancy-related dates. Mute notifications in groups where family photos are shared.
4. Decide on a way out. Where will you go when it hits you? What will you say if you have to leave a meeting? “Back in a minute” is quite enough.
5. Plan your evenings. For the first few days, have something waiting for you after work: a walk, a bath, a call with a friend, time with your partner. Not to distract yourself, but so that grief has room once the day is over.

At the end of the week, take five minutes and note what was easier than you expected and what was harder. You will learn something about yourself — and adjust for the following week.

In all of this, how you speak to yourself matters. Many people are harder on themselves in this period than on anyone else: “You’ve missed a deadline again”, “Stop feeling sorry for yourself”. Self-compassion is not letting yourself off; it is a way of staying on your own side when things are hard. A question that often helps is simply: what would you say to a friend who came into work two weeks after a loss like this?

If you are a colleague or a manager

Perhaps you are reading this because someone is coming back to your team after a loss. You don’t have to know what to say. People are most often afraid of saying the wrong thing, so they say nothing. But silence often hurts more than a clumsy word.

If you are a manager, you can do a little more. Before the return, ask whether your colleague would like you to tell the team anything, and what exactly. Offer adjustments that are within your power — fewer meetings in the first week, work that doesn’t involve dealing with customers, the option to step away. And don’t forget that grief doesn’t last two weeks. An anniversary, the due date or news of a pregnancy in the team can open everything up again — even six months later.

One thing is especially important here: if someone in the team is pregnant, they don’t have to hide their joy. But it helps if at least those who know tell the colleague who has had a loss in advance and in private, not in front of everyone at a meeting.

Where this advice doesn’t apply

Everything I have written rests on the assumption that going back to work is something that needs to be managed emotionally. That isn’t always so.

Some people don’t grieve strongly after a pregnancy loss. Perhaps the pregnancy was very early, perhaps it was unplanned and the loss also brought relief, perhaps a person simply experiences it differently. That is not coldness and not a sign that something is wrong. You don’t have to grieve the way it is described in articles or the way others expect.

Second: if the problem lies in the job itself — in a manager who humiliates, a team where private matters become gossip, or work that was already taking more than it gave before the loss — then a prepared sentence and a plan for the first week won’t be enough. Then the question is broader, and it may not only be about grief.

Third: if after a few weeks you can’t get up, can’t sleep, can’t eat, images from the hospital keep coming back all day, or it feels as though nothing has any point, this is no longer ordinary sadness that a good plan can carry you through. Talk to your GP or gynaecologist. Whether it is too early to work is not decided by anyone on your team, but by your doctor together with you. Depression and work: how to work when you can’t — and when not to may help you think about where the line is.

If thoughts of not wanting to live appear, seek help straight away: in Slovenia, the crisis line Klic v duševni stiski is available on 01 520 99 00 (every day from 7 pm to 7 am), the Samarijan helpline on 116 123 (24 hours a day), and in an emergency call 112.

And finally: here too there is no single way. For some it helps to go back as soon as possible, for others to wait. For some it helps that everyone knows, for others that nobody does. This article offers tools, not rules.

How therapy can help

Therapy after a pregnancy loss isn’t meant to “fix” the pain. It is a space where the loss can exist without having to be hidden or played down — a space that often isn’t there at work, and sometimes not even at home, because partners are protecting each other.

When working with loss, I am also interested in what it stirs up in relationships: between partners who each grieve in their own way, between you and a family who may not know what to say, and between you and your expectations of how you “should” be. Sessions take place in person in Ljubljana, I also work in English, and you are welcome to come together as a couple.

If you recognise yourself in these lines, the problem doesn’t have to be big for you to seek help. It is enough that it is yours. The knowledge base has a short explanation of pregnancy loss that you can also show to someone who doesn’t understand.

What to remember

• Going back to work after a pregnancy loss is often harder than people expect: the body and nervous system are still in the loss while the calendar is already at work.
• You don’t have to tell everyone everything. Prepare one sentence for the team and one for your manager, and choose one person who knows more.
• Work can help by offering structure and a break from the pain — as long as it isn’t the only place you exist, and grief has room elsewhere too.
• Partners lose too. They also deserve space and the question “How are you?”.
• If after a few weeks it isn’t getting easier, seek help from a doctor or therapist. It is not a sign of weakness; it is a sign that the loss is big.