I was a psychologist practicing in Los Angeles, specializing in reproductive and maternal mental health, grounded by the knowledge that I had brought to fruition a passion of mine — aiding any of the one in four women who will experience a miscarriage, pregnancy or infant loss. I had a private practice, a husband, a toddler and a second child on the way. I had the freedom and luxury of working on my own, untethered by the burden of that work holding any kind of personal resonance, grateful for the balance I had struck. I could separate my work life from my personal life… until I couldn’t.
Until it happened.
Sixteen weeks into my second pregnancy, while home alone, I had a miscarriage. Suddenly, and without warning, I saw myself and the overwhelming sense of loss I was feeling in my patients. Learning how to navigate that loss while simultaneously caring for my patients required a level of self-evaluation I was, admittedly, ill-prepared to endure. But as I transitioned back to work post-miscarriage, and learned how to hold space for both my patients and myself to grieve, I realized I was also inadvertently becoming a better mental health care provider.
I found myself able to relate to my patients in a way I never imagined, creating room for mourning to enter my work in a different, far more personal way. I’d always cared deeply about my patients, but I never envisioned I’d one day become them.
Anyone who has a private practice or works independently knows that with the freedom of self-employment comes a lack of built-in support systems. By navigating pregnancy loss and the decision to return to work sans coworkers to confide in or an HR department to guide me, I learned how to maintain the professionalism my patients expect and deserve as I began to heal from a miscarriage. A reported 16 million Americans are self-employed, and, in the absence of a boss or dedicated human resources department, must learn how to protect themselves and their mental health when facing a traumatic experience and returning to work.
Be honest with yourself
The only person who can decide when it’s time to go back to work, is you. Of course, finances are likely to play a role, and for many people who sign their own checks — including the 49 percent of women who say they’re the family breadwinner — the decision to go back to work post-pregnancy loss is less of a choice and more of a necessity.
Like many people who endure a pregnancy loss, I returned to work quickly. Prior to seeing my patients, I emailed to let them know what had happened — a necessity, as I had no one else who could convey this to them. Without a formal policy in place or an HR contact to turn to for direction, the decision was entirely my own. The freedom I felt, as someone who worked with and for herself, now felt like a free-fall: there was no parachute in place, no established protocol, no coworker to confide in or boss to ask for advice. And while I was nervous about holding my patients’ grief and feeling my own grief during each successive session, I knew that taking too much time off would be akin to abandoning my patients in their time of profound need. And, in a way, I needed them, too. I wanted to be engaged with the work I had devoted my entire professional career to.
Self-employed people need mental health care, too
Just as common as miscarriage is the negative impact these losses can have on a person’s mental health. One 2020 study found that one in six women who experience a pregnancy loss or ectopic pregnancy endure PTSD-like symptoms nine months later. Another study found that nearly 20 percent of women experience depression and/or anxiety symptoms post-pregnancy loss; symptoms that can persist for up to three years. The professional, clinical part of my brain quickly acknowledged that the feelings, emotions, and mental health ramifications of my own loss were real and outside of my control. I did not know, however, how I was going to return to work and keep those symptoms at bay. Or if I even should.
Those who work in the healthcare field are often reluctant to ask for help or seek out treatment options for themselves. A 2016 study found that as many as 60 percent of female physicians were reluctant to find or procure mental health care, despite believing they met the criteria for a mental health disorder. So much of my work as a psychologist is attempting to break down and inject compassion into a person’s pre-existing assumptions about mental health; dispelling the shame and stigma that has created an unnecessary barrier to vital cognitive and behavioral treatments, medications and other systemic support; pushing past outdated ideas of how the brain works to better speak to the patient and give them the care and support they need.
Would my patients trust me, as a psychologist, if I appeared just as fallible? Would they view me as a reliable source of support and information if I cried when they cried? Could I hold space for their unique experiences while simultaneously acknowledging, out loud, my own?
Acknowledge and confront feelings of shame caused by stigma
While I felt no shame regarding the unexpected loss of my pregnancy, I had to acknowledge how societal stigma and shame was playing a role in feeling uneasy or hesitant about returning to work. Would my patients trust me, as a psychologist, if I appeared just as fallible? Would they view me as a reliable source of support and information if I cried when they cried? Could I hold space for their unique experiences while simultaneously acknowledging, out loud, my own? These fears — that by appearing more human and expressing valid human emotions would somehow make me less valuable to my patients — are steeped in the belief that pregnancy loss makes us defective. It does not.
A 2015 national survey published in the Journal of Obstetrics & Gynecology found that 47 percent of people who’ve had a miscarriage feel guilty, and 41 percent felt as though they had done something wrong to cause the pregnancy loss. Before going back to work, make sure you explore the ways stigma and shame might be impacting your decision or how you’re feeling at work — it will make it much easier to detect and navigate any triggers that come as the result of returning to a full workload, and how that external stigma and shame manipulate those triggers and lead to pervasive guilt and self-loathing.
Build your community
Since I had no coworkers to confide in, and could not text my husband in the middle of a session, no matter how triggering, I was buried by isolation and a newfound realization that although working in private practice had innumerable benefits, I was faced with one of its drawbacks now. In the initial weeks following my loss, I found myself crying during my commute, knowing I would walk into my office and see no one — have no one — to help me process my loss.
Shortly after, I created an online community — #IHadaMiscarriage. It was not in the workplace, but on the internet that I found the solidarity I needed but was not available to me as someone who works alone. There are, of course, other online resources as well, including the Pregnancy Loss Support Program, Share Pregnancy and Infant Loss Support, and the National Infertility Association’s helpline. Studies have shown that creating community support and chipping away at feelings of isolation and secrecy are paramount to helping a person heal from a pregnancy or infant loss. Just because you don’t have coworkers circling the office water cooler doesn’t mean there aren’t people elsewhere, ready and waiting to support you.
Going back to work might help
The relationship to the work I felt bound to —professionally, morally, and as the result of my personal loss — had changed. Where I was once an empathic observer, I was now a participant. But there was something reparative about listening intently to my patients as they circled the details of their stories. For a set amount of time I was offered the chance to get out of my own head; to reassure my patients, and by doing so, myself, that grief knows no timeline. When I told my patients to take all the time they needed, I was also speaking to myself. By leaning into grief with my patients, I had found the very antidote to drowning in it.
Where I was once an empathic observer, I was now a participant. But there was something reparative about listening intently to my patients as they circled the details of their stories.
While there is no one “right way” to grieve a pregnancy loss, many people report that planning for the future and/or staying busy can help aid the healing process. This is why many couples begin trying to conceive as soon as a medical professional says it’s safe — moving forward in one’s life can help move forward from a miscarriage. If work provides a welcomed distraction — without dissociation — then lean into work shamelessly and without remorse. There isn’t a set timeframe in which you must take off to prove to yourself, or anyone else, that you’re mourning. Do what works for you.
Be aware of triggers
When my patients fidgeted on the couch across from me, I picked at the skin on my thumbs. As they recalled the unique details of their pregnancy losses, tears carving rivers down their cheeks, I saw the intricacies of my own: the image of the baby that fell from my body; the careful instructions to cut the umbilical cord, given by my doctor over the phone; the immediate hemorrhage that followed; the unmedicated D&C and the necessary smelling salts used to arouse consciousness. I strained to hold my tears at bay. I worked to claw my way back — back to being the unscathed clinician who knew pregnancy loss only from a distance, but now navigated it, war torn, from the inside out.
Studies have shown thata pregnancy loss is associated with post-traumatic stress disorder (PTSD), which is often accompanied by triggers — a stressor that reminds someone of a traumatic experience. There were countless triggers associated with my job; triggers I had to be cognizant of prior to experiencing so that I could continue to serve my patients and maintain my mental health.
Getting up and moving between sessions was vital when I experienced a trigger at work — a change in scenery can help ground you in the present. Other exercises that helped, and are recommended by experts, included meditation, deep-breathing, massages, and consistent exercise.
Everyone benefits when we talk about pregnancy loss
Studies have shown that talking about and raising awareness of the commonality and complexity of miscarriage can aid people in seeking the support and mental health care they need. What I failed to realize in the haze of my own grief is that that awareness can start in the smallest of places, like a work space or the confines of a psychologist’s office. I had the chance to model that grief is messy, and nonlinear, and confusing, and even those in positions to help do not always “have it all together.” By engaging in the delicate balancing act of ensuring my practice remained their space to share, to heal and to seek out support — a space purely focused on their struggles — it was also a space of empathy, sympathy, and solidarity. I did not know what it was like to be them, but I knew what it was like to mourn, to heal, to do the hard work of navigating grief, beside them.
We all have to hold it together at work on some level — especially now, as we collectively shoulder the ongoing trauma of a global pandemic that has claimed the lives of over 500,000 Americans and cost millions of Americans their jobs. And when any traumatic experience or profound loss occurs in our lives, the relationships we’ve cultivated at and with our jobs can change. In my particular situation, I became human in the eyes of my patients. I was able to deepen my relationship with my career and personalize my specialization — a specialization that, sadly, can feel cold and sterile. It solidified the palpable connections I share with my patients and allowed them the chance to relate to me as a fellow human as we traversed similar territory. Our conversations became a back-and-forth where we both understood the nuances of pregnancy loss — not as colleagues, necessarily, but as women standing on equal ground.
Jessica Zucker is a Los Angeles-based psychologist specializing in reproductive and maternal mental health and the creator of the #IHadaMiscarriage campaign. Her first book is now available I HAD A MISCARRIAGE: A Memoir, a Movement (Feminist Press + Penguin Random House Audio).
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