Taking time after a miscarriage or stillbirth

When she was in residency, Dr. Kimberley Williams broke her foot. All was well; she was in a supportive psychiatry residency program and had no trouble getting colleagues to cover for her when she needed time off for recovery and appointments. Yet later in her residency, Dr. Williams had a miscarriage and ended up working through an on-call shift.“I could’ve asked to have a call covered, but then I’d have to email out to all my peers why I needed help, which felt a bit invasive and overwhelming, so I just worked a call shift while I was miscarrying, because it felt less invasive just to work it than to ask for help,” she said from her Calgary home, with her 10-day-old baby on her lap.She didn’t need to disclose why she needed time off. She knew that by asking for help and not disclosing it, people would wonder if it was mental health struggles. Even with a supportive program, you’re always trying to get a job when in residency, Dr. Williams explained.Case in point: When she cancelled a half-day of clinic with the approval of her direct supervisor, allied staff complained that she cancelled on patients and they didn’t know why.Looking back, Dr. Williams, a neuropsychiatrist and president of the Federation of Medical Women of Canada (FMWC), wished she’d asked for more help. After all, she’d sat on panels about physician health as part of her work with Resident Doctors of Canada. Still, with a miscarriage, there was a lack of clarity on what to do. It wasn’t like a broken foot.Early pregnancy endProvincial and territorial medical residency contracts do have elements related to pregnancy and parental leave, but not all mention what to do if a pregnancy ends. Resident Doctors of BC do address it, quoting that federal employment benefits treat a pregnancy that ends before 19 weeks as an illness; after, you’re eligible for maternity benefits. In all contracts, medical residents are entitled to medical leave, but contracts tend not to refer to it in the context of miscarriage or stillbirth.Time off after a miscarriage or stillbirth is not only for the body to recover but to grieve.“No matter who you are, a miscarriage or a stillborn is a challenging situation and giving time to decompress and have self-care would be really beneficial for anyone, regardless if it was more emotionally taxing or not. I think people should definitely take time,” Dr. Williams said.Partners also may need time off. With Resident Doctors of BC, if a pregnancy ends after the 20thweek, the resident’s partner is granted three days without pay of compassionate leave. A further paid two days of travel time in connection to the compassionate leave is also available.For staff physicians or those practising in the community, taking time off after a pregnancy ends depends on the contract with the hospital or group practice. Recommendations by a national body, such as the Canadian Medical Association, on time off after a miscarriage or stillbirth would be useful as guidelines for physician contracts, Dr. Williams said.“I think that would be helpful because it would be national and consistent,” she said. While employers could ignore the recommendations, “at least you’re referencing something that larger bodies have signed off on.”Communication and navigationTaking time off means having to communicate it, and knowing that you’re creating work for others.“Even if there are policies to support trainees to take time off with a stillborn or a miscarriage, you also have to navigate it, which leaves your peers covering your call shifts, which we all feel kind of bad about,” Dr. Williams said.Asking for help with this is also different than with a broken foot. With her on-call shift, it would have been better if she’d only had to tell one person, Dr. Williams said. It would be ideal if one person could take care of the scheduling, so there’s not, “an added stressor when you’re already mourning the loss of a potential child,” she said.The FMWC is working on making physician family planning part of the undergraduate medical program. The goal is for students to be aware of the best time to plan to have children, giving them more flexibility for IVF, adoption—or to take leave to deal with potential miscarriages or stillbirths.Speaking about miscarriage and its impact on work is difficult, Dr. Williams said. It’s a vulnerable place to be, but, “I think you have to talk about these things because otherwise, they don’t change.”

Taking time after a miscarriage or stillbirth

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