One diocesan employee in the Midwest was eight weeks into her pregnancy when she realized she was losing her baby. She was in the middle of a Zoom meeting when she began not feeling well, turned off her camera, went to the bathroom, and took ten minutes to herself before returning to the meeting and continuing on. “No one made me go back to the meeting – no one knew – but I do feel like that moment was reflective of how I felt about balancing pregnancy and baby and work in general,” she said. “Even in that meeting, I just felt like I had to go back – I’m in a meeting with two men and it’s important, and I just had to go back. I struggle with knowing I made that decision.” This diocesan employee, who wished to remain anonymous, recalls feeling stressed about her lack of maternity leave options as soon as she learned about her pregnancy.

‍Her diocese offers short-term disability for 6 weeks at 66% of her pay, but since she is the primary income for her family, she wasn’t sure how she was going to make that work. Then, she learned that since she had worked there for less than a year, she wouldn’t qualify for FMLA. There was no legal protection that she would not lose her job or face repercussions if she took time off to care for her newborn child.

“That was a very stressful factor in my life,” she said. “I thought about it every single day from when I found out that would be my maternity leave situation until we lost the baby.”

She described the lack of support she felt upon finding out about her pregnancy – as well as the overall atmosphere she has experienced at the diocese – as contributing to her decision to return to work so quickly after losing her baby.

“I have seen how other women who have babies in the chancery get talked about,” she said. “If there is no room to talk about having kids, there is certainly no room to talk about losing them.”

Understanding the Realities of Pregnancy Loss

Miscarriage, defined as when a baby dies in the womb before 20 weeks of pregnancy, occurs in 10 to 15% of pregnancies among women who already know that they are pregnant. This means that more occur before a pregnancy is discovered, making the estimated total number of miscarriages about 26% of all pregnancies. Stillbirth, defined as when a baby dies in the womb after 20 weeks of pregnancy, affects about 1 in 160 pregnancies each year in the United States. “Pregnancy loss” encompasses both of these terms.

The medical realities of these losses can differ from woman to woman, depending how far along she is.

Miscarriage can happen suddenly, or a woman may bleed and cramp for weeks knowing she is losing her baby. Sometimes, no symptoms occur and women do not find out until they go to the doctor and learn that there is no heartbeat. In some cases, women may use a medicine called misoprostol to pass remaining tissue. In other cases, they may need to have a dilation and curettage (D&C) in order to remove the tissue.

In the case of stillbirth, there are a few possible procedures, once again depending how far along the woman is. One option is dilation and evacuation (D&E), in which the doctor dilates the woman’s cervix to remove her baby. For women farther along, they may induce labor, perform a C-section, or wait for labor to occur naturally, which usually happens within two weeks after the baby has died.

“If it is a late pregnancy loss, then it is physically like recovering from a term baby,” explained Dr. Mary Davenport, former president of the American Association of Pro-Life Obstetricians and Gynecologists. “But even for pregnancy losses that aren’t necessarily physically very difficult, the psychological part is the most challenging.”

In addition to the physical recovery needed from pregnancy loss, women need time to heal psychologically and emotionally. The sudden loss that often occurs before others even know they are pregnant can leave women feeling isolated and grieving on their own. Or, if people do know about the pregnancy, a woman’s experience can often be dismissed by comments such as, “You can get pregnant again, you’re young,” noted Dr. Davenport. Nearly 20% of women who experience a miscarriage become symptomatic for depression and/or anxiety, and in a majority of those affected, symptoms persist for 1 to 3 years.

Dr. Davenport recommends that her patients take one to two weeks off of work after an early pregnancy loss, and up to six weeks off if they were toward the end of their pregnancy and/or were psychologically devastated. She was also sure to note that women who experience ectopic pregnancies (when a fertilized egg implants outside of the uterus, making the pregnancy not viable) ought to be included in this discussion, saying, “I do believe it is a living soul and we have failed as a medical community to deal with that satisfactorily.”

The State of Leave for Pregnancy Loss

There are no national or state laws providing paid leave for pregnancy loss, though there are some bills that have not passed in state legislatures. The most successful effort has come at the city level, with Washington, D.C., Boston, Pittsburgh, and Portland, Oregon offering policies that provide time off for pregnancy loss (though these policies are controversial, because they sometimes include abortion in that category).

Despite the lack of law-mandated leave, private companies have started offering paid leave for pregnancy loss. The dating app Bumble offers 15 days of compassionate leave, which includes miscarriage. Goldman Sachs offers 20 days. Pinterest offers 4 weeks.

The Church, however, is lagging behind this trend. Out of the 176 dioceses that we contacted for our report on maternity leave policies, just one – the Archdiocese of Cincinnati – has a policy specifically for pregnancy loss. They offer 2 weeks of paid leave to both mothers and fathers.

The Diocese of Cleveland specifically mentions miscarriage in their short-term disability policy. The Michigan Catholic Conference’s short-term disability policy states that it covers “pregnancy and its complications,” but with the 10 day waiting period before benefits kick in, even if this applies to miscarriage, it may not be useful. Short-term disability only covers the necessary medical recovery period, which differs from woman to woman, and does not address the bereavement of the death of a child.

“I maybe needed to take off a day and a half physically – cramping and dealing with the physical side – but if, according to our faith, that is the loss of a life, that deserves a lot more time,” said the diocesan employee from the Midwest, who added that short-term disability “doesn’t touch on any level what I was going through realizing I lost my child.”

Several dioceses we spoke with said that instances of miscarriage would be handled on a case by case basis, sometimes citing the possibility of women receiving bereavement leave or family medical leave. While women who work for these dioceses may receive some sort of paid leave if they ask for it, this places the burden on women in the middle of a traumatic time to seek out support amid unclear policies. They may have supportive employers, but without the knowledge that there is a system in place to protect them, it can be difficult to speak up.

One Catholic Relief Services employee (who wished to remain anonymous) recalled being surprised that there was no policy in place when she lost her baby. After learning that her baby no longer had a heartbeat, she told her boss – who was understanding and supportive – and took a day off to “cry in bed and not do anything.” In the week before her scheduled D&C procedure, she continued to work because she “felt responsible to,” she said. She took one more day off when she had to go to the D&C, and when she returned, she had a new supervisor who did not know what had happened. He asked, “How was your vacation?”

“I think in reality I could have used a lot more time to heal and process,” she said, adding that not having a policy “puts the burden and guilt, in a time that is very filled with a lot of different types of guilt,” on the woman. Especially with remote work, it is easy to feel obligated to “work a few hours here and there and go cry in between meetings,” she said.

The CRS employee likened this case by case approach to the trend of companies offering unlimited paid time off, since people at those companies end up taking less time off “because the onus to justify times they take off is on individual person.”

Complications with Health Insurance Provided by Catholic Employers

A month after her D&C, the CRS employee – whose health insurance is provided by the USCCB – received a bill telling her that she owed 100% of the cost of the procedure. This was due to the medical terminology used, which calls miscarriages “spontaneous abortions.” In her case, the term used was “missed abortion,” which is when the baby’s heart stops beating without the mother’s knowledge or the typical symptoms of a miscarriage. Because the insurance provided by the USCCB does not cover abortions, someone made a mistake and billed her for the full cost of the procedure. She had to call her insurance and explain the situation to get the claim reprocessed, and thankfully had it 90% covered.

It was “that extra twist of the knife that comes with having a really black and white health insurance coverage around women’s health,” the CRS employee said.

Valentina Piotrzkowski also ran into problems with insurance when she experienced pregnancy loss. After having worked for the Church for about 6 years, she moved to Lansing, Michigan after getting married because her husband worked for St. John’s Student Center, which serves college students at Michigan State University. It was in the middle of the COVID-19 pandemic, so it was difficult to find a job. She planned to get onto her husband’s insurance in the meantime.

Despite the fact that he had gotten repeated reminders to let the insurance company know within 30 days of the wedding that he had gotten married, they soon found out that she was not eligible to be added to his Michigan Catholic Conference insurance plan until they had lived together for six months. As a result, when Piotrzkowski started bleeding six weeks into her pregnancy, she was unable to see a doctor.

“It was just a little bit at first, so I was trying not to jump to conclusions,” she recalled. “It continued, it got heavier; toward the end I accepted that it was happening and it was just a matter of time.”

Piotrzkowski called doctor after doctor to ask if they would take her, but kept being told no. Finally, after a woman answered the phone and initially gave her the same response about needing insurance, she said, “Please help me,” and the woman agreed.

“She was sensitive enough to take me on regardless of my insurance status, and I am forever appreciative of her for that, but I was too far along for them to stop it,” Piotrzkowski recalled. “I still wonder if it would have been preventable if I was able to act earlier.”

All of the dioceses in the state of Michigan are under this same health insurance policy, which provides coverage for a “Legally Domiciled Adult” who “has shared a primary residence with the employee for at least six months, shares basic living expenses and is financially interdependent with the employee.” It does not have any additional provisions for spouses. If a couple conceives a baby soon after their wedding, this could leave a mother uninsured during a time when she needs prenatal appointments or care after pregnancy loss.

As Piotrzkowski pointed out, this policy penalized them for living out Church teaching.

“It is really disheartening after being such a vocal proponent of pro-life, after my husband and I were states apart for our whole engagement – we made huge sacrifices to follow Church teaching – and it was precisely because we followed Church teaching that I felt punished and I felt alone,” she said.

What the Catholic Church Can Offer Women After Pregnancy Loss

The Catechism of the Catholic Church states, “every human life, from the moment of conception until death, is sacred because the human person has been willed for its own sake in the image and likeness of the living and holy God.” Because the Church teaches that life begins at the moment of conception, Catholics are in a unique position to understand the grief of women who experience pregnancy loss.

“I am very grateful for everything our faith offers me on a personal level for navigating this issue, for the sad days of grief and the waves up and down that come with that,” said the diocesan employee from the Midwest, who especially noted that she appreciates the Masses held for pregnancy and infant loss. In addition to these Masses of remembrance, many Catholic cemeteries will help a woman bury and bless the remains of an early pregnancy loss. Yet, this recognition falls short of providing systems of support for the women who work for the Church.

“On a personal level, there is an abundance. God doesn't leave you wanting for anything you are clinging for,” the diocesan employee continued. “It is just sad because working for the Church feels very integrated to me, personally – when I go to work I feel like I bring my whole self, my whole heart and whole soul. It is disappointing that I don't feel like work responds to my whole self.”

After her experience, this diocesan employee has started going out of her way to make sure that other women who are pregnant while working for the diocese get what they need, but emphasizes that this peer support is not the same thing as having a comprehensive policy to cover women.

“To help avoid pregnancy loss is to feel the support of being a pregnant woman in the first place. It has to start there, the celebration of life at any stage, because if there is not that feeling of support and celebration … then there is just no chance of getting support when you lose that life,” she said. “I don’t want anyone else to go through what I just went through, feeling as alone as I did.”

Instead of following secular companies – which may or may not recognize a fetus as a human life – or waiting for laws to be passed, Catholics can choose to be leaders in this realm by offering paid leave and health insurance policies that take into account the need for women to heal physically, emotionally, and spiritually after pregnancy loss.

“Before joining the club I didn’t want to join, I didn’t realize how big it was and how incredibly sad and painful it is, and how there are so few spaces to process with women openly,” said the Catholic Relief Services employee. “I think the more that we can normalize [the experience of pregnancy loss] in our daily lives, but also in real life policies that impact women, the more we will be able to truly say that we are creating a culture of life.”