The Cost of Pregnancy Loss
Everyone tells you about the cost of having a child. No one tells you about the cost of losing one before birth.
October is pregnancy loss awareness month. This year, the month began with Chrissy Teigan sharing the loss of her little baby boy. I felt for her, so much, having gone through a similar loss myself.
Three years ago, I was lying on the couch in the evenings, dizzy and distraught due to a complicated miscarriage of what my ObGyn suspected had been an ectopic pregnancy. I had just started a job a month before that. I didn’t have any accrued Personal Time Off. I didn’t have any savings. What I did have were a lot of medical appointments. This is my story of what that loss cost me. I share it in hopes of opening a conversation and improving the support system for other women.
When you lose a pregnancy, all you think about initially is the child you lost. Even if you lose the pregnancy in the first few weeks (as I did), even if you don’t think of a fetus as a fully formed human life (I’m not sure if I do), you still are grieving the child who could have been. And for the first few weeks, you don’t think about much else.
Then the hospital bills arrive.
Health Care Costs
It seems cruel and audacious of the hospital to charge you for losing a child, but they do. If you have an uncomplicated miscarriage, then you might only have to pay two doctor’s bills and two sets of labs (one confirming the loss, the other following up on your health). I had what was called an incomplete miscarriage. I was bleeding for a month until they gave me medicine to force my body to wrap things up. So I paid for four doctor’s appointments, eight sets of bloodwork, an ultrasound, and a rare prescription.
I had good, but high deductible, health insurance at the time. I paid around $2000 out of pocket. Fortunately, the hospital let me spread payments out over a year.
For others, miscarriages mean a visit to the emergency room with an overnight stay, a situation that will often land you with a $6000 dollar bill. If the miscarriage or stillbirth comes after a complicated pregnancy, then there might be weeks of hospitalization involved, totaling $20,000 or more.
Often the hospital bills arrive in several iterations, following rounds of insurance negotiations. A mom might just be making headway in her own healing when she gets yet another hospital bill reminding her of the grief.
Time Off of Work Costs
In addition to cash costs, miscarriage or stillbirth has a time cost. You almost always have to take time off of work, paid or unpaid. Had I had PTO, I would have burned through several days or weeks of it.
Instead, I took one and a half unpaid days off to create a long weekend, and worked with my boss to move other hours around my many appointments. To be fair, my boss didn’t know what “health problem” I had. Working in an otherwise all-male office, I didn’t feel comfortable talking about it. I didn’t want to jeopardize my new job. I learned later that if I had told my boss what was going on, he certainly would have given me more days off, but those days would have been unpaid too.
Ironically, my husband had seniority and better benefits at his work and received three days of bereavement leave, over which I was both furious and jealous. How could losing a child only merit three days off?
But time off isn’t just about grief, it’s also about physical healing. A friend of mine had a stillbirth a year ago. Six months later, she had a miscarriage. Now she is on rest orders from her doctor, not allowed to exercise or run around outdoors with her preschooler, let alone work a job. She will end up losing over a year of income due to complications and exhaustion from the back-to-back pregnancy loss. Her situation is not nearly as rare as society would like to pretend.
Mental and Physical Health Costs
Some moms need time off after loss because they are physically struggling. Others of us deal with the mental health burden. At my follow up appointment for the miscarriage, the doctor said something to the tune of “If you are still crying about this in three weeks, you should probably have a checkup for depression.” I remember shaking my head about that. For one, I had been too overwhelmed to have a good cry. For two, what woman isn’t still sad about losing a child three weeks later?
Beyond that gem of a suggestion, I received no mental health care. No one suggested support groups for me to join. No one gave me a pamphlet on helpful resources or coping techniques. There was nothing.
When I felt morning sickness kick in the week after the bleeding had stopped, I turned to Google to figure out what was going on and discovered that residual hormones continue to torment you despite your loss. I also learned that I needed to keep taking my prenatal vitamins, to make up the iron from the blood loss. Those felt like things my doctor should have mentioned. But the doctor didn’t. Perhaps they didn’t want to overwhelm a grieving mom with too much information.
I went through that entire autumn in a mental haze, focused on doing the next thing, trying to pull myself out of a funk. By December, I couldn’t concentrate at all. I would read an email on my work computer, turn to write down a to-do item on a sticky note, and not be able to remember what I read or intended to write.
I called my regular doctor, not the ObGyn. After all, memory problems didn’t seem like an ObGyn problem. My doctor heard me out and suggested that it sounded like depression. But she didn’t link it to my recent loss. Instead, she blamed the miserable Minnesota winter. “You’re low on sunlight and Vitamin D. Get a full spectrum lamp and take supplements. If it doesn’t work in a month, we’ll do a follow-up and see if you need meds.”
I needed a little more than medication. I certainly needed more than vitamin D supplements.
Productivity and Job Costs
When your physical and mental health is suffering, you just can’t perform at work the way that you would otherwise. As the program coordinator for two NGO initiatives in West Africa, I had to juggle time zone differences which required that I be available to my team first thing in the morning. I often found myself fielding questions about security issues and money transfers before I even made it into the office at 8 AM.
I struggled with work. My short term memory was shot. I developed elaborate coping mechanisms to keep myself on track, writing everything down by hand, then transcribing it into typed up notes and organizing things with Outlook reminders.
Inevitable office conflicts left me in tears. I usually have thicker skin than that.
Since I had just started the job a month before my miscarriage, my 90-day review came two months after my miscarriage. According to my boss, my performance was okay. But never in my life have I had such a low score on a performance review.
My boss — short on sleep himself as he was trying to reach deadlines — would do things that aggravated me and I would snap at him. I never snap at bosses. What the hell was wrong with me? But I had no patience that year. Fortunately, we worked things out. I helped him reach the deadlines. He was grateful.
My six-month review was better than my 90-day one. Still, my boss noted that I had trouble keeping up with some of the financial details. Details had never been a weakness before. Granted, I was taking on more financial duties than I had in previous jobs, but without the depression fog, I probably would have kept up.
All in all, when my husband got a job offer in a different city and asked me if I was okay with moving, I ditched my job with nothing else lined up.
A Gentler and Better Way
I almost hesitated to write about mental health and productivity costs because there is so much stigma and pressure on pregnant women and moms already. I can envision some man reading this and saying: “Look, I knew that woman wasn’t keeping up after her miscarriage. She clearly needs to be home resting. I’m going to tell her so and cut her off company payroll.” But that’s not the point.
Women can do well even after pregnancy loss. We are resilient. We do bounce back. We often take solace in work as a distraction from our grief. But we need acknowledgment that what we are doing is hard. We might even need a few accommodations. Above all, we need strong social and medical support.
After we moved, I found myself closer to friends in a sunnier city. With no job of my own, I got the rest I needed. As my second pregnancy progressed into the third trimester, our new hospital walked us through childbirth education classes that discussed postpartum issues. When my energy tanked again after giving birth, I found myself in a strangely familiar mental haze, and finally had my moment of realization. This was postpartum depression, and it felt familiar because I had already been there.
This time, I was encouraged to talk about it. With birth, there were mommy and baby support groups. My doctor put me on meds the first time I raised the issue with her. The hospital had a team of people who called every two weeks to make sure the meds were working and I had the support I needed.
What would be different in my life now if I had received that level of support with my miscarriage?
Since my own miscarriage, I have helped other friends through similar experiences. I am the one who tells them to take their vitamins. I am the one who tells them that pregnancy symptoms might not wear off for a few weeks. I am the one who says “you might have depression” and calls to check in on how they are doing.
I am, of course, happy to be a good friend in these ways, but friendship isn’t enough here. Instead, we need systemic support. Here are a few things that could really help.
- Hospitals could set up a pregnancy loss fund, and quietly cover the extra expenses instead of billing the bereaved mothers.
- Doctors could send moms home with information packets that they can reference about follow up health questions.
- Medical teams could call to follow up two weeks and six weeks later, and include a mental health check in the same way that they do after you give birth.
- Medical teams could immediately refer women to support groups, a counselor, and local resources to deal with loss.
- Employers could offer additional time off to deal with pregnancy loss, and consider a flexible schedule for the first few weeks after a mom returns.
- We could all break the stigma around miscarriage and stillbirth so that it becomes an acceptable thing to talk about in the office.
Having a child costs a lot. The impact of a child on a woman’s bank account and career is well understood. I write to remind you that miscarriage and stillbirth cost a lot too. Maybe we can work together to make the grief and the costs a little easier to bear.