Working while pregnant in a maternal mental health service

The first time I was affected by my pregnancy in work was during an assessment of a woman who had experienced multiple miscarriages and had difficulties conceiving. Understandably, she was distressed discussing her experiences, and how her losses had affected her sense of hope and identity. I was still within my first trimester and had vomited several times in the car on the drive in. I was feeling frustrated with early pregnancy. I was balancing my final year of clinical training, writing my thesis, and caring for a three-year-old. 

As I sat alongside her distress I felt an overwhelming sense of guilt: not only that I had become frustrated with morning sickness, but that, unbeknown to her, I was pregnant. Of course, she didn't need to know and if I had of been visibly pregnant it would have been inappropriate for me to have taken that appointment. Still, the lack of transparency was uncomfortable for me to sit with. 

I had discovered I was pregnant six months into my DClinPsy specialist placement in a maternal mental health service (MMHS) – I had just accepted a permanent, qualified position in the service. My role involved working alongside women and birthing people who had experienced traumatic birth, stillbirth, miscarriage, or tokophobia (fear of childbirth). I was looking forward to completing my training and starting my role in the October as 'Dr Johnson', then taking my maternity leave shortly after. I thought separating my professional and personal life would be manageable, but I was about to experience some real challenges…

First trimester

I knew that I was a resilient person; I'd had a positive experience of birth with my first child and had been working clinically for some time. But my feelings of guilt also surfaced in some of my longer-term work. 

I had been working for a number of months with a woman who had experienced separation from her baby through the family courts. She longed for another baby but was aware that becoming pregnant would likely mean more assessments and another court ordered removal. She had concluded having another child wasn't a possibility for her. I once again found myself feeling uncomfortable working alongside her while she was unaware of my own pregnancy. 

Part of our sessions involved discussing what she would need to consider if she did try to conceive again in terms of involvement from professionals, assessments and legal proceedings that would need to go ahead. I couldn't help but compare our experiences – my pregnancy was so private; a secret limited to my family. Hers however, would be so public to professionals across health and social care. In some ways, it felt like I was lying to these women. 

Second trimester 

As I became visibly pregnant, I moved to working online, where my growing bump could be concealed behind a desk. A lot of clients we work with report difficulties seeing pregnant people, particularly with a bump, so face-to-face appointments were no longer appropriate. During my first pregnancy, my scans were a period of excitement, friends and family were excited to see the baby, and although there were still issues with the Covid-19 restrictions, these scans were filled with excited anticipation. Now, with my second pregnancy, my mind was filled with stories of women who had gone for that 12-week scan and been told there was no heartbeat. Or, women at their 20-week scan who discovered their baby had health complications and a medical termination of pregnancy was advised. 

I became acutely aware of the counselling room in the corridor and the conversations that had likely happened in there. I asked the sonographer to tell me as soon as they noticed a heartbeat, and to talk to me throughout the scan to help me feel calm. They were beyond helpful and put me at ease as much as they could. Thankfully, the scans revealed a healthy baby – a huge relief. 

Third trimester 

As I progressed through the rest of my pregnancy and my due date was approaching, my anxiety became more challenging to manage. Listening to first-hand stories of traumatic births from distressed yet truly brave women stayed with me. I began to experience more physiological symptoms of anxiety, mainly palpitations and a tight chest. I was able to stay calm in online sessions with clients, but once that camera was off, I would really struggle. 

After sharing with my supervisor and senior leadership, it was decided I would no longer offer assessment appointments. Although this was a huge weight off my shoulders, I once again felt a sense of guilt that I wasn't working as much as the rest of the team. It wasn't only direct work that was challenging – attending our weekly multidisciplinary team meeting became too much. Hearing about experiences of traumatic deliveries and still births would result in me leaving a meeting early to protect myself from hearing too many details. 

As a self-confessed perfectionist, not doing my job to my high standards was a challenge, especially as a newly qualified Clinical Psychologist – I was supposed to be able to cope! 

So, what helped?

Despite the challenges I faced while working in the MMHS while pregnant, there were lots of factors that supported me. As you can imagine, a safe supervision space was particularly valuable. I was able to share my concerns with my supervisor as they came up, and was met with both compassion and action points. I could rely on my supervisor to plan and resolve my concerns with senior leadership. I was particularly grateful to my team, who were able to pick up the assessments I was unable to complete. 

I was able to discuss my position in our monthly reflective practice session. I was met with compassion when I shared my anxieties with the team. Despite my worries of not performing to my high standards, my team shared with me their view of how I had managed my work while pregnant. I was surprised to hear this… my inner critic was informing me that I had let people down by reducing my workload and not attending meetings. 

I was also lucky enough to have support from our Specialist Midwife, who kindly shared her knowledge and experience of the induction process with me, empowering me with enough knowledge to make my birth as positive as possible by addressing my fears. At our annual away day, she was able to provide a space for us to understand how our view of birth can be skewed when working in a role like mine, enlightening us with information about the vast majority of births which are medically uncomplicated. 

An ongoing task within the team is the process of making our team meetings trauma informed. I became particularly aware of the number of distressing stories we hear in our multidisciplinary meetings, back-to-back, and the vicarious trauma that is present within the team. The senior leadership team are working to establish proformas for MDT meetings so that the information shared is what is needed for the meeting, without a focus on the traumatic details. Established supervision was in place where practitioners could provide space to work through the distressing stories they had heard in their clinical work. With the help of the Assistant Psychologists, there has been an attempt to activate our 'soothe systems' at the end of the meeting, providing time to check in with our mind and body before moving on with our day. This can involve a mindfulness exercise, or with time spent activating the parasympathetic nervous system through breathing and grounding. 

Unfortunately, at 36 weeks, there were concerns that my baby was not growing as expected and an induction was advised by the team at my foetal medicine unit. My mind was flooded with scary thoughts; the risk of my baby not surviving the labour and delivery, the risk of induction being a terribly painful and traumatic process, resulting in an emergency caesarean section, and my small baby requiring time in a neonatal unit. These were all possibilities that I had heard stories of during my time in the MMHS. 

After a lot of thought, I consented to an induction at 39 weeks pregnant, with increased monitoring from the foetal medicine unit. This meant I began my maternity leave early, primarily due to the increased appointments, but also because I had finally let go of the guilt and the pressure to prove myself as a resilient clinical psychologist. I had decided to prioritise my wellbeing. 

My advice to others who may be pregnant, or considering growing a family in this role, is to lean into and accept vulnerability at this time. Accept help and prioritise self-care. This experience has helped me to understand that my success as a Clinical Psychologist is not measured by my ability to push through challenges, when doing so is really hard. Knowing when to say 'this is enough' is more important. 

Communicate with those who can support you, your supervisors, senior leadership, colleagues, your midwifery or antenatal team. Supporting women and birthing people during this time is a true privilege, but also hard, and that should be considered. Although it is some time away, when I return to work, I will continue to consider how our personal and private lives meet and aim to support my colleagues who may have experienced pregnancy, wish to experience pregnancy or whose loved ones will experience pregnancy.