Explaining ectopic pregnancy for employers
Many will be unfamiliar with what an ectopic pregnancy means. Employers may benefit from reading our informative sections, to broaden their understanding and help them support affected individuals.
Taking time off work, sick pay and sick notes
Following an ectopic pregnancy, you may need to take time off work to recover. Your doctor or surgeon may sign you off work and give you a sick note to pass to your employer/the HR department, particularly if you have had surgery. However, if your doctor does not raise the question of returning to work or being signed off for a period of time, you can request a sick note and you should not feel embarrassed or worried about asking for time off to recover, whatever treatment you experienced.
Each employer is different, but most will request proof of sickness if you’ve been absent from work for 7 days or more (or less in some cases). If you are given a sick note, the note will usually have minimal information on the details of what you’ve been through (e.g. it may say ‘abdominal surgery’ or ‘gynecological illness’). Some women prefer to keep the precise details of their ectopic pregnancy experience private from their workplace, and this is still possible even with a sick note. If, however, you would like more information added to the note, and you’d find it useful for your employer to receive it in this way, you should feel you can ask that of your doctor.
Whilst you are off work, you should report in sick in the usual way and will be entitled to usual sick pay. This should be recorded by your employer as pregnancy-related sickness, separately from other sickness absence. This absence should not count towards any review in the employer’s absence policy and cannot be used for disciplinary or redundancy purposes.
For the first seven days, you can self-certify pregnancy related leave. Following this, you will need a fit note from a GP or medical practitioner to certify the leave is pregnancy-related, which you can give to your employer. If you require surgery or are receiving treatment including expectant management treatment or methotrexate, you may need an extended period of time off from work. Recovery is different for each individual, and it is important you allow yourself sufficient time to heal physically and mentally from treatment.
Whilst off work, you are entitled to the sick pay specified in your contract. This could entitle you to full pay whilst on time off, or you may only receive statutory sick pay (SSP). Those on zero-hours contracts, temporary and agency staff may still be eligible to sick pay. Check with your employer to confirm current rates of SSP and what you will need in order to qualify for SSP. You may also be able to get Universal Credit and SSP at the same time.
Unfortunately, people who have experienced an ectopic pregnancy cannot receive maternity leave or pay.
Partners may be able to request compassionate or unpaid leave.
Employers should have a policy in place for medical absence with regards to time off and pay, but if you feel you are being treated unfairly or are dealing with resistance while trying to arrange time off work for recovery that cannot be resolved with your HR department, you can find more information using the links below.
Whilst pregnant, you are entitled to time off with full pay for pregnancy related appointments. These include medical appointments, classes for pregnancy related health and sessions to support mental health and wellbeing. There is no definitive amount of time off that can be taken, but it must be a reasonable amount. Employers should be flexible, as each individual’s needs are different. Employers can ask for evidence of pregnancy-related appointments.
When do I have to return to work?
Your doctor may suggest taking time off work for one, two, or even three/four weeks. Some may need longer and this may depend on the type of treatment as well as the emotional healing that is needed. This should be a conversation with your doctor, and if you feel you need more time than they suggest (even after issuing a sick note), it is important to let them know. Every woman is different, some find getting back to work relatively quickly helps towards adjusting to a new normal for their healing and others feel they are not ready and need more time. Any of these feelings are valid.
If you do not feel ready to go back to work, you could request a further fit note from your doctor. The amount of leave you can take after an ectopic pregnancy is not limited, as long as it is certified as pregnancy-related by your doctor.
If you return to work then realise you need further time off, you can again ask for a further fit note from your doctor. If your doctor is unwilling to certify this further time off as pregnancy related, you are entitled to visit another doctor to seek a second opinion.
Additionally, you could ask your employer if they provide compassionate leave, request to take annual leave or agree a period of unpaid leave to allow you further time off from work.
Returning to work
Returning to work after surgical management once you have been discharged from hospital, your doctor will usually give you a sick note with details of how long you should be signed off from work for, that you can give to your employer. They may also give you guidance on activity to avoid during recovery such as heavy lifting. If your job involves this activity, it is important you talk to your doctor about this to ensure you’re given the appropriate time off to recover. You may also be managing some pain and discomfort during recovery (though if this becomes unmanageable you must speak to your doctor) and you should not push yourself as your body recovers. Surgery is a major life experience, and as well as the feelings of grief, anger, loss and confusion that ectopic pregnancy can bring, you must be gentle with your body and allow it to heal.
Returning to work after medical management with methotrexate and/or expectant management
After receiving the methotrexate injection or expectant management, you may have experienced a short stay in hospital or may have returned home to recover without an overnight stay. Following methotrexate, you may experience symptoms such as pain, sickness and/or diarrhea, and you must be kind to yourself while your body goes through this. With both methotrexate and expectant management, your hCG (pregnancy hormone) will be being checked and that will likely involve trips to and from hospital which mentally may be triggering or upsetting for you. You will also be given guidance on activity to avoid to give you the best chance of recovering and avoiding rupture. All of this can be emotionally very difficult to come to terms with, and it is worth considering carefully if you are able to return to work through this both mentally and physically. Some people appreciate a degree of distraction – and this can depend on the type of work that you do. However, many feel that they are not ready to go to work and take time off until hCG levels have returned to non-pregnant. While you recover at home, even if you are physically able to return to work, you should speak to your doctor about signing you off work if you feel you need it.
Preparing for your first day back
You may want to talk to your employer or HR department about returning in a phased way. This might mean that for your first day, first week or few weeks, you may want to discuss options of doing reduced hours or taking longer breaks. Returning to work after going through something traumatic can be hard and conversations on what to expect in the first few weeks and months might help you feel calmer and may avoid feelings of being overwhelmed.
Dealing with questions from colleagues
You might be apprehensive about questions from colleagues as to why you’ve been off work and how to answer these questions. It may help to prepare for this before you return so you have an answer ready that you are comfortable with. This might be something factual and/or brief about an ectopic pregnancy experience, or you may way to consider something that makes it clear you’re not comfortable talking about it, such as ‘a personal, medical reason’ or ‘emergency surgery’.
For employers, it is important to be understanding towards individuals suffering physical or emotional difficulties as a result of an ectopic pregnancy. For some, there may be mental health challenges such as depression, anxiety or post-traumatic stress. Going back to work after an ectopic pregnancy can be daunting and individuals may feel unsure how they will cope.
Employees can ask for support even if it is not contained in an official policy. Managers and human resources departments should be able to help offer additional options whilst planning a return to work.
Employers could consider the following to help individuals return to work:
- A phased return to work, with reduced hours or different duties
- Different start and finish times
- Working from home
- Additional breaks
- An occupational health assessment
- Offer counselling or support services
- If long-term changes are needed, flexible working may be a good idea
Before returning to work, it is advised to have a conversation with your employee to discuss and understand how they are feeling and what help they could benefit from. Let the employee lead any conversations and be sure to use sensitive language.
With the individual’s consent, it can also be beneficial to explain to colleagues why they have been off, and share relevant information with them. Ultimately, it is up to the individual how much they choose to share. They may decide not to tell any of their colleagues and their privacy must be respected.
Remember to continue offering extra support and be conscious of situations at work (such as pregnancy announcements), which could be hard to cope with. Employees are encouraged to ask employers for adjustments to help avoid uncomfortable situations.
What if I’m self-employed?
Some self-employed individuals will have flexibility to choose when they will go back to work, and how this is done. However, many will have work related commitments making it hard to postpone returning to work. If you feel comfortable doing so, explaining your situation to clients could allow them to support you in understanding why you need the time off.
As statutory sick pay is not usually an option for those who are self-employed (you are entitled to this if you’re a limited company director), an alternative could be Employment and Support Allowance. If you’re not eligible to receive sick pay, Universal Credit is another option. There is more information about benefits you may be entitled to on Citizen’s Advice Bureau.
Facing discrimination and unfair treatment at work
You have a right not be discriminated against because of pregnancy or an illness related to pregnancy, including related time off. This law applies regardless of how long you have been employed for.
Pregnancy and maternity discrimination protection mainly applies to a specified time known as the protected period. This protection covers a period of two weeks from the end of a pregnancy for women who are not entitled to maternity leave. After that, you can make a claim for sex discrimination, if treatment because of your pregnancy amounts to less favourable treatment.
Discrimination could involve not being given the same level of work as peers, being considered for redundancy or not considered for a promotion as a result of suffering an ectopic pregnancy, taking time off and seeking support following this. If you feel you are being treated unfavourably, keep an ongoing record of events, conversations, emails and messages.
If you are an employee, you also have protection against being unfairly dismissed, provided you have two years of service with your employer. Unfair dismissal on the grounds of pregnancy (including miscarriage or pregnancy related sickness) is automatic, meaning you do not need to have been employed for two years to bring a claim. You are also protected from day one of your employment from detrimental treatment, which includes a range of unfair treatment.
If you believe you have been discriminated against as a result of an ectopic pregnancy, you will be able to bring a claim at an employment tribunal. However, the first step is to try and talk to your employer directly to see if the matter can be resolved informally.
If the matter is unable to be resolved informally, or you believe you have been unfairly dismissed, consider making a claim to an employment tribunal. There is not a requirement to pay a fee to make a claim. You must contact Acas within three months (less one day) from the date of the act you are complaining about if you are making a claim.
Further information and support
Where to go for employment related advice and support, during or after your loss
There are some useful websites which can provide further guidance on your rights on the work place, as well as support for those who have experienced pregnancy loss.
Through the Acas Helpline, you can get advice on specific problems, and explore alternatives to an employment tribunal claim (such as mediation).
The Citizens Advice Bureau has useful resources on workplace discrimination, your rights at work and dealing with problems at work.
The Equality Advisory Support Service offers help and advice on discrimination and human rights.
The Equality and Human Rights Commission offers information and advice about discrimination law. For information for employees and employers about pregnancy and maternity rights in the workplace see here.
Maternity Action is a charity offering information and support on maternity rights at work and benefits, they also have an advice line.
The Miscarriage Association is a charity offering support to people who have experienced pregnancy loss. They have information on miscarriage and the workplace which includes miscarriage, ectopic and molar pregnancy and guidance on creating a miscarriage policy covering those areas of loss.
Pregnant Then Screwed is another charity offering support, particularly for women for have faced maternity of pregnancy discrimination. They offer free legal advice and have a mentorship scheme.
Tommy’s is a charity carrying out research into pregnancy loss, with a pregnancy information service and baby loss support.
Sands exists to reduce the number of babies dying and to ensure that anyone affected by the death of a baby receives the best possible care and support for as long as they need it. They can offer bereavement training in the workplace and resources.
Getting legal advice
Please note, this webpage does not constitute personal legal advice. The Law Society has a useful page to help you find a solicitor offering the services you need. Information is based on English law and practice only.