How to navigate work when you’re neurodivergent and pregnant

Being pregnant is often a complicated experience. You want a family, but resent feeling sick all the time. Buying tiny clothes is fun yet overwhelming. You might feel excited at the prospect of being a mum, but crippled with anxiety.

Being pregnant isn’t easy, but for autistic women and people with ADHD, it can come with some extra challenges. The physical and sensory changes, disrupted routines, hormonal shifts, exhaustion and increased demands on executive function can be overwhelming, especially when you’re trying to keep up with work at the same time.

“Pregnancy seemed to amplify many of the things I already found difficult,” says Ella Smith-Dunn, 29, a HR professional who has ADHD and is sharing her story as part of a Cocoon Healthcare awareness drive.

“I have always been sensitive to sensory input, but suddenly the sensations I was struggling with were coming from inside my own body and I couldn’t remove myself from them. I was hot, sick and exhausted, and at times I felt completely overwhelmed by the fact that my body was changing constantly and there was no escape from it.”

At work, Smith-Dunn carried on as normal. But the sickness, exhaustion, physical discomfort and constant anxiety – on top of the existing executive function and sensory challenges – meant everything felt harder.

“There could be a huge amount happening in my head while I appeared completely fine to somebody else,” she explains. “Concentrating when I was exhausted was harder, switching between competing tasks could take more effort, and stimulating environments could leave me much more depleted than usual.”

Masking is often second-nature to neurodivergent women. According to a survey of more than 600 workers for Pearn Kandola’s Neurodiversity At Work Report, 63% said they masked at work. It’s particularly prevalent among women, who tend to hide their neurodivergence more frequently, and convincingly, than men because of gendered societal pressures to copy neurotypical social behaviour.

“Neurodivergent women often become very good at adapting, compensating and appearing as though everything is fine because many of us have been doing that for years, but pregnancy can reduce the amount of energy you have available to keep doing it,” she adds.

“That distinction matters in the workplace because struggling does not necessarily mean somebody has stopped performing well, and performing well does not necessarily mean they are not struggling.”

"There could be a huge amount happening in my head while I appeared completely fine to somebody else"

Ella Smith-Dunn

What employers need to do to support pregnant neurodivergent women

Offer full flexibility

Flexibility doesn’t just mean offering someone an early finish on a Friday. Employers need to recognise that pregnancy can intensify sensory, energy, concentration and communication challenges for neurodivergent women. True flexibility means flexible hours, working from home, quieter working environments in-office, additional breaks, adjusted workloads and more. 

Flexibility should be an ongoing conversation, with employers regularly reviewing and adapting support as needs change throughout pregnancy. “I was fortunate to be able to be open about what I needed, which allowed me to feel safe enough to discuss openly about how I was feeling and performing, without concern over what that might mean for my career,” says Smith-Dunn.

“Pregnancy can change from one day to the next, particularly when you are dealing with sickness, exhaustion and sensory overwhelm. Being able to respond to what was happening rather than constantly trying to push through it was important.”

Ensure people feel able to speak up

Women, and especially neurodivergent women, have spent their lives trying to fit in, not making too much noise, being told they need to conform so they are less likely to ask for support when they need it.

Psychologically safe workplaces allow women to feel that they can speak up for what they need without fear of being judged as incompetent or weak. To create psychological safety, bosses need to lead by example. Make sure all requests and ideas are listened to, accepted and discussed without judgement.

“Where you have a culture that promotes psychological safety, people are able to ask what they really need to be able to perform their best work,” says Smith-Dunn.

“For me, this meant that when I had been sick so violently that it was all in my hair and I wet myself, I was able to contact my manager to tell her, who responded by telling me to do what I needed to do, which was have a shower.”

Promote workplace adjustments

There’s a massive burden on employees to ask for adjustments, with 78% of disabled employees having to initiate the adjustment process themselves rather than the employer. It can be anxiety-inducing to ask for simple and reasonable requests.

“We can sometimes make workplace adjustments sound like enormous formal interventions, when the thing that allows somebody to continue doing their job well may actually be relatively straightforward,” says Smith-Dunn. “A large barrier to accessing workplace adjustments, especially for neurodivergent people, is that you don’t know what is available to you, you might not feel comfortable asking.”

It can help to have a list of common adjustments available for employees to look at,  including examples like later starts for a quieter commute, to see what might be helpful to them. Or, at the very least, employers should start the conversation and ask if someone needs any changes to the way they’re working to make life easier.

Don’t make assumptions

There’s no standard, one-size-fits-all approach to supporting pregnant women, or pregnant women who are neurodivergent. The most useful starting point is a genuine conversation about what the individual employee is finding difficult and what would allow them to continue working, rather than assume or guess.

Remember that coping mechanisms are often invisible

Neurodivergent women may have developed routines, structures and ways of working that allow her to thrive. Pregnancy can suddenly disrupt these carefully curated systems, leaving her to navigate sickness, poor sleep, physical and hormonal changes, appointments, sensory overload and more.

“Many neurodivergent women have spent years trying not to appear difficult, forgetful, overly sensitive or overwhelmed, so there can already be a tendency to adapt ourselves to the workplace rather than asking whether the workplace could adapt slightly to us,” says Smith-Dunn.

“Pregnancy can make maintaining that much harder, which is why creating an environment where somebody feels comfortable speaking before they reach the point of being completely overwhelmed is so important.”

We’re an independent digital magazine, and your support helps us keep doing what we do. If you enjoy our work, please consider buying us a coffee here.