Helping patients cope with pregnancy loss

A patient recently came in to the office to follow up after having a spontaneous miscarriage at eight weeks gestation. She had gone to the emergency room in the middle of the night, bleeding and cramping. 

This woman shared that the most upsetting part of the experience was a comment a nurse made to her as she and her husband were discharged: “You should be happy this happened. It's for the best because there was probably something wrong with the baby.” 

This seems ridiculously insensitive and uncaring, but it is far too common, even among health-care professionals. I once heard a physician tell a couple that had just delivered a full-term stillbirth, “At least you didn't get to know and love the baby yet.” 

Miscarriage, at any gestational age, is heartbreaking for the family and often particularly devastating for the mother.  Women and their partners need to go through the grieving process whether the loss occurs at six weeks or 40 weeks.

I don't believe that clinicians are being intentionally cruel when they make insensitive comments. It seems like more an instance of not knowing what to say.  As providers, we really don't need to say much more than, “I'm so sorry for your loss.”  Then we should close our mouths and start listening. 

Personally, I try to prepare my patients for the things other people might say when they are trying to be nice.  “You can try again,” seems like a lovely thing to say, but for many women who have recently suffered a miscarriage, this is not comforting.  They don't want to have to try again and go through the anxiety, stress and fear that they might lose another pregnancy. Many still want to be pregnant now.

I try to warn couples  they might have different individual grieving styles and that this is normal.  I try to prepare them for future stressors related to the loss, such as the baby's due date and seeing their friends give birth.

I also encourage them to find a way to memorialize the pregnancy, whether privately or publicly. This can help remind the couple, as well as family and friends, that this was truly an important loss in their lives. 

Possibly the most important thing I do is refer these couples to support groups made up of people who have similar experiences, who understand what they are going through. These groups often also provide grief-counseling training to health care professionals.  Whatever your approach may be, it is well worth the time to gain the skills and understanding to help patients during this very sad time in their lives. 

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