The loss of a baby in pregnancy can be a very unhappy, frightening and lonely experience. It’s not a major event for everyone, but feelings of shock, grief and loss are common.
I hope that the following thoughts may be useful for you in supporting patients affected by miscarriage, ectopic pregnancy or molar pregnancy.
It is estimated that one in four or five pregnancies ends in miscarriage. A further one in 80 pregnancies is ectopic, where a pregnancy develops outside the uterus or womb, which can be life-threatening for some women; and another one in 600 pregnancies is a molar pregnancy, where an abnormal fertilised egg implants in the uterus.
You’ll almost certainly know this. You’ll know that miscarriage is very common, that it’s most likely to occur in the first trimester, that the main risk factors are maternal age and a history of miscarriage, that some couples experience repeated miscarriages.
You’ll know that ectopic pregnancy is much less common but potentially life-threatening and may reduce fertility. Molar or hydatidiform mole pregnancy is rarer still, requiring surgical management and specialist follow-up over a number of months.
Sadly, many of your patients will only learn this after they have experienced a loss or losses. It’s not been something we teach in schools, where the focus is on preventing pregnancies and sexually transmitted diseases. It’s not mentioned much in pregnancy books, other than a line or two about contacting your doctor or midwife if you have any vaginal bleeding. Women and their partners may know that miscarriage can happen, but as with road accidents, they don’t expect it to happen to them.
How parents react to pregnancy loss
As with any illness or medical condition, people react differently to pregnancy loss. Some may see their miscarriage just as a ‘blip’ in their pregnancy history and move on quite quickly. Some might feel relief at the natural end of an unwanted pregnancy. For many, though, the overwhelming feelings are shock and distress, along with an acute sense of loss – for their baby and for the hopes and plans they had for their future family.
Their physical experience is also likely to play a part. This might be:
- severe pain, heavy and prolonged bleeding and passing their pregnancy, perhaps in the toilet;
- second trimester labour and delivery, and producing milk;
- emergency treatment for ectopic pregnancy, perhaps in a state of collapse;
- a letter from the trophoblastic tumour screening centre after a molar pregnancy.
There may be circumstances that cause additional distress, such as:
- the loss of a pregnancy after years of infertility and/or assisted conception
- fear of the health implications of molar pregnancy, especially the risk of cancer
- fear of another ectopic pregnancy but also anxiety about diminished fertility
- loss of one or more of a multiple pregnancy
- this being the last chance of a pregnancy, due to age, financial barriers or simply because they could not cope with another loss.
For some, their loss may give rise to depression, anxiety or symptoms of PTSD (see this research), either de novo or by exacerbating existing mental health or social problems. The pregnancy or its end may cause or worsen relationship problems.
And sadly, many people will find that family, friends and colleagues do not always acknowledge or understand their feelings and needs after a loss or losses. Comments meant with the best of intentions can instead have the opposite effect.
Workplaces may not be supportive, and some women may feel forced to return to work long before they are ready to avoid disciplinary action or dismissal.
How you can help
Whether you are a nurse or midwife based in the community, you can make a positive difference to women and their partners who experience pregnancy loss.
In most cases, their experience of hospital care will have been very brief – indeed, during the pandemic, some may have had only a telephone consultation. Almost all will appreciate your contacting them, to acknowledge their loss and to check if they need further support or information or simply time to talk.
It can be much more difficult if you are contacting a patient about an antenatal appointment without having been informed of her loss. That may be very distressing for her and upsetting for you too. Even so, simply apologising for not knowing and expressing sympathy for her loss may help her, demonstrating that there is someone to turn to if she needs further help.
While everyone’s needs are unique to them, here are the key things that may help:
- acknowledging the event – something as simple as saying ‘I’m sorry to hear that you had a miscarriage. How are you doing?’
- listening – the best way to learn about her feelings and concerns
- providing information, explanations or advice as appropriate and
- being ready to find out more and get back to her, or to ask someone else to contact her if it is outside your area of knowledge
- recognising key times that might be difficult, including the first period after a loss ( a physical reminder of the loss itself and of her no longer being pregnant)
- understanding any anxieties about trying again – because of worries about another loss or about fertility
- understanding increased anxiety in pregnancy after loss:
- reassuring her that such feelings are completely normal and understandable given her experience
- offering further support, perhaps including the option of referral for an early scan if she feels this might help (but bearing in mind that this may not be possible during the pandemic)
- referring or signposting to other sources of help or support, within the NHS or trusted charities (check their websites and make your own judgement).
Remembering your needs
It can be difficult and distressing to be on the receiving end of patients’ anxiety, grief, loss and perhaps anger and frustration too. That might be especially so if you have been through something similar (as so many people have) and perhaps find these consultations triggering. You may simply be feeling exhausted, physically and emotionally, especially during the pandemic.
Do try to identify sources of
- support: from colleagues/managers, whether in your practice or in another one; or perhaps from organisations such as Mind and the Miscarriage Association
- information: on the facts and feelings of pregnancy loss, and through online learning, including the Miscarriage Association’s online learning.
You can make a positive difference to people who have been through pregnancy loss and you probably do already. Thank you, for all your care, compassion and commitment.
All quotes from people who had experienced miscarriage were provided by the Miscarriage Association.
The Miscarriage Association is a national charity which offers information and support to anyone affected by miscarriage, ectopic pregnancy or molar pregnancy.