Monday, March 29, 2010

Lessening the trauma of loss

An anonymous commenter left this link, awhile back now, about a group of mothers in England -- from an Internet forum, no less!! -- calling for the establishment of a new code of practice to help lessen the trauma of miscarriage. Go have a read; it's a great article.

As the article says, you would think that, with at least one in four pregnancies ending in miscarriage, our healthcare system(s) would know how to properly care for women in these situations. But as far too many of us know from personal experience (whether we live in England, Canada, the United States, Australia or elsewhere), this is too often sadly not the case.

As a volunteer facilitator for a pregnancy loss support group for more than 10 years, I heard many sad stories of how an already-awful situation was made even worse by the actions & attitudes (ranging from indifferent to brusque) of medical staff. Those who had experienced multiple losses often compared the way they were treated from one loss to the next, sometimes at different facilities but sometimes at the very same hospital.

(This is not, of course, to say that all parents have bad experiences. I've also heard many, many stories of incredible kindness & compassion shown by caring doctors and nurses.)

Beyond any attitudinal adjustments needed, there is no clear, single protocol that's followed when a baby is miscarried or stillborn. Practices and procedures differ not only from hospital to hospital, even within the same city, but sometimes from shift to shift, depending on who's working that night. In some hospitals, women are delivering stillborn babies next door to women celebrating the birth of live, healthy, wailing infants with their jubilant families. In some hospitals, autopsies are performed as a matter of routine; in others, they're not.

The vast majority of parents, of course, have no idea whether there are alternatives to the way they are being treated. They're in a situation where neither they nor their families have many precedents to fall back on, that their prenatal classes didn't prepare them for. This is where established protocols & gentle guidance and suggestions from well-trained staff are so important.

What did you think of the article?


  1. That's really interesting. Even though I consider the care I received to be excellent, I recovered in L&D after losing Charlotte. Through my morphine haze I remember being horrified at the sounds of labouring women and screaming newborns down the hall. Once I was stable, I spent the rest of my time in gynecology, which was a welcome reprieve from the maternity ward.

    I completely agree, there needs to be better staff training and better hospital protocol. It's horrible how some people are treated.

  2. Well written article outlining some of the issues.

    The ER doc we had was kind. He was direct, honest, & sympathetic. But the doc on the floor was a jerk. I'd sent my husband home to get some sleep & the floor doc wanted me to terminate the pregnancy with the baby's heart still beating. I told him i couldn't make that decision without my husband & he was angry with me.

    Next morning, instead of listening to our decision on what we wanted, he said, "I'm sending you home. You're going to lose the baby. It will hurt. Don't come back." He sent me home severely anemic.

    A friend who lost a pregnancy last fall tells me the nurse asked her, "Why are you crying?" She seemed irritated with my friend & to be truly ignorant that someone could want the child or be sad at the loss.

    The article did a good job of pointing out that while miscarriage is "common" & medical care givers see it frequently, it is NOT common to the people going thru it. The medical professionals may be blase about it, but it is a major life event for many of us going thru this. It is the death of hopes & dreams, even if more children do come to the couple.

    I thought it a good article. One to share with folks interested in the pain of this & to share with people who have gone thru it.

    Thank you for sharing it. :)

  3. hi there. I post on the forum which is trying to get this through :) Glad to see that mumsnet reaches beyond the UK.

    I recently had a scan midway through the injections for IVF (am on the 2WW). The person who scanned me was the same person who told me I was going to miscarry about 11 months ago. Not only was she really unsympatheric at that early pregnancy scan but at the Follicle scan she asked me 'have you ever had an internal scan before?' At the very least she could have read my notes and would have seen that yes indeed I had and she was the one who did it!

  4. I read the article and I wish womens' organization or patient advocacy groups should demand that medical staff be trained. I've had a couple of friends who have had miscarriages and when they told me about their experiences at the hospital, I was amazed at the lack of compassion in which they were treated.

  5. I read the article and I wish womens' organization or patient advocacy groups should demand that medical staff be trained. I've had a couple of friends who have had miscarriages and when they told me about their experiences at the hospital, I was amazed at the lack of compassion in which they were treated.

  6. Very interesting read. No matter what it's a hard thing to go through, though. I do think there is always something more that a doctor/nurse/hospital could do to comfort and help a woman who's just experienced a loss. Thanks for sharing.

  7. I have not experienced pregnancy loss or baby loss, but my close friend has and was treated quite crudely on both occasions, especially when she pressed for an appointment for genetic testing.

    Having edited several obstetrical nursing textbooks, I know that the academic information these nurses receive about stillbirth is, to say the least, minimal. It's always a very short section in the textbook, with mostly sidebars and little actual discussion. Generally there is a box of "Clinical Tips" on putting a symbolic leaf or rainbow on the patient's door, not saying anything like "Don't worry, you'll have another and forget all about this one," etc. And that's about it. Two pages in a 480-page book, and generally toward the very end of the book near the appendices (right next to infertility!). Miscarriage is discussed earlier in the books, within the 1st trimester section, but it's very clinical -- little wonder that nursing staff gets hung up on "defining" the type of loss and reminding the patient that her experience is very common. The humanity is lost. Once I did have an entire book on neonatal emergency, with much more extensive information (very strong advocacy of photography and keepsakes), but it was a physician handbook and had maybe one twentieth the print run (number of copies) as any nursing obstetrical book. So there definitely needs to be MORE training and formal recommendations, because I can attest that this information is just not being presented in any kind of adequate or sensitive manner.