The Tragic Optimist

question about miscarriages and getting the news

An acquaintance of mine is a doctor, she recently had to tell a woman that she’d had a miscarriage. She wrote: “I don’t think I did a great job of it and I want to do it better next time. If anyone’s been on the receiving end of this kind of news, what was helpful or not helpful for you to hear? Did you prefer medical language (e.g. is “embryo” or “fetus” too harsh for non-medical people?)”.

I’ve never been through a miscarriage, but I know that some readers have.  If you have thoughs, you can leave them here (you are welcome to post anonymously, if you’d like).

Advertisements

10 Comments

  1. [comment by a copied from previous post – she commented before I got a chance to publish this post -Ann]

    Here from LFCA…regarding your friend’s discussion of miscarriage with patients. I think it is important to only use embryo or fetus when speaking in general terms. She might want to say something like, “In general, a miscarriage happens when there is a genetic abnormality with the fetus/embryo. We don’t know what happened with your baby.” That way, she can give the important scientific information while still personalizing the message. Also, mention that there will be grief, the woman (and her partner) should be aware of it, and they should take some time to go through the grieving process. She should inform the patient that, in most cases, women go on to have successful pregnancies (and back it up with some stats), and when it is physically possible to start trying again.

    Of course, this is only appropriate for a first miscarriage for someone who is conceiving naturally. If there are procedures involved or repeat miscarriages, a little more sympathy for the struggle would be in order, in addition to recommendations for future strategies.

  2. I think it is appropriate to use medical terms, but a little sympathy is appreciated. I went through this recently, and it seemed that some medical personnel were reluctant to acknowledge that it was a sad thing that had just happened. Maybe they were afraid I would break down, but I would have liked a “I’m so sorry this happened to you” somewhere in the conversation.

  3. Ah, this is a tough one. Part of it is so dependent upon the person who is receiving the news and whether the doctor knows them well. The other part is whether the person had an inkling that there was something amiss or was generally gobsmacked. I’ve been in both categories.

    I think the best path to go is to be simple, direct, and honest, but at the same time compassionate. My old RE diagnosed both of my miscarriages and in both, I appreciated that he didn’t start the scans (both were diagnosed this way) with, hmm, something isn’t looking right. When he had made his final determination, he said, I’m sorry, but the baby is gone (or something to that effect). He offered to answer any questions that we had and was super patient with us.

    That last part – offering to answer questions and to listen – is so important. Only at the end of the appointment should you bring up options for resolution of the miscarriage – i.e. D&C, etc.

    Good for your friend for asking. That is a wonderful first step.

  4. S

    What strikes me is that your acquaintance has recognised that there is something severely wrong (about 98% of the time, and yes I just plucked that statistic out of my imagination) with the way that women are told about their current, past or impending miscarriages. Kudos for that.

    Having been on the receiving end of words like “missed abortion”, “blighted ovum” and “fetus” (after my doctor was told the name of my baby girl) – and choice phrases like “the pregnancy tissue is dead” (ok so that was a sonographer not a doctor) – this is a topic near and dear to my ranty little heart.

    Miscarriage is a gentler word than abortion- which carries all sorts of ethical, moral, emotional (legal) implications – its a heavy word laden with guilt especially when it is obvious that the woman/couple suffering from one very much wanted the baby. So – I’m very glad that your doctor acquaintance used the word miscarriage.

    The word baby is a good choice to use, in my opinion. Even if medically speaking the baby was nothing more than a mass of cells – to the woman/couple it was a BABY. It does no real harm once you’ve established what the basis of the miscarriage was – e.g. ‘missed miscarriage’ instead of ‘blighted ovum’, which is a ridiculous way of blaming the egg! More guilt for the price of admission. Cervical weakness instead of incompetent cervix etc. (I have a pdf document of what one of the states in Aus have implemented in their health policy if your friend is interested – it lists terminology which is no longer permitted to be used).

    Personally, the word embryo is an okay choice when explaining the basis of the miscarriage – eg “so when the embryo didn’t develop past 6 weeks…” etc, but if possible use baby.

    If it is a second or third trimester baby death perhaps use baby instead of fetus or as it is likely the baby was named, use the baby’s name.

    I personally feel its so important to validate the emotional trauma that the woman/couple are going through. One GP I had seen (not my normal one) actually said to me “your blood results are back. Looks like a miscarriage. Unfortunately that’s the nature of the trying game, nothing I can do about it” and sent me on my way. It is lucky that I was deeply devastated because in my normal fiesty mood I would have said something! My ex-fertility specialist kept referring to my daughter as “the fetus” – I reminded him gently that her name was Janaki. He just kept going back to ‘fetus’. Not the primary reason why he’s the ex-specialist, but damn, it was up there. My ob-gyn got brownie points plus 10 when he took my medical history, then asked for my daughter’s name and wasn’t afraid to use it – even though he pronounced it wrong. That was so amazing. It was kinda pathetic how grateful I felt for that but that is how it should be.

    Once the news has had a few minutes to sink in, it really doesn’t hurt to offer a “I’m so sorry this has happened to you (‘again’ – if necessary)”. Perhaps offer some hope where there is sound medical reason to do so – for example “I still think that your pregnancies are a good sign that we can keep trying and when you’re ready again we can talk about what the next steps are” or “with cervical weakness, I have had so many patients where a cerclage was put in and things have gone well barring complications”.

    Of course if it is not possible to offer hope – offer that you’re sorry, but you’re being honest, perhaps if they’d like a second opinion you can write a referral etc.

    Think that’s about all I can think of at the moment. Hope that helps in some way. Don’t mean to sound like a know it all – just my experiences and opinion.

    Cheers
    S

  5. Stopping by from LFCA –

    For me the most important part of the conversation is not the words used, but the compassion instilled in them.

    In the case of both of my m/c, the doctors who informed me were rather cold. In typical male fashion (not meant in a derrogatory way, just in a male-fix-it kind of way) they jumped right in to what could or should be done, without really giving me a moment to process the impact of the news.

    Recognize that this is some of the worst news a woman can receive, and give her a moment to let it sink in. Offer her a tissue and/or a moment alone with her husband before jumping in to treatment.

    Thank your friend for seeking out this info. It’s important for doctors to continue to grow as they serve their patients.

  6. My miscarriages were both early. To be honest, I don’t remember exactly what was said to me. I know my doctor was very compassionate and held my hand when she told me how sorry she was. When looking at the u/s, I think she told me first that there was no heartbeat and then pointed out what she did see – gestational sac, fetal pole – and said at this point you would expect to see a heartbeat.

    I do remember after my second miscarriage, seeing ‘habitual aborter’ as my diagnosis on my billing sheet. That was devastating.

  7. I’m here from LFCA, too.

    My sister recently went through a miscarriage (her third), and her midwife was very cold and lacking compassion when she informed her of it (Literally just a “There’s no heartbeat, your baby is dead.”). In my personal opinion, most people think of their pregnancies as babies, even if they’re called “embryos” or “fetuses” medically. Therefore, a simple, compassionate, “I’m so sorry, but we can’t find your baby’s heartbeat. You seem to have had a miscarriage” would be appropriate. Then, when trying to get to the bottom of the “why,” they can use whatever medical term is appropriate to talk about it in general, while still referring to THIS patient’s loss as her baby. I think it’s important, too, to sit with the patient and explain, to the best of your ability, what is going on.

    I was telling my best friend about my dislike of how the situation was handled and she made a VERY good point. She said, “Even if, as a midwife or doctor, you’ve told a million women they’ve miscarried, you haven’t told THIS woman a million times, so some compassion and sympathy is required!”

    Thanks for drawing some attention to this!

  8. sigh. I’ve been there too many times.

    I agree with the previous commenter that to me, the words aren’t nearly as important as the compassion (although an “I’m sorry” speaks volumes.)

    I will never ever forget my RE – when my ectopic pregnancy was discovered by ultrasound, he held my hand and actually cried with us. I was so touched by that.

  9. far away

    As someone who went through this over the last 2 weeks, I can say that I experienced both very BAD attitudes and very compassionate and kind attitudes.

    Unfortunately the first reaction I got was the head ER nurse yelling across three people at me that I should know what was going on (I didn’t know at the time that I had been pregnant). Tip: don’t do that.

    Then I had several other doctors and nurses aghast that I did not know. Another tip: don’t belittle the person who’s already in the midst of a huge emotional pit of despair when she realizes that she just had a miscarriage and projects backwards of all the things she could have done differently and was it her fault and how could she have been so oblivious (etc., etc.).

    Then there were the sonogram techs that talked to each other and my uterus as if I was not in the room. Tip: the patient is a person, scared, and just wants to know what is going on.

    Then there was the matter-of-fact: there’s nothing left, you probably had a spontaneous abortion. Tip: even if the woman did not know she was pregnant, don’t assume she doesn’t care.

    But then there was the nurse who sat down, showed me the pictures of her daughter that she had after two miscarriages and explained that many first pregnancies end up that way and I definitely wasn’t the first woman to not know she was pregnant and have a miscarriage. Tip: while the showing of pictures was not helpful (I was alone in an ER in a strange city and didn’t particularly want to break down until I got home to see my husband), the kindness and speaking to me as if I was a human being was all one could have asked.

    In short, I don’t think there is any easy way to tell someone, but there is definitely a way to NOT tell someone. Also, it is different I think when you were where I was (turns out about 6 weeks along and unaware due to a phantom period), versus knowing and connecting with the idea. All I really needed was someone to explain what was going on and how it could happen the way it did and acknowledge that I might be feeling a loss (and regret, and guilt) even if I did not know before.

    Treating a patient like you would want to be treated is all we can ask as patients and women.

  10. Erin Q.

    I had a miscarriage after a year of taking Clomid prescribed by my OBGYN. At the time our insurance wouldn’t cover us under “Infertility”, but if my OB prescribed it for irregular periods, it was covered. Anyway, I went in for lab work at around 5 weeks and they found that my progesterone was low, but they felt it might be ok…(MIGHT?!!). I read all about it on the internet and most medical personal agreed that extra progesterone wouldn’t hurt you, but could for sure help you keep a pregnancy going until the placenta kicked in around 10-12 weeks. They still refused because their protocol was only to give progesterone to a woman with past miscarriages. :o( I had a little spotting around 8 weeks so I went in for more lab draws. I was called a day later to come into the office and my OB proceeded to tell me all of my hormone levels were dropping and I was about to miscarry. Her response to me during my crying was “This happens all the time and the good news is that now you have a history of miscarriage and next time we can give you the Progesterone!!” and she said it with the biggest smile, as if I should be thankful I just lost my sweet angel! She never once said she was sorry for me.

    The one good thing is did take from this is ALWAYS being able to put myself in someone else’s shoes now. I worked in a Trauma ICU at the time and was very used to my patients dying…and at times I’d grown cold to it. So this experience taught me that even though I’ve seen the same sad story a bunch of times it the ONLY story that should matter to me at that moment. Those family members are losing that loved one for the 1st time and it hurts them so badly and the last thing they care about is that “it happens all the time”. I will never forget the way I was treated with my miscarriage and for THAT I am thankful. It has changed me for the better.

    SO – my advice for someone giving this kind of news to someone else would be to just be honest, but spare the statistics until asked for them. Give the patient some time to comprehend what just happened and just grieve with them for a moment. You don’t need to shed tears or anything like that, but a few moments of silence, a soft rub on the shoulder or just an “I’m so sorry” would be perfect. There’s nothing that you can say at that time to make her feel better, so just being human is all you can do.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: