(This article discusses miscarriage and may not be appropriate for some readers because of the sensitive content. If you are struggling with a pregnancy loss, this article may be difficult to read.)
“You can always try again.”
“It’s good you weren’t very far along.”
“At least you can get pregnant.”
These were the statements I heard from my nurse coworkers when I experienced my miscarriage. While meant to be comforting, they only added to the pain and isolation I was feeling by inferring that my loss was not a big deal, that I should be grateful instead of grieving, that I should look forward and move on. But I will always remember one particular nurse who said something different. She looked me in the eyes, started to cry, and said she was so sorry for my loss. She shared that she had had a miscarriage a long time ago and it was so difficult.
Medical professionals are among the first, and sometimes only, people to know about a woman’s miscarriage. They are often the ones who have to break the news to her. They are the ones she looks to for information, explanation, and guidance for treatment. Yet there are too many stories of medical staff who are unprepared, uncomfortable, and abrupt in their encounters with women who have miscarried. For as frequently as it occurs (estimated 1 in 4 pregnancies), miscarriage continues to be a topic treated with uncertainty, awkwardness, and a lack of empathy. However, when doctors and nurses go against this tendency and instead give compassionate, holistic care and support to a woman suffering a miscarriage, it can make all the difference in her ability to heal both physically and emotionally.
Here are five ways the medical community can better support women during their experiences of miscarriage:
1. Acknowledge her loss
It may seem small and hidden to those who have never experienced miscarriage, but to the woman who just lost her unique and unrepeatable child, it is a deep and painful loss—sometimes all the more painful because it was so hidden and unknown to others. Simply having all the staff she encounters say a heartfelt, “I’m sorry for your loss,” can be balm for her soul.
Encouraging medical staff to use thoughtful, compassionate terminology is also helpful for patients who have miscarried. Terms such as “spontaneous abortion” or “products of conception” do not convey an empathetic sensitivity to her loss of a child.
2. Give clear, accurate, and thorough medical information on what to expect during and after a miscarriage
Many women are blindsided by the amount of physical pain and bleeding if they decide to miscarry at home. Many women also want to know if it’s likely for her to pass and see the tiny body of her child. By educating based on gestational age, staff can help her be more prepared for what might occur, as well as when to seek emergency care. If a woman chooses or needs a dilation and curettage (D&C) procedure, she will need all the information of what to expect from the procedure.
Providers also need to be prepared to give compassionate, evidence-based answers to questions such as:
- What will D&C recovery be like?
- Will she need her spouse or a support person with her immediately after the procedure and for the rest of the day?
- Will she need to arrange childcare for any other children?
- Given that many women find closure and comfort if they are able to bury the remains of their miscarried child, will this be possible after a D&C?
- Does the local hospital or funeral home provide any services for miscarriage? (One woman I know said her hospital owns a small plot at the local cemetery, and offered to bury the remains of her miscarried child after her D&C. She found this incredibly comforting.)
3. Consider offering further testing after a miscarriage
Most physicians wait until a woman experiences a miscarriage three times before pursuing further testing. Although many miscarriages are due to genetic factors that are untreatable, there are many other preventable reasons for miscarriage, such as low progesterone levels. A woman should not have to endure the trauma and grief of three miscarriages before being evaluated for possible treatable conditions.
Treating each patient individually and evaluating any risk factors she might have empowers her with information and the possibility of preventing more loss and grief. If a physician is uncomfortable pursuing further evaluation after a first miscarriage, a referral can be made to a physician trained in NaPro Technology or Restorative Reproductive Medicine, specialists who often treat factors of miscarriage such as low progesterone or the MTHFR gene.
4. Offer extensive resources and referrals to help her grieve and remember her child
Because shock and denial is often the first stage of grief, many women will struggle to process and retain any information given during a medical appointment for a miscarriage. Having printed information to take home will enable her to review it at a later time and with any support people in her life.
A resource sheet for patients can be compiled and included in a care package (such as one from Missing Grace Foundation, an organization that provides miscarriage care baskets for purchase by hospitals or medical facilities). Sufficient Grace Ministries not only provides a similar care package for medical professionals to purchase but also provides training for staff (virtual or in person) on how to better support patients through miscarriage and infant loss. If a facility is unable to offer care packages for patients, many of these organizations offer them to patients at low or no cost. Elizabeth Ministry International and Heaven’s Gain offer burial vessels for miscarriage or stillbirth. Trappist Caskets offers handmade caskets at no cost to families who have lost a child. There are many companies that offer tokens of remembrance. Held Your Whole Life offers remembrance jewelry at no cost beyond shipping costs to families who have lost a child. It is also important that healthcare professionals be familiar with any local resources, including state laws on burial, funeral home services, and counseling or support groups.
5. Follow up with patients in the coming weeks, either by phone or by a scheduled visit
Women who experience miscarriage are at increased risk for developing depression and anxiety, and even post-traumatic stress disorder (PTSD). Clinical depression, or specifically postpartum depression (PPD), can occur due to both grief and hormone fluctuations, compounded by the feelings of isolation and misunderstanding that surround miscarriage in our culture. Medical professionals should educate patients on the five stages of grief as well as signs to watch for if grief may be turning into clinical depression or PPD. Written referrals for counseling and information about local or online miscarriage support groups (such as this online one or this Zoom-based one) can be provided with encouragement to use these resources early in the grieving process, rather than as a last resort.
While each woman’s experience of pregnancy loss and the accompanying grief will be unique, the medical community can offer support and comfort after a miscarriage by being sensitive to the universal stages of grief, being informed about local laws and resources, and offering simple yet heartfelt condolences as well as tangible resources. These steps can go a long way in providing the holistic care each woman deserves and desires during this physically and emotionally vulnerable time. In a world that minimizes and misunderstands her loss, medical professionals can be part of her healing.