Breaking the worst news: How to talk to your patients about miscarriage
Guest Post by Heather Rupe, DO, OB/GYN
It always seems to happen to nicest couples. They come in holding hands, beaming with excitement over the much desired pregnancy in her womb. She’s done everything right. She’s researched the perfect vitamins and followed all the ‘rules.’ They are there for a routine visit, no bleeding, no pain, no idea anything is wrong. When I look at the ultrasound screen, my stomach drops and I realize that in a matter of seconds I’m going to break their hearts. There is no heartbeat.
While miscarriage is an all too common problem we see in our offices, we must remember the emotional toll it takes on our patients. How we deliver the news can either bring the patients comfort or make an awful situation even more difficult.
Acknowledge the loss
When I am diagnosing a miscarriage, I look the patient in the eye and say as gently as I can “I am so very sorry, but your baby does not have a heart beat.” I avoid the medical terms of fetus and embryo at this stage, because to this family this isn’t an “embryo,” this is their child. Often the patient is still undressed, so after breaking the news, I find it helpful to give the patient a few minutes to process and get dressed. Then I come back in to give a more detailed explanation. I hate giving bad news when women are undressed and in a vulnerable position, but if I am doing a transvaginal ultrasound, I think it is important for them to be able to see the baby’s heart is not beating.
Often a miscarriage is the first big loss of a woman’s life. She may not have had enough life experience to experience death on any other level. The lack of heartbeat can be devastating. While to us providers, miscarriages are sadly all too common, we must remember not minimize the loss, but to reassure our patients that that it ok to hurt and mourn.
Don’t overload her with information
As doctors we are “fixers.” We want to help people and make women feel better. But while the shock of their loss is sinking in and the tears are flowing is not the time to discuss detailed statistics and extensive medical testing options.
I do explain the options for treatment. I give my patient the choice of waiting for the tissue to pass naturally, taking medication, or performing a D&C. I have handouts for each of these, because they often do not remember details of the visit and that is understandable. I encourage patients to go home and process the information and call back and let me know how they want to proceed.
Reassure your patient that she’s not at fault
While I don’t overload the patient with statistics, I do try my best to reassure her that the loss was not her fault. When any tragedy occurs we all want a find a reason—something we can change or fix to have a better result next time. Our patients overanalyze everything they ate, drank, or lifted for the weeks leading up to the loss, desperately trying to find out the ‘why.’ I explain that most losses are caused by chromosomal issues and not due to external factors. If this is her first loss, I can reassure her that her risk of another loss is not significantly increased. If she has had multiple losses or has risk factors that could have contributed to the loss (smoking or poorly controlled diabetes), I encourage her that we can work on maximizing her health, should she choose to try again.
Take your time
When our patients are experiencing loss, that is when they need us most. The other patients can wait. I find that some patients may want to escape the office as soon as possible, but others just need someone to listen, understand their loss, and provide comfort. If you feel tears welling up, let them fall. So few people are intimately involved in pregnancy loss, so when the patients see your heartbreak, it helps them to see someone else cares about their loss.
If they are blessed with another pregnancy realize that they are likely going to be more anxious. Give them some grace if they call a few more times than normal. I usually offer to see them more frequently in the first trimester if they want. Some patients find this reassuring, others find it more nerve wracking.
For patients who have experienced second trimester losses, I try to send them a card on their baby’s due date to let them know I’m thinking about them. This is an extremely difficult date for them and having someone else remember and acknowledge their loss can be comforting.
Miscarriage is common, but that doesn’t make it any easier on the patient or us. Acknowledge their pain and encourage them to grieve. Reassure them that they are not at fault. We can’t ‘fix’ their miscarriage, but at the time of pregnancy loss, our patients need our compassion more than our medicine.
Guest Author Bio:
Heather Rupe, DO, is a mom, wife, runner, writer and board-certified OB/GYN in private practice in Franklin, TN. She is the co-author of The Pregnancy Companion: A Faith-Filled Guide for Your Journey to Motherhood and The Baby Companion: A Faith-Filled Guide for Your Journey through Baby’s First Year. She writes for WedMD Women’s Health Blog. You can connect with her on twitter @drheatherrupe.
You can grieve with hope after miscarriage:
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