The Emergency Nurse Guide to Dealing with Early Pregnancy Loss

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Specializes in Cath Lab, OR, CPHN/SN, ER.

This is by no means anything scientific. This contains my own thoughts and what I believe to be best practice in being a patient advocate for women in the ER setting who are facing early pregnancy loss. My thoughts are based on my own experience as an ER nurse, a mother, and someone who has infertility and has had a miscarriage.

1. This baby is very real to the mother.

We may not know the full background behind the pregnancy. This mother might have had fertility problems, and this baby could have been conceived through advanced treatments such as IVF. IVF is a very expensive, time and emotionally consuming process. The mother may have already has several pregnancy losses prior to this one.

The mother may already have dreams for this child, a name, clothes, and room decorated. Regardless of the gestational age, the pregnancy and baby are very real to mother.

2. Keep your mouth closed and watch what you do say.

Do not offer much advice, especially if you have never been there before yourself. Remember the last sentence of #1. Regardless of the proper medical terminology, it is very offensive to the mother if you call it "products of conception". This is her baby, not a ball of tissue.

DO NOT offer advice like: It's ok, you can have another. It was really early, so it wasn't a real baby yet. There must have been something wrong and this is God's way of dealing with it.

That advice is a slap in the face to mothers facing infertility and miscarriage, and yes, people are stupid enough to say that stuff (having been told it myself and seeing others offer the same advice).

3. Keep nursing assignments in mind.

I got into a fight with my team leader when I was about 7 months pregnant with my child. I was assigned to several rooms that had pelvic beds, as was another nurse. I had one empty bed, he had three. My last bed was going to be filled with a woman who was probably having a miscarriage. I asked if that patient could be placed in another room or given another nurse. It happened, but not without fighting on my end.

It is a slap in the face of the woman having a miscarriage to have an obviously pregnant nurse. While this woman faces her own demons (self- blame, denial, anger), a huge pregnant belly is in there taking care of her.

I understand there might not be a choice in the matter and the pregnant nurse might have to take care of the miscarriage patient, and that's ok. If given the option, keep this is mind though.

4. Keep her pain under control.

I've had to fight with doctors over this, who wanted to give a mere 800mg ibuprofen for pain. The further along the pregnancy is, the more likely the pain will be increased (more tissue to expel=more intense cramping). That cramping is like contractions. Mentally and physically this is painful.

Give her time to grieve. Provide information on pregnancy loss, and if not available, try to make packets with information about local pregnancy loss support groups. The pain does not end once the miscarriage is over- the pain is relived with the due date and the anniversary of the miscarriage. I can still tell you the day I was due, the day I found out I was pregnant, and the day I began to miscarry. I can tell you where I was at, what I had eaten and where I was going- the pain is real.

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This was wonderful and thoughtful advice. I have three grown kids, but I remember the terrible anguish I felt when I had a miscarriage. I was four monthes along. I cried, all the time. In the grocery store, when people came to visit. I took months to get my life back. Two years later I had my first baby girl.

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Specializes in Critical Care.

This past January I had a miscarriage. The baby stopped developing at 7 weeks, but I was 13 weeks along. To some, the baby wasn't real, to me it was so very real.

Thank you for posting this.

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Maybe it's not scientific; but it sounds like very good advice to me. Years ago my wife suffered 2 miscarriages, both in the first trimester. Although I didn't make some of the worst blunders ("God's way of dealing with it") I still feel I could have done better. Since I didn't know what to say; I said very little. In hindsight, I was wrong.

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Specializes in Cath Lab, OR, CPHN/SN, ER.
Maybe it's not scientific; but it sounds like very good advice to me. Years ago my wife suffered 2 miscarriages, both in the first trimester. Although I didn't make some of the worst blunders ("God's way of dealing with it") I still feel I could have done better. Since I didn't know what to say; I said very little. In hindsight, I was wrong.

I think it's a guy thing. :lol2: My husband didn't understand. Sure, he grieved the loss and provided support when I cried and mourned after the loss.

But a year later, we were at the same mall I was at when I noticed the cramping the day the bleeding started. I was in the turn lane to leave and I started crying. He had no clue what was wrong, and no clue what to do. It was a normal day, and it was an awful anniversary for me.

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Specializes in Pediatrics.

Thank you so much for posting this. I am a nurse myself and have been through 2 very tough pregnancy losses (and thankfully now have a beautiful baby boy). I have heard every wrong hurtful phrase in the book from nurses who took care of me to other nurses I work with. I've done my best to bite my tongue and chalk it up to their ignorance.

I've had friends go through similar experiences. During and after their losses I tell them I am very sorry for their loss and then I listen. I offer my hand to hold and my shoulder to cry on. I will also tell them as they are a few weeks out that the worst has happened and now healing can begin. Miscarriage/infant-fetal loss is a terribly sad traumatic event. I mostly needed compassion and a listener as I began to work through the pain and loss of my babies.

I hope that many will read your post and pass along the information. As nurses we are so important in our patients lives, by offering our compassion and listening we can do so much. (in all situations)

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Specializes in Cath Lab, OR, CPHN/SN, ER.
Thank you so much for posting this. I am a nurse myself and have been through 2 very tough pregnancy losses (and thankfully now have a beautiful baby boy). I have heard every wrong hurtful phrase in the book from nurses who took care of me to other nurses I work with. I've done my best to bite my tongue and chalk it up to their ignorance.

I've had friends go through similar experiences. During and after their losses I tell them I am very sorry for their loss and then I listen. I offer my hand to hold and my shoulder to cry on. I will also tell them as they are a few weeks out that the worst has happened and now healing can begin. Miscarriage/infant-fetal loss is a terribly sad traumatic event. I mostly needed compassion and a listener as I began to work through the pain and loss of my babies.

I hope that many will read your post and pass along the information. As nurses we are so important in our patients lives, by offering our compassion and listening we can do so much. (in all situations)

You're welcome. I hate that we all have so many angels. :redbeathe I think it's important (on a personal level, not as a patient) to keep in touch with friends who might have a loss. As with any death, there is an inital outpouring of support, but as time passes they might feel forgotten. Remember the anniversary- a call or a card means the world, that someone else remembers your baby.

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....As with any death, there is an inital outpouring of support, but as time passes they might feel forgotten. Remember the anniversary- a call or a card means the world, that someone else remembers your baby.

And that was where I made my mistake. The DW was in the first trimester; wasn't showing yet; and not everyone knew she was pregnant. It didn't quite seem like the loss of a baby to me; but it was too her. To her it didn't matter if she was in first trimester or third. I didn't tell the extended family or suggest cards of condolence. My mom wasn't sure of the proper course of action either; and so a big deal wasn't made of it. In the case of my wife (and I suspect many others in her situation) this was wrong. I was reminded just a few months ago of how much this inaction nearly 25 yrs. ago bothered my wife. I don't remember how the topic came up, but the DW commented, "your mother didn't send a card or anything.... it was like it didn't ever happen."

Inaction was the wrong action; I hope others can learn from my mistake. :heartbeat

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Specializes in OB, OR.

What a well written post.

As a woman who suffered extreme infertility, and the loss of a twin in a very hard fought, emotionally and financially draining conception, this advice is spot on.

Platitudes and cliches don't help. The only appropriate thing to say is a sincere, "I am so very sorry for your loss."

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Specializes in ED, Flight.

Thanks for posting this.

Our youngest recently lost her first pregnancy at 18 weeks. To my mind, she clearly could have gotten more understanding and support from the medical folks than she did. The aftermath has been very hard for her, and so for us.

I pray that I've learned something from her experience, and treat my patients a bit better.

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Specializes in NICU.

Thanks for this :heartbeat. I've lost babies and support can be hard to find. I think people aren't always sure what to say--especially if it is 1st trimester and Mom isn't showing yet.

My mom was wonderful, she got me through mine. DH, not his best shining moment, although I believe he truly didn't understand the depth of pain I was in.

I'm glad you brought up pain control. One of mine was more painful than the labor was for the baby I got pregnant with the next time. Nobody offered my anything and that was poor care on their part. I didn't know to ask.

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God bless you for putting this out in the open. I was actually taught when I starting ER nursing to tell the Mom that this was God's way of dealing with a baby that had a defect and was actually preventing suffering. I never could say that to someone, however. Some docs are pretty cold about this too.

I lost a baby girl, Anna, at 26 weeks, and it was literally the most devastating event in my life. It was even harder than losing my Mom, who had been my best friend. She was perfect, except a virus I contracted during pregnancy made her go into heart failure and die. I was so thankful to be surrounded by caring medical personnel, from the ultrasound tech who first saw she was gone, the MD, and the nurses in the peripartum unit. These nurses hugged me as soon as I came up to the floor. They cried with me, they let me hold the baby, they arranged (on a weekend) to have a chaplain come in to bless her, and they were INSISTENT to the MD that my pain from the Cytotec/contractions get controlled. I cannot imagine how much harder it would have been if they had not been so good.

Thank you again for bringing this up. It may help some patients in the future.

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