When a Mom Miscarries

[CountryMomma, ASN, RN]

Having overheard some really insensitive, stupid remarks about miscarriages lately, I would like to share something with all of my Facebook friends. Especially my friends who are medical professionals.

In between Jaylen and Matthew, I had a miscarriage at 7 weeks 6 days. It started with spotting. It slowly progressed to a steady trickle of blood. I had no cramping, no pain, no symptoms of a miscarriage at all. The MD I saw first said there was nothing I could do to prevent a miscarriage if it was one, and to go home and wait. WAIT. I was bleeding away a baby that I had already met on an ultrasound screen, and it was like a ******* Zen lesson from the MD.

Lesson one: do not pat a mom (who is scared and unsure) on the hand and tell her to be patient. To wait at home. To wonder, each time she goes to the bathroom, if she's going to be pregnant tomorrow or if this is the last time she can dream that dream.

The other MD at the practice I was at took pity on my panic. She called me and said I could come in for an ultrasound to assess the situation and see if anything could be determined about my slow but steady bleeding. I made the hour drive to the clinic and waited in the lobby, surrounded by big, smiling mommies-to-be, feeling even more scared and even jealous, because there were ladies with big healthy pregnancies, and here I was, no one could even tell I had a baby I was losing.

Lesson two: if you have a miscarrying mom, please don't pop her into the lobby with all of your healthy, term mommies. Have an office or exam room ready. Offer staff or ask the mom to bring family/friends.

I eventually was called back for the ultrasound. The tech was very kind and did her job quickly and smoothly. When she identified the beating heart, she showed me the screen, counted the rate, and assured me that a good heartbeat like that was 95% positive for a healthy pregnancy. She quieted down and began frowning once she started measuring the rest of the baby's structures. The gestational sac was a week behind the rest of the measurements, but she wouldn't say anything else.

Lesson three: Please. Do not offer empty statements like "Oh a heartbeat's a good sign!" or "I think this baby looks great!" when the woman is being referred because of bleeding, cramping, or other early pregnancy loss risks.

I went home for the weekend, hopeful that the bleeding was a little hitch in the road and that it would resolve, just like the tech mentioned. Everyone is in such a hurry to reassure moms that bleeding in early pregnancy is often not a fatal issue. The MD glossed over the gestational sac issue and just said she couldn't predict the future, she wished us the best, and that I was to call if the bleeding changes or I develop cramping.

That Monday, I got up with Jaylen, bent over to get dressed, and felt a woosh.

I lost my baby.

I called the nurse in tears. She was so kind. So patient. She asked if I was able to bring any of the tissue I passed to the clinic, so they could do testing and try to help me figure out what had happened. I did. It was one of the most heartbreaking actions of my life.

I had to go back, give the nurse the rest of my lost baby, and have another ultrasound done to make sure I didn't have anything left, retained, that could kill me. I had the same ultrasound tech. She was very somber. I was very angry. I was hurt. I hadn't fully grasped the finality of this last ultrasound. Ultrasounds are supposed to be happy times when you are pregnant. They are supposed to be a time to meet the baby, see the wonder of life in your baby bump, build your dreams. They aren't, in any mommy's ideas, a time to confirm, without a doubt, that you aren't a mommy-to-be anymore. I couldn't believe I had just been here, less than a week ago, with that same stupid tech telling me I was a part of the 95% with a reassuring heartbeat. Now she was showing me my empty womb. I was the 5%. The anger and injustice I felt from that one ******* "statistic" did so much damage to my grieving.

Lesson four: When mommies have a couple different negative signs going on (in my case, bleeding, partially opened cervix, and small gestational sac) STOP SAYING STUPID PLATITUDES. Women are not skittish stupid animals that must be lied to. They need the truth. If there's a good chance she's going to lose her baby, tell her that. She'll find that sliver of hope, but she'll also begin the slow, painful process of thinking through the loss of her baby before she ever had the chance to hold it. Feel it. Name it.

The worst part of the miscarriage, for me, was that I felt no pain. I had no cramping. It was like I had just had a flushing handle installed in my uterus, and I went from pregnant to not pregnant with one flush of my womb. No pain, no symptoms. Like it meant nothing to my body. Staff kept offering me pain medications, like percocet and norcos, fretting that I didn't have to suffer for nothing. Their focus on treating my (nonexistent) pain made me feel even worse. Like something was completely wrong with me. Incompetent of carrying my own baby.

Lesson five: LISTEN. Listen to the mom. Listen to the friends and family of the mom. If she says she doesn't have pain, reassure her that this is not abnormal or a failure, tell her its okay to not have pain. If she's feeling ashamed or guilty, sit down and show her why it isn't her fault. Listen to her explain how she's a horrible person and then build her back up and validate her experiences. Miscarriages are still wrapped in shame and misinformation. Women aren't usually told the reasons behind their miscarriage, and they will find or make a reason. Because the mommies aren't able to hear the real, medical reason for their miscarriage, they will take the blame, make their actions the cause. There is no correction, and her family and friends won't know either, which leads to a vicious cycle of blame, guilt, and shame.

I had a family that took care of me. Even though they couldn't see the baby I had lost, they couldn't see the emotional pain I was in, they stayed with me, cried with me, and loved me. Many women aren't that lucky.

Short list: Don't assume. Don't lie. Don't say stupid zen things to make yourself feel better at the mom's expense. Don't be afraid to cry. Listen. Educate. And always be aware, and be available.

I hope this can help others. Please be aware.

[SionainnRN]

I'm very sorry for your loss. I can't imagine how hard that was for you. However, it sounds like you were given great medical care and everything possible was done. I think it's such an emotional time, that no matter what was said or done, you would have been unhappy with your care.

Every patient is different, just as every spontaneous abortion is different. There is honestly no way to please every patient every time. What one may find comforting, another may find insulting. I think the staff was just doing their best.

I hope you're doing well.

[Here.I.Stand, BSN, RN]

Hugs mama...I'm so very sorry for your loss.

[CountryMomma, ASN, RN]

SionainnRN, there is no reason an ultrasound tech should be spouting off comments about how awesome your pregnancy is going. Especially since the pregnancy was being evaluated for a threatened abortion. That's not top notch care. That's careless.

I feel like you didn't actually read this. It wasn't just me. I wrote from my perspective, but I have amassed the knowledge, feelings, and regrets of all the women I talked with when I spoke with others about our miscarriages. Sitting next to term moms while you are actively losing your baby, being told to be patient as you bleed away hope with no explanation, that's not top notch care. That's careless.

I hope you never experience that special kind of hell. But honestly, with your reaction, it exemplifies perfectly the trouble in our healthcare. "Don't complain, you got perfect medical care!" Medical care is not a one-size-fits-all. Women facing the death of their embryo/fetus/baby, they need to be approached differently than the woman coming in for a healthy checkup, that isn't rocket science.

Why would you honestly say that it is the mother's fault for being emotional and not at all a problem with the care? Isn't emotional support supposed to be PART of the medical care?

I remember last time you commented on an "article" I wrote, arguing that it was my mother's fault she was being beaten by her husband and that abused women are to blame for staying. I feel sorry that your empathy seems to be limited.

Tschus.

ETA: I didn't write this seeking pats on the head or there-there's. I've had time to take the ache away. I really wanted to help reduce the pain and anger of women to come.

[FutureRN101]

SionainnRN, there is no reason an ultrasound tech should be spouting off comments about how awesome your pregnancy is going. Especially since the pregnancy was being evaluated for a threatened abortion. That's not top notch care. That's careless.

I totally agree. I remember getting an ultrasound during my miscarriage (mine was a missed miscarriage, so we went in at 14 weeks and there was no heartbeat on the Doppler so they sent me for an ultrasound) and as the wand went over my belly and I saw no flutter and the tech measured my baby and it was only 7wk 5 days (i was 14 weeks) and tears just streamed down my face silently the tech just sweetly asked if I was ok. I know my situation is a bit different because it was obvious there was no heartbeat and growth was far behind so I already knew but I think it would be inappropriate and out of scope of practice for an ultrasound tech to try and tell a mom that things are looking good and 95% and blah blah blah. The dr is the one that interprets the ultrasound, the tech should say nothing about it.

[klone, MSN, RN]

I work in OB/Gyn. I see women primarily at the beginning of their pregnancies, so a lot of the women I see do go on to have miscarriages. And I believe in giving women facts. When they have first trimester bleeding, or other questions or concerns about viability, I give them the facts. And the facts are, 25% of all pregnancies end in miscarriage. And if you have first trimester bleeding, then you have a 50% chance of having a miscarriage. And once cardiac activity is seen or heard, your chance of miscarriage is reduced to

I'm sorry you lost your pregnancy. I've had a miscarriage too, and it can be pretty devastating.

[SionainnRN]

SionainnRN, there is no reason an ultrasound tech should be spouting off comments about how awesome your pregnancy is going. Especially since the pregnancy was being evaluated for a threatened abortion. That's not top notch care. That's careless.

I feel like you didn't actually read this. It wasn't just me. I wrote from my perspective, but I have amassed the knowledge, feelings, and regrets of all the women I talked with when I spoke with others about our miscarriages. Sitting next to term moms while you are actively losing your baby, being told to be patient as you bleed away hope with no explanation, that's not top notch care. That's careless.

I hope you never experience that special kind of hell. But honestly, with your reaction, it exemplifies perfectly the trouble in our healthcare. "Don't complain, you got perfect medical care!" Medical care is not a one-size-fits-all. Women facing the death of their embryo/fetus/baby, they need to be approached differently than the woman coming in for a healthy checkup, that isn't rocket science.

Why would you honestly say that it is the mother's fault for being emotional and not at all a problem with the care? Isn't emotional support supposed to be PART of the medical care?

I remember last time you commented on an "article" I wrote, arguing that it was my mother's fault she was being beaten by her husband and that abused women are to blame for staying. I feel sorry that your empathy seems to be limited.

Tschus.

ETA: I didn't write this seeking pats on the head or there-there's. I've had time to take the ache away. I really wanted to help reduce the pain and anger of women to come.

Wow, really? So you see me saying that I'm sorry you went through this and I'm sure people were doing the best they could, as an attack? I'm sorry you can't seem to understand that people have different emotional needs when going through the same situation. While you obviously wanted the ultrasound tech to focus on you having a 5% chance of miscarrying, others would have been comforted by hearing the 95%.

I never said not to complain or that you received top notch care. Only that they were probably doing the best they could and it's impossible to please everyone all the time.

As to me supposedly saying women deserve to get beat, that is blatently untrue. You obviously can't see my input for what it was and are just projecting maybe you need to work on your empathy and reading skills.

[tnbutterfly - Mary, BSN]

Thank you for what I am sure was a nightmare and a tragic loss for you.

I hope others will read and learn from your heartfelt suggestions.

[RunBabyRN]

I'm so sorry for your loss. Thank you for sharing your experience with us. Miscarriage is difficult, no matter the situation. Even when it's a relief, as mine was at about 6 weeks along, there is still sadness and a sense of loss, and I think a lot of people don't know how to talk to someone going through that. I am a new nurse, but I've had a couple of patients experiencing miscarriage, and I think the #1 takeaway from what you said is listening to the patient, and validating what they are going through. I would agree with you that any false reassurances should be avoided (they should be avoided in ANY situation, really).

I agree with the statements others have made that the healthcare workers probably did they best they could, which isn't an excuse, but rather, a lack of training on how to handle such a delicate time for a family. Some people are naturally better at speaking with people in this situation than others. When I had a miscarrying patient in the ER during my clinicals there, I could tell the nurses were very uncomfortable and weren't sure how to "handle" her. I think this is a common problem, where speaking about any kind of death is taboo. We have such a general fear of death of any kind, and the loss of a child, born or unborn, is beyond what most people can handle emotionally.

We do have to take different approaches with different patients, but honesty over false reassurances is very important, regardless. Part of this honesty, and again, lack of education, is reassuring the mom that it's very unlikely related to anything SHE has done. Guilt is a common emotion (especially among moms in our society), and validating that is important, but being honest with her without the crass, "Well, that just means it wasn't the right time/baby/genetic makeup" should be a part of the conversation. Moms likely won't hear it initially, I would guess, but hopefully with time it'll sink in some.

I wish there was a better alternative to having a mom experiencing what you experienced in a room with other moms with healthy pregnancies abound. I agree with you that advising the r/o M/C mom to bring at least one support person is good advice.

Thank you for sharing your experience. As a new nurse going into OB and eventually midwifery, hearing these experiences is good, as they offer a lot of learning opportunities. I wish you well.

[BSNbeauty, BSN, RN]

Sorry for your loss. Perhaps you can offer these suggestions to that OB office so that another women will not experience the same thing.

I do believe they did there best but when you are in that situation everything is so palpable and can easily outrage you.

Turn your anger into something positive.

[CountryMomma, ASN, RN]

RunBabyRun, thank you! I hadn't made the connection to the struggles we face with so many death and dying situations, but it really does have the same awkward, fumbling feel as those when people get terminal diagnoses or mortal trauma. That gives me something to think about.

[CountryMomma, ASN, RN]

prnqday, thank you. I actually have channeled my feelings into positive outcomes, including talking with other moms about miscarriages, being open and honest about my own experiences, and writing this "article". I did mention my experiences to my MD after the miscarriage was complete, and she was unhappy with her team. I was sent a note a month after my last appointment that let me know she was involving grief counseling, empathy training (whatever that is :) ), and emotional healthcare training. I had another child through her service and they were very kind and understanding of my fear and apprehension all up to the birth. Once one loses a previously viable pregnancy for unknown reasons, following pregnancies can be nerve-wracking and they were sensitive to that.