What you can do to help your patients–and yourself–deal with the trauma of pregnancy loss

Losing a pregnancy is devastating to the patient and her family—and often traumatizing for the attending physician and the healthcare team. Yet many doctors don’t know how to react and cope when a patient's pregnancy ends in a miscarriage or stillbirth, Dr. Sarah Gower, a family doctor in Elora, Ont., said during a presentation on pregnancy loss at the recent 2022 Family Medicine Forum, hosted in Toronto by the College of Family Physicians of Canada. This inability to respond appropriately can lead to patients feeling their doctor provided poor care at a time when they needed the greatest support. “I’ve heard stories from my own patients who thought they weren’t treated adequately or in some cases who felt they had even received substandard care,” Dr. Gower told the Medical Post. “But I don’t think their doctors were necessarily uncaring—they just didn’t know how to react and were likely also struggling with their own feelings.” In many cases, doctors don’t even realize they’ve been through a trauma themselves, even though the circumstances surrounding pregnancy loss often bear the hallmarks of a traumatic medical event. Read: Anorexia nervosa and pregnancy a bad combo: more screening needed “They’re often unexpected, they involve younger patients and there’s often disturbing imagery, with lots of blood and, in cases where the baby has been dead for days, when you pull it out it’s limp and grey,” said Dr. Gower. “And there’s usually very intense patient and family reactions.” It also doesn’t help that doctors have largely been trained to conceal their emotions, even in the face of death, she added. This deeply ingrained teaching often gets passed on to residents and other young doctors who tend to model the behaviours of their preceptors and of senior physicians. Start with empathy Physicians dealing with pregnancy loss can help themselves and their patients by allowing their emotions to come through in a way that’s empathetic and focused on supporting the patient and her family, said Dr. Gower. “Don’t be afraid of tears—I cry for patients all the time,” she said. But, she added, “you have to watch that the crying you’re doing is not about yourself, and you don’t want to be crying to the point that now you have someone worrying about having to comfort you.” Read: Most at-risk women for preeclampsia not given recommended prevention Humanize and normalize If the baby has been given a name, use it. Add it clearly to all records and include the due date where appropriate. In addition to speaking with the parents, talk to the patient’s other children and to grandparents, said Dr. Gowan. “And never be afraid to bring up your patient’s pregnancy loss with them during future appointments,” she said. “Keep asking them how things are going with them. Consider giving yourself reminders to call them on their baby’s death anniversary. You may be the only person, aside from them, who remembers it and acknowledges it.” Dr. Gower recalled how one patient who had lost her baby a decade ago told her she was the only who talks about the loss. “So I said ‘should I stop asking?’ and she said no, it’s comforting to her to talk about her baby and she appreciates that I always ask.” Read: Research links COVID-19 in pregnancy with stillbirths Be alert to signs of enduring post-traumatic stress behaviours An audience member at Dr. Gower’s presentation cited the case of a patient who created a doll that looked like the baby she had lost and started to cradle it. While this may seem strange—and possibly psychologically unhealthy—to some, studies suggest carrying a weighted doll or stuffed toy may comfort grieving mothers and help them cope with their pregnancy loss, said Dr. Gower. In the hospital where she works, a weighted stuffed bear is part of the kit that’s given to patients who have lost a pregnancy. For doctors worried that their patients may be suffering from post traumatic stress disorder, she suggested following up with an assessment that includes questions such as: What’s happening to you when you get up the morning? What thoughts and emotions do you experience as you go through your day? How do you react when you see a baby in someone else’s arms? “In all trauma-informed care, the clues come from how a patient is functioning after the event,” explained Dr. Gower. “Because the trauma isn’t what happened, but the impact of what happened. So what you’re looking for are signs of that impact.” Read: High rates of trauma in Canada among forceps and vacuum deliveries: study Don’t forget your learners The trauma from pregnancy loss is often shared by other members of the healthcare team, said Dr. Gower. Yet she’s heard of situations where the doctor in charge left a student to deliver a stillbirth in order to attend to a live baby. “I understand that a doctor may be feeling terrible in that moment and thinking ‘on top of all this, I have to teach this student too?’” But in addition to recognizing that how they deal with such events may shape a student’s way of dealing with similar events in the future, doctors need to be there to support their team, said Dr. Gower. “Sit down with them, even for just a couple of minutes to check in on how they’re feeling,” she said. “If you already know that there’s going to be a pregnancy loss, then prepare your students so they know what to expect. Let them know there may be hemorrhaging and that they may need to use forceps because there won’t be any (muscle) tone to help during the extraction.” Read: Infertility treatment linked with slightly higher risk of pregnancy complications

What you can do to help your patients–and yourself–deal with the trauma of pregnancy loss

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