Working through Prenatal Loss Nurses Can Help Patients Recognize Loss, Grief

t’s been 10 months since my miscarriage, but just the

thought of it still makes my heart flutter. Although hearing

of a woman losing a baby is common-approximately 20

percent of all pregnancies end in miscarriage-the unique charac-

teristics of prenatal loss sometimes make it hard for nurses to

provide care and comfort for their patients.

Some women may feel a sense of relief, as though it wasn’t meant to be, but more often women are left with an overwhelming sense of grief for a child that they will never fully know. As time passes, you patiently wait for a sense of peace, well-being, and even an answer to the begging question: “Why”?

losing a Baby My experience was dramatic and tragic. I was only 12 weeks pregnant when I had to be rushed to the emergency room because of light spotting. I was forced to wait for approximate- ly two hours because I wasn’t “far enough” along to go to a labor and delivery unit. Looking back on that time, two memories come to mind: the feeling of watching all of the children in the room, including the newborns being brought in by worried parents; and a feeling of hopelessness, knowing that my bleed- ing was increasing and that I would inevitably lose this baby.

After being ushered to a room, I was left there for what seemed countless hours. The nurses breezed in and out, not offering any

Sherry L. Thomas, BSN, RN J

emotional support. I MS instead left with the feeling that they would rather have ushered me right out of there so that they could have the extra bed. My spouse wasn’t allowed to stay with me, but rather was allowed brief, short visits. Emergency room regulations stated that each patient could only have visitors for five to ten minutes at a time. This ohly added to his sense of impatience with the process and aban- donment for his own grief. How different it would have been had the nurses acknowledged his grief as well.

As nurses, we often forget what it’s like to be the patient. We should try to never to loose our objectivity, and focus. If you could put yourself in the patient’s shoes, you’d might be a little more giving of yourself.

Waiting, and Waiting After you receive a diagnosis of a “threatened miscarriage,” you’re sent home to wait on something, or nothing, to happen, for a period of a week on bed rest. Everyone tells you to be strong, remain optimistic; however, within your heart the truth lies. You are aware of the fact, somehow, that despite all the waiting, elevated feet, return doctor visits, and decreasing blood hormone levels, you won’t be able to continue 1 with the pregnancy. I

(continued on page 79.) 1 B c .- Sherry L. Thomas, BSN, RN, is a labor and

delivery nurse at Oakwood Hospital in Dearborn, MI. -

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80 L i f e l i n e s December 1997

(continued from page 80.)

In fact, it took just more than a week for the ultrasound result, decreased hormone levels, and con- stant bleeding to give the doctors enough evidence to tell me what I had already known-the baby was gone. Hearing the words brought a level of despair that neither me nor niy spouse were ready to handle. No amounts of “sorry” would suf- fice. It felt odd to agonize about an early pregnancy. Even though I had only known for a short time, I had quickly accepted the pregnancy and had began to feel a level of love for the life I carried inside of me. My grief continues to this day.

Once I lost the baby, the tragedy continued. A visit to the doctor was required to determine whether a D&C was necessary, and to provide for a general check-up. This seemed like necessary follow-up, b u t 1 was unprepared for the naive reception I received. After a long wait, 1 was escorted back to an examination room. Twenty minutes later, a nurs- ing assistant arrived with a “New Mom” gift basket. I had to explain the nature of my visit (which was given upon entering the office). She apologized and I regained my com- posure. After a lengthy wait, the doctor arrived and being new to the office, she began some general ques- tioning: my age, marital status, last

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Resourm for Dealing wzib Preg-nancy Lass “Losing During Pregnancy or in the Newborn Period“ by James R. Woods, MD, and Jennifer Esposito Woods, MBA. contains 20 chapters, each with clinical cases and suggested nursing implications surrounding prenatal loss. Published by Jannetti Publications, inc., Pitman, NJ.

Hygeia-An interactive journal for persons who have been affected by mis- carriage, ectopic pregnancies, stillbirths, or pregnancy terminations (httpi/www.connix.com/-hygeia/)

Support Infomation and Resources: http://wvmv.pinelandpress.com/sup- port/miscarriage.htmI; frequently asked questions: http://scalos.mc.duke.edu/-brookOO6/miscarriage.html International Council on Infertility Information: httpi/inciid.org

SHARE Pregnancy & Infant Loss Support, Inc.. St. Joseph Health Center, 300 First Capitol Drive, St. Charles, MO 63301-2893; (800) 821-6819.

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menstrual period. Then, with a gleaming smile, she informed me of my baby’s due date, and extended her congratulations. She, too, was mistaken. After redirecting her that I had just lost a baby, her apologies seemed to go on forever. To this day, this series of incidences reminds me of how great an impact niy seemingly harmless interactions with patients and others can have.

It’s a well-known fact that patients rely on nurses throughout any crisis. Nurses are the primary care givers and are with their patients for increased periods of time. Nurses need to focus on the

Miwrnhge in the News Do stress and long hours increase the risk of miscarriage?

Perhaps so, according to a study from the University of California at Davis Law School (Journal of Occupational and Environmental Medicine, June 1997). Researchers in the study looked at 584 women who graduated from the law school from 1969 to 1985. Of those women, those who worked more than 45 hours a week were three times more likely to have had a miscarriage in early pregnancy than those who worked less than 35 hours a week.

I Age (vrs) Risk f o r miscarriage (XI

Source: American Society for Reproductive Medicine I

December 1997

Does miscarriage lead to depression? It can. In a study from the New York State Psychiatric Institute, researchers discovered that 11 per- cent of women who had had miscar- riages had an episode of major depression within six months, twice the rate as that of a control group in the study. The risk of depression was also five times higher among childless women who miscarried compared with women who had already had chil- dren at the time of miscarriage.

ability they possess to make a sig- nificant impact on a client’s well- being. It should be part of our role as care givers to take advantage of caring opportunities as they present themselves. It’s not the quantity, but the quality of the time spent with each patient that really counts.

Looking Ahead To this day, I don’t deny that I’ve loved, and lost, a baby at 12 weeks of pregnancy. I am one among many women who have had the same misfortune. I recognize that everyone who loses a baby grieves for the loss of the unknown and feels sometimes at fault. Nurses should never classify a miscarriage as a common occurrence, o r down- grade it because a woman may be able to become pregnant again or has other children already. All too often health care providers f ai ‘ I to recognize that miscarriage is a loss. No matter how far along a woman is into the pregnancy, there’s still a loss of life. From the moment a woman confirms her pregnancy, she begins to develop feelings for that child.

a child, is miraculous. For many women pregnancy becomes a very negative time because they come close to carrying a child to only lose yet again. Nurses can help women face each pregnancy with a positive, supportive, and caring attitude, as well as her spouse o r significant other. It’s both our role and our privilege. +

A pregnancy, the ability to carry

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