Supporting patients through pregnancy loss is an important component of obstetrics and gynecological care, as well as for other healthcare professionals, such as psychologists, who provide support and counsel through one of life's most challenging circumstances.
Alexa Bonacquisti, PhD, PMH-C, an assistant professor of Clinical Psychology, and Kristen Hawk-Purcell, PsyD '23, PMH-C, who owns a private practice, recently presented to Philadelphia College of Osteopathic
Medicine (PCOM) students about ways to approach this emotionally impactful experience
with their patients. Both psychologists specialize in reproductive health psychology.
First, healthcare professionals should be mindful of unconscious narratives or expectations they may have about starting a family and what that journey looks like, as it varies widely. There are also different types of pregnancy loss, such as a chemical pregnancy (a loss that occurs early in the gestational period, during which birthing parents may not even be aware they are pregnant); a neonatal loss (in the first 28 days of pregnancy); an ectopic pregnancy, where a fertilized egg develops outside of the uterus; a miscarriage; stillbirth; a termination for medical reasons, such as to save the life of the parent; and an abortion. Infertility could also be considered as an experience of loss.
“The patient who is sitting in front of you, you might be seeing them for a miscarriage, but think about the range of reproductive experiences,” Bonacquisti said. “They may fall into a lot of these categories, and think about the cumulative trauma that may create.”
People experiencing pregnancy loss can have strong emotional reactions, including anger, self-blame, confusion and sadness. There can also be a lack of expressed emotion, which doesn't mean the person isn't upset; they may be in shock or feeling numb. Components of grief can also include physical sensations, such as shortness of breath, lack of energy or tightening in the chest. These symptoms can be referred to primary care to be sure that the association is with grief and not something physically wrong.
Bonacquisti asked students to prepare to be present with a person experiencing pregnancy loss and to gauge their own comfort with tears and other visible displays of sadness, “especially during one of the most traumatic experiences of someone's life.”
“We want to validate this as a loss and to not pathologize somebody's sadness,” she continued. “How can I support them right now and, as time goes on, if they're still not functioning well or having some trauma symptoms or reactions that are preventing them from engaging in their life, we might refer them to a mental health professional.”
Hawk-Purcell added that “we don’t want to medicate grief.” Patients sometimes request that, “but we want them to experience and work through that grief with their support system in the immediate aftermath. … Be open and curious about the patient's experience and don't make assumptions about what they may be thinking or feeling. No matter what the stage or the reason, we want to be validating that the loss is real.”
In order to effectively and sensitively relay information about a pregnancy loss, Bonacquisti and Hawk-Purcell recommend to:
Language mattersWord choice is critical when interacting with people experiencing pregnancy loss. Bonacquisti and Hawk-Purcell suggest matching language that patients use. As an example, don't say fetus if the patient says baby.
Healthcare professionals can also ask about the child's name and use that name throughout the conversation. Even if a loss occurs early in a pregnancy, a parent may have already chosen a name or a nickname.
“Giving them permission to use that name is validating that their loss is real, and you also using it is even more validating,” Hawk-Purcell said. “It's personalized and individual and is a small question that can have a major positive impact.”
Repetition can also help, as the trauma of the experience may make it difficult to process information fully at first. Therefore, review and repeat, including assessing the patient's understanding of what happened. A patient may also benefit from hearing it's not their fault more than once.
Hawk-Purcell added that healthcare providers should take opportunities to give the patient control of the conversation, including regularly asking permission as the discussion proceeds (such as, “would it be OK if I offer you information about…”).
“For the person sitting in front of us, this is probably the worst experience they've been through,” Bonacquisti said. “I always try to think about that to really bring that perspective to what we do and why it's so important to have patience and compassion.”
Brandon Lausch
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Email: brandonla@pcom.edu
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