Future midwives

I’m sure I received some training on loss when I was in midwifery school. I don’t remember the specific lecture or chapter in the books, but there had to be some educational experience I received. I remember more the on the job learning. I worked as a Labor and Birth nurse while I was in midwifery school. I helped woman as they worked hard laboring for a baby that was extremely premature, that was unlikely to live, that had already died. I was scared at first- I think scared of saying the wrong thing, of not knowing what to say, of doing something that would make the situation worse.

During school, while I was working as a nurse, I remember caring for one woman who was being induced around 24 weeks, the cusp of viability. Her uterus and amniotic fluid were infected, meaning the baby who already faced significant life threatening struggles that came with extreme prematurity, also faced life threatening infection. Truth was, this baby had very poor chances of survival. The neonatologists knew this and gave her the option of resuscitation or comfort care. As her labor was induced she talked and cried with her family, with her healthcare providers about what was best for her baby. She had a family member who had extremely preterm twins who suffered many long term effects from being born so early. She was unsure if she wanted that outcome for her baby, but also could not imagine not doing something for her child. When my shift was done, she was just getting into active labor and had not decided what to do. I found out later from the nurse who relieved me, that her baby came suddenly, without the doctor even in the room, and she still had not decided. Her baby did not survive. The worst part of being part of her story, was not knowing how to help her. I know, even with all the training and experience in the world, I still might not have been able to help her decide, but maybe I could have. I’ll never know.

I have since been with mothers as the doctor couldn’t find a heartbeat on the ultrasound. I’ve had mothers whose babies come prematurely and die sometime after birth. I’ve had mothers who choose to terminate for a fatal diagnosis and a mother who has carried to term despite one. I helped mothers through subsequent pregnancies and subsequent miscarriages. Each woman I have cared for, I have learned from- more so than in any class in school. Ultimately I have learned most from my own experience.

This week I’ll be joining the program director of my local pregnancy and infant loss non profit in a guest lecture about loss to the local midwifery students. It is at the school I went to, I worked at and I still (though rarely these days) precept at. I sort of invited myself when the program director mentioned it to me- how could I not? This is what I do- I’m a midwife and I’m a babyloss mom.

As we talk to the students, I want to give them all I can. I want them to remember the talk and I hope, being given by someone who knows both sides will help. But I need your help too- I only have my own experience. I’ve come up with some points I wish to make- I know it’s not a perfect list, and so I encourage you to give me your suggestions to. I also know that these do not apply to everyone’s situation and it’s not a comprehensive list encompassing nearly everything- I am trying to look at it from both perspectives- a provider and a patient.

Tell me: What did you want your midwife or doctor to do? What did they do that was great? What did they do that you wish they didn’t?

 

Stillbirth

  • Be honest. There is no good way to say your baby is dead. Don’t sugar coat; just be clear.
    • I was with a mom with a stillbirth at term. She had been sent from the office to OB triage when the midwife couldn’t find a heartbeat on the Doppler. I sat by this woman as the APRN did a scan looking for a heartbeat. We were waiting for the Maternal Fetal Medicine doctor to come and make it official. Since he was tied up, the APRN started scanning, all of us hopeful she’d find something with the ultrasound that the Doppler could not. The room was silent as she scanned, the parents on edge, the nurses and I staring at the screen. It felt tortuous for me- I can only imagine what it felt like for the parents. Finally, because no one was saying anything, I said simply, “they don’t see a heartbeat. I’m so sorry.” I explained how we had to wait officially for MFM doc and I stayed by her side until he came. There were a lot of “whys?” and I was honest there too “We don’t know. We may never know. But here’s what we can do to try to find out…”  
  • Describe the process- let the patient know what happens next (do they want to go home, gather things, wait at all? Induce right now?) Discuss induction and pain management. Discuss the baby coming out- mention about skin color changes and bruising that might be apparent. Offer to call NILMDTS

 

General Loss Guidelines

  • Say “I’m sorry”
  • Use the baby’s name…. over and over.
  • It’s ok to cry- in front of the patient too.
  • Get familiar with the process- offer autopsy, karyotyping, TORCH titers, thrombophilia workup. Talk to the hospital social worker to learn what happens to the baby, how parents arrange services (cremation, burial?)
  • Sit. Be with patient.
  • Coo at the baby- talk about all the aspects of a baby you would otherwise- the hair, whose nose she has. Encourage parents to explore- undress baby, open eyelids. I never opened Mabel’s eyes- I wish I did, just to see the color (likely dark gray as most newborns are, but now I’ll never know)
  • Be a photographer- take photos, encourage parents to take photos. Call professional photographer. Since no one from NILMDTS was available for me, my nurse and midwife took photos- so many photos and I am so grateful they did.
  • Let parents stay with baby as long as needed. Encourage patient to call and invite any support they choose.
  • Send patient to a floor without babies for PP recovery
  • Early discharge
  • Prevention of lactation (also milk donation)
  • Offer sleep aids
  • Referral to resources- counseling, local bereavement groups, books, websites.  Go through your hospitals bereavement box, so you know what’s in it.

 

Follow up

  • Call patient- some potential questions beyond “how are you doing?”
    • How are you sleeping?
    • Who is around to help you?
    • Are you eating?
    • How are you spending your days?
    • Services?
    • Have you looked through bereavement box yet?
  • Postpartum visit
    • Plan first morning appt- so pt does have to wait in waiting room with other pregnant patients
    • Plan extra time for appt
    • Be prepared to go over autopsy
    • Discuss birth control or preconception- no judgement on whether it is “too soon”
    • Ask about photos- ask to see if she has some and wants to show
  • Remember due dates- good time to call or send a card
  • Anytime you are reminded of that patient, tell her-call or text her- she would love to know she is not forgotten
  • Attend services if you are invited and can go

 

Fatal diagnosis (if carrying to term)

  • Frequent appointments if pt desires
  • Listen to FHR first thing
  • Plan for longer appointments
  • Consider frequent ultrasound if pt desires
  • Help patient with birth plan
  • Coordinate care with specialists- NICU, pediatric specialists to discuss immediate care of baby
  • Encourage special plans- blanket, outfit, photographer for baby
  • Discuss logistics- funeral home, cremation, burial
  • Connect- give resources
  • Help patient celebrate pregnancy

 

Subsequent Pregnancy

  • may need more frequent appointments, reassurance of FHR
  • If previous stillbirth- testing (level II, NSTs, early delivery)

 

Miscarriage (also applicable with fatal diagnosis choosing to terminate)

  • Say “I’m sorry”
  • It’s ok to cry
  • Discuss logistics- expectant management, miso, D&C, D&E
  • Discuss “why” (most common known cause- chromosomal, but often we have no idea why…)
  • Listen
  • Discuss future fertility if patient desires
  • Call patient for emotional follow up (“just wanted you to know I’ve been thinking about you)
  • Referral if indicated (recurrent pregnancy loss, genetics)

What am I missing?

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38 thoughts on “Future midwives

  1. That is a great list and you are going to help a lot of midwives, doctors, and parents. As someone who carried to term, I would add that video clips of ultrasounds meant so much to me and I would have liked a recording of my daughter’s heartbeat if they could have given me one. At the time I didn’t know if those would be my only memories of her. I appreciated when my doctors were honest but sensitive.

  2. The most traumatic thing for me was that an unexpected code was called right after the delivery, and no one talked to me. The baby was crying and no one told me anything about what was going on or why a code had been called — for at least 15-20 mins. For the first few mins, I straight-up thought that I was dying myself. I thought they’d hit an artery and I was bleeding out. I think they didn’t tell me anything because they had no clue what was going on themselves and wanted to wait until they had more info – but, that choice made things *much* worse!!!! Talk to the patient, you have to talk them through what’s going on, you have to tell them. Also: if there’s a chance a baby might not make it, you have to prioritize letting the parents see the baby while working out the logistics. I didn’t get to see my kid until after he was gone. I even asked but was told it was too complicated. That’s still absolutely devastating to me, and probably always will be,

    • One other thing: I was given the choice to go to private room on postpartum, or to a different floor. I really appreciated having a choice.

      • And one more thing that made an enormous difference was when I finally saw my son in the NICU, and the nurses were taking such gentle care of him and being so sweet with him. Treating him just like any other precious baby. That was so huge for me. Perinatal loss can be such an “ambiguous loss”. It was so validating to see everyone reinforce that he really was a real baby (a concept that almost all brand-new mothers struggle to comprehend at the moment of birth).

    • communicate! yes! I think people are worried to say anything because they dont know exactly whats going on, but they dont realize what kind of panic that can cause in a patient. Simply saying something like- your baby’s not crying yet, so the pediatricians are working with him to help him. Or maybe even- I dont know what’s happening- the peditaricans are assessing your baby and we’re working on your bleeding? providers are afraid of the “i dont know”s. i think they are fine to say- and then say how you will help. “i dont know, but I keep you posted as I see things happening!”

      It pains me that people didnt bend over backwards logistically to get you to your baby! providers need to look at the whole picture!

  3. You have already covered a lot of ground and i imagine you will be able to cover even more by answering students’ questions. I think it is really great that you are willing to speak from your point of you knowing both sides.

    I recently did an interview with an acquaintance who is starting to study to become a midwife and wanted to explore neonatal loss as she thought the training planned in their coursework around neonatal loss and grief is very light. I hope this is something that gets corrected over time…

    I did not experience a stillbirth or a miscarriage late enough to be treated by a midwife but my midwives were great after Paul’s death. So i would add a few items for infant losses :
    * Welcome the parents to the planned follow-up appointment even if the baby is not there anymore. I don’t know how long midwives care for the mother and baby after birth in your state, but we were able to go to our 6-week appointment as a follow up for us and even though it was really hard, we really appreciated both midwives being there for us. (and yes to extra time)
    * Even if the death occurs later, call or write to or visit the parents. We so appreciated that one of our midwives and her intern were able to make it to the ceremony we held for Paul. But a call would have been just as meaningful.
    * If applicable, invite the parents to share a photo of their baby for the baby photo board or book.

    And for subsequent pregnancy: if you need to discuss the death of the previous baby, give notice in advance so the parents can prepare (especially if you need them to tell their story, or to dig into the traumatic events). Also, i was offered a viability scan i didn’t “need” but that was really reassuring (i don’t know if that would be a general advice but maybe something to consider…)

    • Yes- I totally think the simple communication part is key to helping you feel welcome back at the practice. the photo one- especially resonates with me- I’m going to be sure to mention that.

      absolutely on the viability scan- I have learned over the years that a simple ultrasound or two can go a long way with patients who have had loss (miscarriage or later) or even simply anxeity. I am quite liberal with those! I like the idea of asking a patient if they want to talk about the death of their previous child then or at a future visit- giving choice is great

  4. Two main thoughts: With miscarriage (or infant death in general I suppose), even if there is “something wrong” with the baby that you can prove with genetic testing, no one should ever say, “It’s OK–the baby had a problem anyway.” I’ve noticed a lot of pregnancy books use this kind of logic, and it’s bad. We don’t throw out people or stop caring about them because they’re sick, so why are we supposed to feel better that our baby that died wasn’t perfect, and that caused his death?

    Also, maybe I’m the odd one, but I was horrified and angry that someone from the hospital I didn’t even know called me on my due date to “check up.” It felt like checking boxes and was not an act of compassion. I told this to a nurse friend of mine and she was aghast as well. Maybe if a nurse who had actually attended to me called, it would have been all right, but don’t just assign it to some person whose job is to just “monitor progress” of their less-fortunate mothers.

    • yes- I totally agree! There are many babies that live that have “something wrong with them.” It doesnt invalidate their lives.

      and I feel the same way about strangers calling. I got a call from a nurse employed by my health insurance. I understand why she called, but I didnt know this woman- she couldnt help me! It feels crummy to be just a box to check.

      • I got a call from an OB RN with my insurance company, who wanted to discuss prenatal care ith me. The only problem was that she called three days after my D&C. It wasn’t her fault. She was mortified, and frankly one of the most compassionate people I’ve talked to about my loss. Imagine that… A compassionate person at Humana! She gave me her direct phone number, and sent me a big packet of resources in the mail. She was wonderful.

        It did highlight a flaw in their system, though. When my D&C was authorized, I should have been removed from the OB call list. She made it clear with her compassion that I was a person to her, but Humana’s process made it clear that I was a box to be checked to them. Teehee. A “box” to be checked. Sorry, couldn’t help myself…

      • wow, I’m so impressed with that nurse and so appalled by the system! Funny how that works with insurance. When I tried to see a fertility doc a few months after losing Mabel, they surely knew I had had a baby recently so couldnt possibly have been trying for more than a year! they knew that, but they couldnt see your D&C?? jeez!

  5. You are so brave for doing this. I hope the students learn and remember something.
    For prematurity, discuss expectations, treatment options, etc. – I guess this is done already, probably by a neonatologist.
    Encourage parents to hold, kiss, love, bathe their baby. I’m glad (if that can ever be the right word in this context) to have read babyloss blogs long before the twins were born. Otherwise I might have hesitated much more. (Or not, who knows. We did have lovely and supportive nurses).
    If you’re uncomfortable handling a dead baby, please ask one of your colleagues to take over. This was our only negative experience with the staff – and it felt awful to have someone reject our precious babies. Remember that these parents need your care, support, love perhaps more than anyone else on the floor.
    I’m not sure about calling, but our hospital sent a card for A&C’s first birthday, which I thought was lovely.

    • oh yes, such good thoughts. Dare I say, role model how to hold a dead baby? parents need to know it’s ok- that the bay is still a baby, a real one. providers should hold the babies as if they are their own and living. to have someone reject your babies feels so awful on top of awful!

      I agree- a card can mean so much (especially if its from distant people, not those who worked closely with you).

  6. Great idea, Meghan, and I think you’ve covered most of the points. I would add a few points specific to NICU loss – to make sure parents have all mementoes of their baby that they would like; to make sure parents know they have not been ‘cast adrift’ from the unit – you become so close to the staff while your baby is being cared for going home is like an extra wrench on top of the loss of your baby; to make sure parents know how to access counselling. I would also add a couple of points about traumatic birth – whether it’s something like PPH or an illness such as preeclampsia and HELLP syndrome – that mums know where to get information about what happened to them and why, and how to access support/forums/debrief about the birth.

    • yes! this is something I”m actively working on in my practice- there recently had been a bit of a disconnect between the NICU staff at our hospital and informing the oB care team what was happening to their babies. Had i not been following some babies very closely on my own, we might not have learned of the saddest news. I notified the important people so that this mistake wouldnt happen again and I’m even working on how to help our NICU moms within our own practice. such good points!

  7. I think it’s great you are going to talk to student midwives about loss, I think back to my nurse practitioner program and it was really not a topic we handled in class at all. I did have one visit during an OB clinical that was a followup from a full-term fetal demise… I mostly observed this visit but I remember being really saddened, amazed at the mother’s strength, and truly naïve thinking that such a thing could never happen to me. Four years later I was that woman, sitting in the OB office following my 19 week anatomy scan when the midwife came in with a student and very coldly and matter-of-factly started to explain the slight anomaly found on ultrasound. When I started to cry the midwife offered little support and I could tell she was busy and I think she really believed the finding was nothing major and that I was over-reacting. It was the student who came back into the room alone and sat with me, let me cry, and explained what was going on as best she could. So my advice to your students is that there will be days in clinic when you are busy and running behind and stressed, and these are the days when you might have to break bad news to a patient (or several patients), and your pager might be going off, and your receptionist might be reminding you that you have 3 patients in the waiting room, and you will probably have a huge stack of papers on your desk that need to be reviewed… but in that moment, for that patient- your time and presence is what she needs most.

    I ended up switching OB practices after that visit and was being followed by MFM when we ultimately received our daughter’s fatal diagnosis. The high risk practice was so incredibly different, the support and resources we were offered were timely and practical- even if I could not see the benefit through tear-stained eyes at the time. Looking back, I probably should have made some funeral plans earlier, I was caught off guard when faced with all the questions after she was stillborn. But mostly I was too sad during my pregnancy to make these decisions, and it was not something that was really brought up prenatally. I think I asked the social worker about something about a funeral and she sort of deferred my question telling me the labor and delivery staff would have more useful information for me when I needed it.

    In terms of carrying to term in spite of a fatal diagnosis, I have little to add, but the ultrasounds at the start of every appointment to see the heartbeat are my favorite memories and the only times I got to see my daughter moving. At our final prenatal appointment when we learned her heart had stopped beating, I said to the doctor, “I wish I had recorded her heartbeat”. Another piece of advice from that appointment that I would share is don’t forget to include her partner, he is just as grief-stricken and shocked as she is. When the doctor could not find the heartbeat, she started to cry and asked if she could give me a hug. I was not crying, I think on some level I already knew she was gone. But when I looked at my husband he was crying, and I think he might have needed that hug from the doctor even more than I did.

    • absolutely- I have been that midwife facing a patient with terrible news, knowing I was only slotted 15 minutes for them. I sat with her for 45 min as we talked about what kind of care she wanted to give her baby with a fatal diagnosis if she were born alive. I kicked myself for not telling the staff to allow her more time when booking the appointment. my next patient was very huffy and I yearned to tell her- “i’m so sorry I kept you and your healthy pregnancy waiting, but I was spending time with someone whose baby is going to die!” but i didnt. my standard line now (one I learned from my MFM doc from that same practice!) is “I give every patient the time that she needs.” I sometimes add, if they arent getting the point “If I”m running late it’s usually because someone is having a hard time” THis is a good lesson to teach the students. give patients the time they need.

      i agree on the wishing I recorded the heartbeat too- I see so many patients do it with their healthy babies- why I didnt for mine? I dont know. paying attention to partners is so key too.

      • “If I’m running late it’s usually because someone is having a hard time” is a GREAT thing to say, in my opinion. Healthy women with healthy babies, in my experience and I’m sure yours even more so!, so very often are completely daft to the fact that women have complicated pregnancies and babies die. I remember a few giggling, overly enthusiastic pregnant women giddily asking me about my baby, and when I would tell them that he wasn’t expected to live, they gave me blank stares like they had no idea what that meant, and then kept chattering on about diapers and car seats and cribs they were deciding on, as if that meant anything to me at the time. Sometimes other women are having a hard time. Yes. And sometimes others are having a VERY hard time!

      • really? people would go on chattering like that?!?! I would say that’s unbelievable, but I’ve learned that people are nuts. like really nuts.

  8. Miscarriage is a very different type of loss, but painful in its way, too. While a professional who has seen full-term babies die — and who has performed abortions — might have a hard time relating to the pain a family feels losing a first trimester fetus, for that family it can be the worst thing that ever happened to them. It might be tempting to let the parents know that their loss isn’t a big deal compared to what other people go through, but that can be very disturbing to the grieving parents. Don’t tell them it was nature’s way of getting rid of damaged goods. It was their baby. They loved that baby and would have done anything to save it. To you, it was a blighted ovum, or a common Trisomay problem, or “barely even a positive” — but to that family it was precious and beloved. The loss is still very real, no matter how unformed the physical person may have been.

    • yes! getting rid of damaged goods! arg! as someone who’s body didnt get rid of damaged goods, I particularly resent that one. remembering the patient perspective is so key.

  9. Your list is EXCELLENT. Some things that meant the most to me – keeping in mind that my perspective is as a NICU mom, so maybe a bit different. Our nurse hung a doorsign of a baby in an incubator on our door so that those entering my postpartum room would know that we had a NICU baby. That was great as it eliminated any too-cheerful questions. However, at my six week postpartum checkup, the doctor didn’t know my baby had died. Granted, he had been alive for a month – but as my doctor’s office is actually in the hospital, one would think that somehow that record would make it through. Additionally, when I had a visit this fall before TTC, the nurse cheerily chirped, “so you’re 20 weeks pregnant?!” I was like, um…. I was at my first visit LAST year at this time. Seriously people, get your sh*t together.

    I couldn’t agree more with being honest – it helped us know when it was really time to let him go. Because my doctors were honest every step of the way, I trusted them when they told me we were out of options.

    Respect the parents. Our doctors gave us studies on the newest drugs so that we could make informed choices. They constantly told us that we were the parents, and while they would present us with the options, they would do whatever we wanted for our child. This helped us feel like parents and not just bystanders.

    Cry, take photographs – YES. And remember, you can never tell a loss mom that her baby is too beautiful, too perfect, too special and too unique. She will never hear this as her child grows. Give her a lifetime of school picture Oohing and Aahing in the short time you have with her. Use the baby’s name, a lot – YES.

    We didn’t get any follow up calls. However, some of our NICU nurses gave us their personal emails or cell numbers, and while we use them sparingly, we do appreciate being able to thank them on special days, and we sent them pictures. Two we have actually become close friends with. This means a lot to me as I know they will be there for us the next time I’m (hopefully!) in the L&D ward!

    Respect that the mother is going to be plagued by anxiety in the years following the baby’s death, especially if trying to conceive again. I don’t know how I’ll be treated, but hopefully my doctors have seen your tips!

    • I think the part of your list here I like the best is “you can never tell a loss mom that her baby is too beautiful, too perfect, too special and too unique. She will never hear this as her child grows. Give her a lifetime of school picture Oohing and Aahing in the short time you have with her” so so very true.

      • Right? One of them told me he was the most beautiful preemie she had ever seen. I could care less if she was lying through her teeth. Lie! Who cares? Build up that mama’s ego – it’s going to take quite a beating in the next few years.

      • sigh. I totally loved your quote on that- and honestly I’m sure she really did think that. Sometimes knowing how sick a baby is, makes him even more beautiful (plus your kid was actually a gorgeous baby. preemie model material.)

    • The door sign is a good point. When our son died, I was moved from the postpartum floor back to L&D, but in a corner by the staff offices (I assume they intend this area for bereaved mothers). They put a picture of a leaf with a teardrop on the door so that I never got any questions about, “How’s the baby?!” or startled looks from the young men delivering my meals when they saw a deceased infant in the bassinet. It was helpful and shielded me from having to answer the really hard questions (like “how is the baby doing”) for at least a couple more days…

      • They did this for us too – a teardrop on the door. It really helped. Also, we were fortunate enough to be tucked away from crying, healthy babies – I never heard any of them. My anesthesiologist asked me about Max’s story. He wanted to know the whole story and I told him. It really meant a lot that he cared and wanted to know. It doesn’t matter if he didn’t “really” care, it just made me feel better, like Max was real to people other than me.

      • I love that you had such a positive experience with your anesthesiologist. I hate to admit to stereotyping, but anesthesia is not known for their people skills.

  10. i was pregnant with our 2nd baby and had our first u/s at 9 weeks. they couldn’t find a heartbeat. it was hard and still is. i recall the u/s tech saying, “oh i just know you’ll be back in 3 months pregnant again!!!”. she was just so hopeful. but thats not what i wanted to hear. i needed to honor THIS baby and THIS loss. so overall, i just wanted the midwife team to honor the present and respect what we are going thru at the moment.
    i also asked for the u/s picture and 10 months later, the picture is still proudly on my fridge- as its the only picture of my baby i’ll ever have!

    • such a minimizing phrase- talking about future children. first, there is no guarantee about future children for anyone! second, it totally minimizes how you feel about your current loss. i think if nothing else, I was to teach these students how to simply say “i’m sorry” and avoid platitiudes.

  11. I love that you are working on education for healthcare providers. It’s something I want to get involved with when I am ready. Can you come talk to my OB/GYN office? I just had the most horrible annual exam appointment there. The 1st part was just bad luck, and there’s nothing the staff could have done about it. I expect there to be pregnant women in the waiting room, but I have the bad luck that it is always somebody I know, so they want to sit with me and talk about their pregnancy. Ouch. The rest of it was all on them, though.

    First, while the nurse was taking my history, I said that I’d already had an appointment with them since my D&C, so that should be in my chart already. Well, evidently it wasn’t, so she proceeded to ask me a series of rapid fire questions in a clinically detached monotone:
    “Was it for bleeding?”
    “No. It was for missed miscarriage.”
    “Is that the only time you’ve been pregnant?”
    “No..” Before I could finish that thought…
    “How many pregnancies?”
    “Three.” I’m crying by this point, but she just steamrolls on.
    “And they all ended in miscarriage?”
    “Yes.”
    “Did you have to have a D&C every time?”
    “No, just the once.”
    This entire exchange was inexcusable for a few reasons. First of all, My R/E regularly sends my records to my OB/GYN, so even though my OB/GYN wasn’t following me for these, they should have had this information in my chart already. Furthermore, two of the miscarriages & the D&C were before my annual last year, so there is absolutely no reason for that not to be in my damn chart! Finally, she never slowed, never softened her tone, never said, “I’m sorry,” or offered me a tissue, or even looked at my face. Any of those actions would have been so simple. I don’t expect my providers to truly feel the depth of my pain (because there is only one way for them to do so, and I wouldn’t wish it on anybody), but do something to show me that you care that I am in pain.

    I’m afraid my Nurse Practitioner did nothing to make my visit better (and I’ve always liked her, but now I’m considering finding a different practice). She meant well, but made so many missteps. Her first was insisting to me that grief is temporary. Even after I said that it isn’t–It softens over time, but doesn’t ever leave us, she argued with me. Never tell your patient she is wrong about her grief. You are not her therapist. When I told her I’d like to eventually become a bereavement doula so I could be a caregiving of a type that wasn’t available to me, she practically shouted, “Oh no! You don’t want to do that! It’s too sad.” Her strongly negative reaction to that made it obvious to me that she is uncomfortable with the bereavement associated with babyloss. If that is the case, she is in the wrong field. She then suggested I get involved with NILMDTS. I agree that they are a wonderful organization, but they are for stillbirth, and neonatal loss. She missed the point that I wanted to help people suffering from miscarriage. And finally, After my exam she told me that I have a “healthy body for bearing babies.” Don’t blow smoke up my ass (or my cooter in this case)! Since I cannot get pregnant on my own, and the three times medical assistance has gotten me pregnant I did not make it out of the first trimester, I would beg to differ with that statement. It may look healthy, but something is obviously going dreadfully wrong somewhere. Oh, I almost forgot! She ended the appointment by saying she hoped to see me for pregnancy very soon. Yeah, she’s expressed that hope to me at my last four annual exams. I know she’s trying to be positive for me, but I don’t need her to be. I need her to acknowledge that I may never carry a pregnancy to term, and that it is a heavy burden to carry.

    Apart from that, I’d like to reiterate what somebody else said–don’t forget about the father. He lost his child too, and it’s likely nobody is checking on him. It’s also likely that he is so concerned with taking care of his wife that he won’t even tell her how he’s feeling.

    • oh, MAN! what a time you had! As someone who works in an office, I agree- many of those things are avoidable!!! Even if it was a stupid mistake (happened in my office recently to a baby loss mom- an assistant didnt know and asked about the baby- eek!!), apologies need to follow (there were so many tears from my assistant and even though the patient wasnt there to see me, I popped in and spoke with her). there are ways to be sensitive.
      I’m totally aggravated by your experience with your NP! That is just poor education- it kills me how people often want us to remain optimistic, when their positive attitude just makes us feel invalidated in our grief. I’m glad you were able to at least attempt to educate her on grief, even if she wasnt able to hear it!

  12. Pingback: Words of Advice from Baby Loss Moms | Expecting the Unexpected

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