Understanding the Impact of Care Provider Support on Pregnancy Loss Grief

Grief is a weird thing, as sometimes you can feel fine - and then suddenly it hits you again. Although we understand that grief comes in many forms during an infertility journey, today we are focusing on miscarriage and grief. We have gathered some learnings from the clinic perspective on how to approach bereaved parents, and how the clinic can help in supporting patients through grief. 

Did you know that up to 1 in 4 pregnancies ends in a miscarriage? This means that there are up to 1,000,000 miscarriages in the United States per year. In the United Kingdom, the number is approximately 200,000, and in Australia, 147,000. Despite how common miscarriages are, and how traumatic the experience can be, the emotional impact and grief of miscarriages and other types of baby loss are often overlooked. So if you have experienced pregnancy loss and are not feeling okay, you are definitely not alone. In fact, baby loss has been shown to have a large psychological impact, and is associated with post-traumatic stress, depression, anxiety, and sleeping disorders.

So how do you deal with miscarriage and grief? There is no easy answer to that - and it’s important to recognize that grief is always a personal process. However, research does point out that the support given by the health care provider following the miscarriage has an important role to play and that the interactions with health care professionals have a large influence on the intensity of the parents’ emotional trauma. In fact, patients who are satisfied with the support from their care provider following a loss are less likely to suffer from depression, anxiety and long-term grief.

Here are a few things that impacted how satisfied bereaved patients were with the support of the care provider:

• Insufficient information; regarding the medical and physical implications, next steps, what to expect mentally/emotionally, and the grieving process. 
• A lack of acknowledgment of their loss, and not feeling listened to.
• An absence of psychological care.

A worsening factor in how women and their partners (in general) are affected by miscarriages is having had this unfortunate experience before - as is the case with recurrent miscarriages. 

The clinic perspective

We have thus invited someone who has a lot of experience from working with bereaved parents having undergone several pregnancy losses: Lorna McErlane, Deputy Clinic Manager at the Center for Reproductive Immunology and Pregnancy Miscarriage Clinic, CRP Clinic, a UK clinic with two clinic sites that specializes in treating recurrent miscarriages.

Lorna, you are meeting with patients that have experienced recurrent miscarriages on a daily basis. What is usually the emotional state of the patients when you meet them for the first time?

Going through one miscarriage is emotional, going through several is very tough. Normally our patients have been through a lot when they come to our clinic, and can sometimes be in a very heightened emotional state. We try our best as a team to ensure our patients feel listened to and cared for, to try and make a difficult time a little easier. 

Research suggests that one way to support women and their partners is for them to feel that the care provider is giving enough information, both orally and in written form (as oral information alone can be hard to process in a heightened state). How do you address this, and are you doing anything differently than a regular provider? 

We make sure to set aside enough time to sit down with the patient(s) and go through the information with them. It can be about the causes of a miscarriage, what are the next steps and why are we suggesting them, etc. Our nursing team is available to speak to via phone or email if patients have any queries outside of clinic times. We also have an app where patients can access their personal data and information about the procedure afterwards.

There is data showing that patients value not only information around their treatment and physical health, but also on what to expect mentally. How do you enlighten the patient around this aspect? 

At the CRP clinic, our patient-facing staff have an understanding of common mental health issues and also have knowledge of grief and its potential implications. We also have digital support tools that our patients have access to and a counsellor associated with the clinic to whom we can refer our patients. 

Lack of acknowledgment from the provider can negatively affect how the patient deals with the grief according to research. Anything from word choice when speaking about the loss as well as body language. When patients come to you, they have often been through several losses. Do you recognize them feeling that their loss has not been acknowledged before? How do you work differently with this?

Unfortunately, we meet many patients who have not felt supported enough by their clinic or local hospital. This can be due to lack of time or training regarding fertility and miscarriage, but many raise that they have not felt heard, and that their losses have often not been acknowledged. At the CRP clinic, we meet with patients every day who have experienced multiple losses, so this is something that we have all made our professional focus. We’ve done this through training, but also through daily experience we have gathered experience in what to say and when/how to say it, and are not afraid of the emotional side of our patients’ history. By being compassionate towards our patients and having an in-depth understanding of the emotional challenges, as well as having tools that we can refer the patients to, we are able to customize the support for patients to a large extent.

Thank you Lorna for sharing your experience and knowledge of working with bereaved patients!

Psst: Did you know that all patients at CRP Clinic get access to Tilly? If you are interested in making sure your patients get the mental and emotional support they need during a tough fertility journey, please do reach out to us at hello@mytilly.co to learn more about our services.