The emotional anguish of miscarriage is one of the most difficult experiences to go through. Heartbreak, grief and confusion can become ever harder to cope with the symptoms and physical challenges that can be a part of loss.
To put it plainly, it is awful.
Unfortunately, many women find that on top of the inherent devastation of miscarriage, they do not receive the emotional support they so desperately crave from medical providers, making the experience all the more difficult.
Certainly, this is not always the case, but it is common enough that we need to address it.
Miscarriage is common, affecting up to 15% of pregnancies. For this reason, healthcare workers see it all the time—and this can lead to desensitization. I'll be honest here: this is often intentional. As a midwife, the first miscarriages I diagnosed for women destroyed me. I cried for days and had a hard time going back to work. I realized, though, that in the grand scheme of things, if I "let" myself fall apart every time, I would get burnt out, jaded and ultimately unable to do this work anymore. So I forced myself to harden a bit.
But we have to be careful not to take this self-protection too far. Because it may be the third miscarriage we've seen that day, but to the woman going through it, it is everything. Statistics mean nothing when you are the one experiencing the tragedy.
There are ways to support women while maintaining our own wellbeing. Self-care is essential as a healthcare worker, as is the admission that we too are human, and all humans are allowed to have bad days. We need to be self-aware enough to know when we are not capable of providing the appropriate support, and we need to support our co-workers when they do the same.
"I am going through something at home, and I don't think I have the emotional bandwidth to nurture this patient through her miscarriage today. Can you please work with her instead?" is as noble as all the other times when we do summon the courage.
Sometimes it can feel like healthcare workers aren't doing anything. The medical side of this is that so often, there is simply nothing to be done. Miscarriages usually cannot be stopped, so our only course of action is to ensure that the woman in front of us is safe and comfortable.
But to the woman experiencing the miscarriage, inaction feels like apathy. I think the key here is communication. So often, knowing that there is a plan in place can provide immense comfort. "I am going to let you rest and wait for the midwife to answer my page. I will be back in about 20 minutes," feels significantly better than just disappearing into the hallway.
Our culture has a hard time with sadness. There is this pressure to "move on" and "stay busy." And we also tend to feel like we have to "fix" everything. Sitting still with feelings of sorrow is incredibly difficult and uncomfortable, and so we do—we move quickly, or we say things that we think will make the situation better. This is noble in intention, but the truth is that so often, it makes it worse.
What might be comforting words for us could be the absolute last thing the woman in front of us wants to hear. For example, we might make an assumption about the spiritual implications of her loss that she does not connect with—comments like "it wasn't meant to be," or "they are in a better place," may have no relevance to her.
Minimizing the significance of her loss can also make things feel so much heavier. "At least you know you can get pregnant," or "you were only five weeks pregnant," are not appropriate statements.
I have learned that so often, the best response is to simply be. Ask for permission, and if granted, just sit with her. Don't touch her, don't say anything, just be. In the quiet space that we hold for her, she will understand that she is not alone. And that can make all the difference.
Lastly, we must acknowledge that the woman having the miscarriage may not be the only one having an awful day. If she is partnered, or if she comes to the ER or office with a family member, that person has a lot of needs too. They need to be included in our care. And we need to do with without making assumptions. Within this is remembering that all families have miscarriages, and heteronormative language and gender-based discrimination have absolutely no place here. If we are unsure of how to address someone, we need to ask.
Ultimately, we need to ask the people in front of us what they need.
"What are you feeling right now?"
"Do you have a sense of what might be helpful? If not, can I share some ideas of what others have needed and you can tell me if any of those sound right?"
"Would you prefer to have space or would you like me to stay here with you?"
"We have a social worker/therapist/pastor/etc. working today. Would you like to speak with them?"
And to the woman having a miscarriage: "First, I am so, so sorry."
"Second, please know that you can ask for whatever you need—and what you need it allowed to evolve as you go through this process. It is an honor to care for you during this time. You are important."