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Unit 1: Understanding women’s experience of pregnancy loss, their feelings and how you can help

Unit 1: Understanding women’s experience of pregnancy loss, their feelings and how you can help

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Learning outcomes

After completing this unit you will:

  • Be aware of how pregnancy loss can affect women in different ways
  • Appreciate the different behaviours that women may display; each woman and each pregnancy is unique
  • Understand the importance of acknowledging women’s feelings and emotional state

What does a pregnancy loss mean?

  • From a medical perspective, pregnancy loss is a common, and generally a minor, complication of pregnancy, but for women going through it, it can be distressing, frightening and lonely.
  • For most women, pregnancy loss means the loss of a baby, whatever the gestation. The majority of women would want you to recognise and understand the emotional impact of their loss by showing empathy and acceptance of whatever they are feeling.
  • Some women may face additional complications for their future health or fertility, e.g. after ectopic or molar pregnancy or after assisted conception.

Sometimes just having someone listen to how you feel, the guilt and the heartbreak, helps to ease it.

The human aspects of care

  • Everyone experiencing pregnancy loss wants good medical care based on up-to-date knowledge of miscarriage, ectopic or molar pregnancy. The human aspects of care are equally important. Kindness, understanding, clear information and sensitive language are just some of the ways that doctors, nurses, midwives, paramedics, ambulance staff and sonographers can help people cope with their experience.
  • The NICE guidance on the diagnosis and management of early pregnancy loss stresses the need for health professionals to be trained in providing supportive and sensitive care, breaking bad news and giving clear information.
  • The professional guidance set out in the NMC Code and GMC Good Practice Guide highlights the importance of effective communication and information giving, balancing this alongside compassionate and effective care. The HCPC standards of conduct also provide guidance on communication.

Emotions associated with pregnancy loss

  • Early pregnancy problems can carry a whole range of emotions, some of which you may not have considered or may find surprising. Those emotions are likely to reflect each individual woman’s circumstances and the meaning and significance of this particular pregnancy.
  • The positive pregnancy test may have been hoped for or a shock, good news or bad, or there may be a mix of emotions. The pregnancy may be planned or unplanned, wanted or unwanted, but that might not affect the level of attachment or feelings about a loss. It is crucial to guard against making assumptions.
  • Everyone reacts individually to pregnancy loss and there is no ‘right’ way to feel. However, many if not most women are very distressed and anxious and see this as an emergency needing urgent help and advice from health professionals. They can find it very difficult to cope with uncertainty if scans or tests need repeating over time.
Emotions associated with pregnancy loss

Reactions to miscarriage

Women can react in different ways to the diagnosis of miscarriage. Here you can explore the various reactions that women may have to a miscarriage.

Here are 12 words that describe the reactions that people may have to a miscarriage. First, click on the six words that are, in your experience, the most common reactions.

  • Shock

    Shock

    Particularly common with a missed or silent miscarriage, diagnosed at a routine scan. This is a completely unexpected result, and there was no indication that anything was wrong. Also common after diagnosis of an ectopic or molar pregnancy.

  • Denial

    Denial

    She has had no pain or bleeding and feels all the normal pregnancy symptoms – she thinks you must be wrong. This may be a reaction with a missed or silent miscarriage.

  • Confusion

    Confusion

    She knows she was pregnant, so if there’s just an empty sac, where has the baby gone? If the pregnancy is much smaller than expected or if it is a pregnancy of unknown location, how does this make sense?

  • Tears

    Tears

    She was expecting a baby and now it’s gone, along with all the hopes, dreams and plans she had for it.

  • Devastation

    Devastation

    This is a devastating blow and a life-changing event. Perhaps this was a pregnancy after fertility treatment or the last chance to have a baby.

  • Self blame

    Self blame

    She assumes it must be her fault – age, a couple of drinks, exercise, picking up her other child, or not really wanting this pregnancy.

  • Anger

    Anger

    She is sure you are wrong and wants to talk with someone more senior. You may try to assure her that you are right.

  • Withdrawal

    Withdrawal

    Unable or unwilling to communicate. She does not want to discuss or hear anything. It is important to recognise that this is not the right time to discuss things further and it is better to let her go home with written information and contact numbers for when she is ready.

  • Acceptance

    Acceptance

    These things happen and it’s a disappointing set-back, but not a disaster. Or, maybe she’s not someone who expresses her feelings in public – for personal or cultural reasons.

  • Anxiety

    Anxiety

    About the physical process to come; about other people’s reactions; about it happening again; about future fertility.

  • Seeking explanations

    Seeking explanations

    She needs to understand why it happened in order to make sense of it and cope with the news.

  • Relief

    Relief

    This wasn’t a planned or wanted pregnancy – perhaps she’d considered having a termination – so it’s made things easier. Or, she’d rather miscarry now than have a baby with an abnormality. Perhaps it’s a relief to have a final diagnosis after weeks of uncertainty.

Reflection: reactions to miscarriage

Think about the reactions that you have explored just now.

  • Are any of these reactions that you might not have thought of?
  • Are there other reactions that you could add from your experience of working with women experiencing miscarriage?

Experiences of miscarriage

Miscarriage can be a devastating experience. For some women it is a great sadness; others are upset at the time but can recover quickly. Miscarriage is not like grieving for someone you knew. Instead women might mourn the loss of their baby’s future and their own future as that baby’s parent.

In this film clip you can listen to the experiences of two women, Catherine and Emily, who have experienced miscarriage in different ways. They each explain the impact of the experience has had on them.

Experiences of miscarriage video

Click to watch the video above

Reflection: acknowledging women’s reactions

  • Think about the issues Emily and Catherine raised about uncertainty, the importance of empathy, and of providing information.
  • What have they made you think about your own practice and how you could help support women experiencing pregnancy loss?
  • How can you help women who are having to make difficult decisions?

Ways you can help the woman

You may have thought of the following ways to help support the woman.

  • Miscarriage is never easy – for the woman involved nor for the staff who are looking after them. You may not get it right for everyone, but women will always remember your care, kindness and compassion.
  • You might not be able to meet all a woman’s expectations but understanding and acknowledging her feelings can help.
  • Providing clear information can help to reduce distress and uncertainty and enable some sense of control.
    • Acknowledge the woman’s emotional response, whatever it is
    • Say you are sorry for her loss, if appropriate. There will be very few women who won’t appreciate a simple ‘I’m sorry’
    • By being sympathetic, taking some time, listening and appreciating that this may well be a very significant loss in her life, you can make a big difference
    • Don’t assume that the shorter the gestation, the less the sense of loss
    • Recognise that uncertainty is difficult to cope with and acknowledge how hard it is to wait for a scan, or a specialist appointment, or test results

I cannot fault the care I received last week. At no point was I unsure of what was going on and nor was I given false hope (which would have done more emotional harm).

The nurses were incredibly sympathetic and caring with their words, their tone and their time.

Miscarriage in different settings and stages

Health professionals who care for women in different settings and at different stages of miscarriage may have different experiences of women’s feelings.

Click on the folders below to see what a miscarriage might mean to the woman at different stages of her journey.