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Unit 2: Supporting women through pregnancy loss

Unit 2: Supporting women through pregnancy loss


Learning outcomes

After completing this unit you will:

  • Understand the importance of giving women a balance of information and support
  • Be able to support women with clear and accurate information, sensitively given, so that they can make decisions that are right for them
  • Be able to provide practical support appropriate to your role in the woman’s journey

The physical experience of loss

If the physical process of loss has not yet happened, women may find it difficult and distressing to have to make a decision about next steps. All management methods have upsetting or frightening aspects and all mean the final loss of their baby. It can feel impossible to choose between equally distressing options. And in some cases, there may be little or no choice.

Women can be quiet, shocked, very distressed, confused or overwhelmed. Those with a loss beyond 14 weeks’ gestation may be particularly shocked that they will need to go through labour and delivery rather than have surgery.

Your approach can make a positive difference to the woman’s experience.

I started to realise what the three options really meant. I would essentially have to bleed everything out of me, but this could take 2 or 3 weeks to happen; I could have some medication to make this happen faster; or I would have to have it surgically removed. None of these options appealed to me at all.

Empathy and information

We return to Catherine and Emily and follow their stories further as they experience the management of their miscarriages.

It’s evident that Catherine and Emily want clear and honest information presented with kindness, sensitivity and acknowledgment of the emotional impact of pregnancy loss. However, it can be difficult for health professionals to have these conversations, particularly when women are distressed and there are pressures on clinical time.

This video features first trimester miscarriage. But the principles noted above apply equally to women with second trimester loss, ectopic pregnancy or molar pregnancy, alongside the issues specific to those losses.

Empathy and information video

Click to watch the video above

A doctor’s thoughts

In response to Catherine and Emily’s stories, Dr Naomi Page explains what she thinks is important in supporting women experiencing a miscarriage.

Supporting women at this time video

Talking about management options

We have already noted the importance of providing clear, honest and accurate information about management options in a sensitive and kindly manner. You should also explain why one or more option might not be possible or advisable.

It is important not to over-emphasise the risks or disadvantages of one option while minimising those of another. If asked for your advice, this should be on clinical grounds only; if asked what you would do, it is almost certainly better to help the woman choose the method that she feels she can cope with best.

If a woman is likely to miscarry at home, explain that she may have strong to severe pain and heavy bleeding which may contain large clots of blood; and that she might see something that is recognisable as her baby. If you do not provide pain medication, advise her about over the counter options such as co-codamol and also suggest that she buy sanitary pads suitable for a heavy flow.

You may feel as if you are scaring her by being honest about possible pain and bleeding. But as we heard from Catherine and Emily, being clear about what might happen will help women decide and prepare.

Explain what she needs to do and whom to contact in an emergency, e.g. if the bleeding is excessive (soaks more than one pad per hour), if she feels faint or unwell or is unable to cope with the pain. Ideally, provide this in written form as well. Distress can make it harder to digest or remember new information.

You may also need to provide information about what she might do with the remains of her baby. Your hospital should have this available in written form, but we also talk about this in Unit 4.

Giving support and information

Women tell us they are often upset or frustrated by processes and timing. Although you may not be able to change this, you can help by empathising with their feelings and explaining more about processes and next steps.

Selection of Miscarriage Association support leaflets

If you can’t give clear answers, think about who might be able to, in the hospital or elsewhere. If appropriate, pass on details of the Miscarriage Association as a source of both support and information.

If you can’t give clear answers, think about who might be able to, in the hospital or elsewhere

  • Be honest if there’s something you don’t know (for example, processes and systems in other departments) and say what, if anything, needs to happen to find out more.
  • Acknowledge that not having answers or having to wait longer without knowing more can be very difficult and upsetting.
  • Don’t be tempted to give false reassurance to make the woman feel better.
  • If you have to break bad news, do it gently, succinctly and with compassion in an appropriate environment. [See Unit 4 for more information about breaking bad news]
  • Too much information, especially if the woman has just had unexpected or distressing news, can be counterproductive. Give her the option of talking through the details when she has had some time to assimilate what’s happened. She may want to talk it through with her partner or someone else; she may also choose to go home and come back at another time.

A more positive experience?

Many women present to A&E with early pregnancy problems, often because they feel it’s the quickest way to be seen and treated. In reality it is rarely the best place to go and they may have to wait a long time to be seen.

This short film follows a couple as they wait in A&E. Even if you do not work in A&E, you will find there are many general issues to consider here.

Accident & emergency video

Click to watch the video above


As you watch this film, reflect on how the A&E doctor could have made the couple’s experience less distressing.

Couple waiting in hospital

I didn’t like being left to sit in the waiting room, covered in blood from the bottom down.

Reflection: Improving the couple’s experience

Many women find the experience of bleeding in a public place or a waiting room embarrassing and distressing. Consider the following ways to improve the woman’s experience:

  • If you can, find her a more private space
  • If vaginal bleeding is visible to those around her, offer a blanket, gown or other covering and sanitary pads if she wants
  • Give her as much information as you can about how long she will have to wait
  • Try to pass on her information to relevant colleagues so she doesn’t have to explain her situation more times than is necessary
  • Offer pain relief if and when appropriate
  • If she is still bleeding or her clothing is soiled when she is discharged home, offer a sanitary pad, net pants, and an incontinence pad (to protect seating on the way home) and anything else that can support her dignity.
  • If she cannot be offered a scan there and then, explain why and acknowledge how she might feel about that
  • Uncertainty is always difficult to cope with and she may find it very hard to have to wait or return for a scan at a later date. She may feel this wait puts her pregnancy at increased risk, so explain gently that sadly there is rarely anything we can do to stop a miscarriage from happening, especially in the first few months of pregnancy.
Couple waiting in hospital

At the time I just wanted to get out of there but now I wish I had asked for more information. I wasn’t told that I would keep bleeding.

Reflection: Improving the couple’s experience

Many women find the experience of bleeding in a public place or a waiting room embarrassing and distressing. Consider the following ways to improve the woman’s experience:

  • She may be frightened about going home and what might happen. She will appreciate information about:
    • what might happen in the meantime if she begins to miscarry: strong, perhaps severe abdominal cramps, heavy bleeding, passing clots
    • explain what she needs to do and who to contact in an emergency, such as if the bleeding is excessive (e.g. soaks more than one pad per hour), if she feels faint or unwell or is unable to cope with the pain
    • what she might see: possibly a recognisable sac, fetus or baby [See Unit 4 for more information about the sensitive disposal of the remains of the baby]
    • how to manage her experience: adequate pain relief, heavy-flow sanitary pads, coming back to hospital if she feels safer there
    • when to seek medical advice again
  • If she has to make decisions about next steps, give her information about options and timing. Allow her time to consider any options and to ask questions.
  • Where possible refer as soon as possible to Early Pregnancy Assessment services or specialist gynaecology support.
  • On discharge, provide her with a 24-hour direct phone number where she can seek help or guidance from someone with experience of caring for women with early pregnancy problems.