Our helpline: 01924 200799 Mon-Fri, 9am-4pm

Accident and emergency

Caring for women and their partners experiencing pregnancy loss*

* miscarriage, ectopic or molar pregnancy

A note of caution  This film includes scenes and conversations that some viewers might find upsetting, especially if they have been through pregnancy loss themselves.  You may prefer just to use the good practice guide alone.

I knew you couldn’t stop it, but you could still help me get through it.

Our good practice guideae1

From a medical perspective, miscarriage is a common and generally minor complication of pregnancy but for patients and their partners it can be distressing, frightening and lonely.

If they have come to A&E they may be bleeding heavily, in pain and very frightened for their baby and perhaps for themselves.

You’re unlikely to be able to change the outcome of this pregnancy, but your approach can make a positive difference to the patient’s experience.

We spoke to patients and A&E staff about what helps and what makes things harder. Here’s a summary of what they told us.

 

Listen to the patient and her partner

Taking a good history includes listening to additional information that the patient (and perhaps her partner) gives.

Not only can it aid diagnosis, but good listening can also makes patient and partner feel respected and cared for at a vulnerable time.

If a woman of child-bearing age presents with acute abdominal pain, ectopic pregnancy should always be considered, even if she does not know if she is pregnant.

Consider how she might be feeling

Whatever the patient’s situation, she is likely to be very distressed and anxious and see this as an emergency requiring urgent intervention.

You might not be able to meet all her expectations but understanding, kindness and acknowledging her feelings can make her situation easier to bear.

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

Give whatever practical support and care you canae5

Think about your language

It may have been ‘products of conception’ to them, but to me it was my baby.

When it comes to pregnancy loss, women and their partners are often acutely sensitive to the words you use. They may not understand some medical terms. The language you use should be clear, sensitive and understandable to the average lay person.

Give her clear, honest information about what is happening now…

A&E staff have told us that it can be difficult to give clear information without access to scanning facilities and/or specialist staff. However, anxious and distressed patients may not understand that and might think you are withholding information.

I wish they had been honest with me instead of saying ‘it’s probably fine’.

… and about what might happen next

I had no idea I would get contractions and it was scary as hell.

ae3As you saw in the film, 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 your patient’s feelings and explaining more about processes and next steps.

 Got more time?

These additional resources might be helpful.

E-learning module Sensitive communication and breaking bad news produced by the Association of Early Pregnancy Units in association with the Miscarriage Association (this requires a subscription).

A short teaching video on ectopic pregnancy, by Professor Tom Bourne (courtesy of BMJ Learning).

Have a look at this example of good practice on Patient Opinion.

Take a look at the Miscarriage Association’s leaflets Your feelings after miscarriage and Management of miscarriage: your options.

View other films in this series.

Consider your needs too

Working in A&E can be hugely rewarding but there’s no denying that it can also be very stressful.

I find it very difficult breaking bad news without the appropriate privacy.  The patient is usually very anxious and upset.

Patients who attend because of suspected or obvious pregnancy loss are unlikely to be viewed as emergencies. By the time they reach you, their levels of anxiety, distress and possibly pain may be very high. You might encounter some difficult emotions not only from the patient but also from anyone accompanying her.

We hope some of the following suggestions will help – for miscarriage patients and perhaps others too.

Identify the difficulties

These may include:

Identify your sources of support …

Your most likely source of support will be your peers:

You might also consider:

… and make use of them

It’s one thing to know where you can find support. It’s another thing to do something about it. It’s worth considering that your peers may have similar concerns and might also benefit from talking about these issues together.

 And finally

Miscarriage is never easy – for the woman or couple involved or for the staff who are tasked with looking after them. You may not get it right for everyone, but patients will always remember your care, kindness and compassion.

To the doctor I saw at 7 am who couldn’t do much until the EPU opened, thank you for finding me a quiet room to wait in.

We really need your feedback