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A nurse’s view

Dr Sarah Bailey, a lead nurse, coordinates the care of women experiencing recurrent miscarriage. Here she shares a nurse’s view on pregnancy after a loss.

Pregnancy after miscarriage

Here, Sarah shares her thoughts about what can help during pregnancy after miscarriage:

When you have had a miscarriage you really have to pluck up courage to try again. While you are excited to find out you are pregnant, it is often very quickly overtaken by severe worry that you will miscarry again.

I want to say to everyone who is pregnant again following a miscarriage that the anxiety and sometimes mixed emotions you feel about the pregnancy are completely normal.

When couples have experienced multiple losses they often don’t tell people they are pregnant again. The challenge here is that it leaves them with all these thoughts and feelings going on in their head and no one to share it with. It doesn’t help that people are sometimes advised to not speak about a pregnancy until they have reached the 12 week mark. This can make people feel quite lonely. I think talking about your concerns to understanding friends and family can help people to feel more supported and less isolated.

I sometimes suggest to my patients they write down how they are feeling. If the pregnancy continues, hopefully they will see an improvement in how they feel about the pregnancy. If the pregnancy doesn’t continue, at least they have something that acknowledges the pregnancy existed.

It helps to have a health professional who is aware of your background and understands that the next nine months will be difficult. Peer support can also be very valuable. Many of my patients have found the online forums and private Facebook page run by the Miscarriage Association supportive. It can help to talk to people who are going through a similar experience.

When a woman becomes pregnant again following recurrent miscarriage the worry about pregnancy can overtake everything, so it is important to try and take pleasure in something, no matter how small. I advise my patients to not to give up the things they enjoy doing as that helps to root them into everyday activities.

It is really important that you try not to be hard on yourself. Some women may feel guilty that they may have let your partner or others down – but this is not the case.

I know many people do want regular reassurance scans, especially if they have had a missed miscarriage. Some people do get upset if they have experienced one miscarriage, but are not offered a reassurance scan. This is understandable. I see how reassurance scans can help and gives people a milestone to work towards. However, the challenge with reassurance scans is that the anxiety and concern can quickly return after the scan.

It is going to be a challenging time for couples. That is why it is important to recognise how you are feeling is completely normal, and do let the healthcare professionals involved in your care know how you are feeling so they can try to support you through it.

Recurrent miscarriage

As a nurse, there is nothing I can do to influence the outcome of a pregnancy. I can’t promise anyone a healthy baby at the end of nine months, although when no cause for the recurrent miscarriage has been found then the chances of having a successful pregnancy are good. However, I can recognise the waiting is long and help women find ways to help manage that waiting and sustain their ability to cope. I always try and be honest about what I can and can’t achieve.

Naturally many who have experienced miscarriage want answers. Sadly, once we have done the few investigations we can, we are often left with no real answers to give them. When you can’t find a cause or reason it is natural to search for one yourself online. Sadly, there is still much information online that is clinically unproven or unfounded. That is why access to good, accurate information is so important. I always direct my patients to look at the Miscarriage Association leaflets because they are accurate and do not provide false hope or promise.

Sarah’s research

Sarah has also completed a PhD in developing supportive care for women with recurrent miscarriage.

In 2009, I began working in Southampton as a research nurse and this involved working on a research study investigating a potential treatment for recurrent miscarriage.

When women became pregnant again following miscarriage they often felt extremely anxious, worried that they would experience a further miscarriage. Yet despite their extreme levels of anxiety, limited support was available. There seemed to be a gap in care of these patients.

This inspired me to undertake my own research in this area, developing and testing supportive coping techniques for women to use during the early stages of a new pregnancy.

Self-help cards based on something called ‘positive reappraisal’ have already been developed for women who had undergone fertility treatment. They were given to them to use during the two-week wait period between the treatment ending and the pregnancy test. The cards seemed to make women more able to cope during the waiting period.

The cards help remind people that even though they are in a difficult situation and are worried about the future, something good happens every day. They work by encouraging people to look at the good as well as the bad in this challenging situation.

For some women, it has encouraged them to take pleasure in the things around them, perhaps their relationships with friends and family, or for some of my patients – their pets. Others choose to focus on work as an escape from what is going on in their head.

Of course, this approach doesn’t work for all women and it is important to recognise that everyone is very different.

I wanted to see if the same approach would also be useful for women who are pregnant again after recurrent miscarriages. These women faced a similar waiting period between a pregnancy test and a confirmation by a scan that all is well in their pregnancy.

47 women were randomly put into two groups after they reported a positive pregnancy test. Both groups were given a weekly questionnaire to monitor their wellbeing and a weekly record-keeping form. One group was also given the Positive Reappraisal Coping Intervention (PRCI) self-help cards and information on how to use them.

I compared the results from the different groups and found that people were open to using the PRCI and that using it seemed to benefit them. There did not seem to be any downsides to using it.

It would suddenly be five am every morning and I was waking in a complete panic, that’s the only way I can describe it, then I would have a cup of tea and read the card and think right, OK just calm down.

I also found that people found it useful to use the questionnaire to reflect on how they were feeling each week and any difficult emotions. It also helped them reflect on the progress of their pregnancy.

When I actually sat down and really thought about each [statement] very carefully, it made sense and helped me think about these things.

Now this study has been completed successfully it has shown the potential of using this technique. I will now be running more studies to investigate how it can form part of a supportive care package for women who are pregnant after recurrent miscarriage.

You can read the full study here and about my other work research on pregnancy after recurrent miscarriage here.