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Pregnancy after miscarriage – a nurse’s view

Sarah Bailey, a lead nurse, coordinates the care of women experiencing recurrent 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 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 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.

 

On 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 is also undertaking 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 the often extreme levels of anxiety, limited support was available. It was evident there was a clear gap in care of these patients and this inspired me to undertake my own research in this area.

My research is about investigating the development of supportive coping interventions for women who have had recurrent miscarriages, to use during the early stages of a new pregnancy. From my own observations, care provision in this area is often limited and women are often left to cope alone with any anxiety or worry they may feel.

Self-help cards had been developed previously for women who had undergone fertility treatment, to use during the two week wait period between the treatment ending and the pregnancy test. The cards appeared to sustain women’s ability to cope during the waiting period. Having seen how these cards worked, I wanted to see if they would be useful for women with recurrent miscarriage who faced a similar waiting period between a pregnancy test and a confirmation by scan that their pregnancy is ongoing.

The cards help to remind people to think that even though they are in a difficult situation and are worried about the future, something good happens every day. So, 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. For others, they choose to focus on work as an escape to what is going on in their head. However, this approach doesn’t work for all women and it is important to recognise that everyone is very different.

I’m testing the feasibility of using a self-help card based on positive reappraisal to help women sustain their ability to cope and improve their psychological wellbeing during the early stages of any subsequent pregnancies, a time period they often find very worrying. If it goes well, I plan to run a large scale definitive study.