An Obstetrician’s Point of View: The Devastation of Early Pregnancy Loss

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An Obstetrician’s Point of View:  The Devastation of Early Pregnancy Loss

As an obstetrician, I enjoy entering the exam room and seeing the excited, yet nervous, faces of the newly expecting couple.  I see the wheels turning in their mind.  Will it be a boy or a girl?  Can we do this?  Are we ready?  Seeing the start of a new family or an extension of an established one is one of the best aspects of my job.   Unfortunately sometimes, I walk in the room to sad faces and teary eyes.  All hope and aspirations gone with an ultrasound that shows no heartbeat.  I see the wheels turning in their minds, also.  What happened?  Did I eat or drink the wrong thing?  Maybe I’ve been under too much stress!  What if we can never have a baby?  My first words are always, I am so sorry.  It never gets mundane or become routine.  This should be one of the most joyous occasions in a couple’s life; however, it has now become sad and depressing.

Early pregnancy loss is quite difficult.  From the couple’s standpoint, it’s the end of a dream for that child they had probably been praying for.  They probably had imagined how spoiled and loved this little one would be.  Ideas about the color of the nursery had probably already begun in the crevices of their mind.  They probably went so far as to already have the name picked out.  So heartbreaking.

 From my standpoint as an obstetrician, I grieve, too.  Sometimes, I even cry with them.  Every time, I cry for them.  I wish I could take away the pain and sadness.  I wish I could give a sound medical reason that would take the hurt away.  I wish I could answer that question that every single person asks that experiences this…why?  Unfortunately, when the loss occurs so early, we rarely know why.   Many times, it’s likely a chromosomal defect or a natural error in development.  My answer is always the same.  I tell them that they haven’t done anything wrong to cause such devastation.  I encourage them not to blame themselves, because it is not their fault.  I tell them it’s okay to be sad and grieve, regardless of the fact that they are only a few months along.  For most of us who have had babies, we know the love for our baby starts with the positive pregnancy test.

 Be strong.  To all those negative people that can’t understand why you are so upset, ignore them and say no to their “helpful” advice.  No! You are not crazy for being so sad.  No!  You can’t just get over it.  No!  You can’t just decide to have another baby to replace the one you lost.  

 Allow yourself time to mourn the loss of the child you’ll never feel kick in your womb.  It’s okay to mourn the loss of that first cry.  Weep for the sleepless nights you would’ve been up feeding the little one or changing a diaper.  Weep for the loss of the first crawl, the first step, and the first word.  You, my friend, are allowed to mourn, to be hurt, and to cry.  Please, don’t let anyone tell you otherwise.  You have lost a precious piece of yourself.

 When the mourning is over and you have received closure, know that happiness will find you again.  Be aware that you are not alone.  Pregnancy loss is sad, but it’s more common than people think.  This commonality concerns me at times, because it makes some erroneously think that this is no big deal.  Any woman who has ever suffered in this way knows firsthand the traumatic and emotional impact that such a loss can bring.    You must believe that at your core, you are a wonderful human being and you’re not being punished for any wrongdoing in your life.  Your season will come.  You will never replace the child that you lost, nor will you forget.  And no one should ask you to.  But because of this lost, when you are blessed with a child, you will love a little harder and truly appreciate the gift of life.  Surround yourself with positive people and remember that time heals all wounds.

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  • Pamela Lacy
Comments 2
  • Tina
    Tina

    While this is a great note on how the OB feels…and has some good “you are not alone” sentiments, lately it falls flat for me…especially that time heals all wounds, both because grief never really lessens in my opinion, we just adapt to carry it…but more because so much loss could be better studied and prevented.

    At this point I’ve been a member of the loss community for 9 months, since my daughter was stillborn in February, and there ARE things that doctors can do.

    My frustration is that in loss boards and blogs we can see repeating patterns that may answer some of the medical communities “we don’t know why” thoughts, but we are not often heard.

    The following are real issues in consistency and best practices, in my (not a doctor) opinion, but especially in more rural areas, or if a patient has poorer insurance, are not followed:

    If a woman has early bleeding, an OB should investigate. There are lots of reasons that are treatable (or at least diagnosable) if an office just takes the time to check. To simply be told, “You are either miscarrying, or you aren’t” isn’t helpful to any patient, and doesn’t add any other data to the pool for future research.

    When an OB does investigate early bleeding, they should do so in a comprehensive way and consistent way, by checking progesterone, betas, and doing an ultrasound. I can’t even tell you the amount (hundreds to thousands) of stories I’ve read of women whose pregnancies could have been saved by early progesterone testing. Instead, many OBs won’t even check progesterone until at least 2-3 previous losses. It doesn’t make sense to me, as the out of pocket for the test ranges from $70-$100, and the treatment is a prescribed suppository…if you consider an embryo a life (which is granted, a touchy subject…I’m not even sure where I stand on it) that is one of the cheapest “life saving” tests available for any condition…it’s cheaper than even doing a strep culture in most places.

    In addition, community driven loss data seems to say that issues due to subchorionic hematoma are far more common than previous studies imply. This may be because some OBs refuse ultrasounds (the only place an SCH can be spotted) until it may be too late. It is problematic that some OBs will give US at 6 weeks, some at 8, some at 10, and some not until 12, even with extenuating circumstances like spotting or weird discharge.

    Doctors should define a best practice for early pregnancy testing. Some women’s doctors won’t officially call them pregnant unless they show increasing HGC levels over at least two tests. Others say, “If you peed on a stick, and it said pregnant, you are pregnant.” While others want their own urine test done in office.

    More studies need to happen for both maternal and fetal health. The problem in the US is that most of these studies won’t be funded in the same way a commercially viable “product” would be. Pubmed has less than 200 studies on SCH. Pubmed has over 6000 studies on viagra.. If funding just won’t free up for things like the value of maternal bedrest in certain situations, or best practices for nutrition, because there isn’t a sellable prescription involved, then more community provided data sets need to come into play. Things like the ongoing self-submitted Harvard study on antidepressant and antipsychotic drugs during pregnancy. While drugs will never be tested “on” pregnant women, there are thousands for whom their current treatment plan on category C drugs is deemed the best course of action, who are willingly providing their medical data to see if there are trends or issues with any of these specific mess.

    In this time of big data, when Facebook can ad retarget you with that lamp you saw at Sears, and Google can track demographics of a website including age, interests, and cross sell cohorts, it is immoral that big data hasn’t been truly applied to finding common medical patterns. Now that 23andme has FDA approval, I am hoping they and other companies can serve a gap that traditional medical research and publications are missing. There ARE patterns, and there ARE often things,that can be done. Medical OBs need to stop saying “I’m sorry” and start saying “How could this have been prevented.”

  • Toni Hill
    Toni Hill

    Thank you so much Dr. Lacey for this post. As a mother who has lost, and one who has supported many other women through a loss, it is comforting to know that at least one (I’m sure there are others) of the people on the other side understand those feelings. It can’t be easy to see so often and to be the person who has to “bear” the news. Thank you! You are a blessing to many..

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