‘Little support’ for women emotionally following miscarriage: Expert

Evelyn Lewin

21/02/2020 10:32:36 AM

Pregnancy loss can lead to significant grief and trauma, but the emotional aftermath often remains under-acknowledged, according to one expert.

Sad woman
Pregnancy loss can lead to significant grief and trauma for women, with an expert lamenting the focus on physiological, rather than psychological, outcomes.

‘The memory of our motionless baby boy on the ultrasound screen awakened me in the middle of the night. I squeezed my eyes shut repeatedly, but I couldn’t escape the image.
‘My body ached, my heart raced and tears streamed down my face until they led to uncontrollable sobs, eventually waking my husband.
‘I cried until morning.’
That is American author Katie C Reilly in a recent story she wrote for The Washington Post, detailing how she spent her first night after she miscarried at 12 weeks’ gestation.
While her experience was clearly harrowing, Ms Reilly also shared her frustration about how her emotional needs were addressed.
‘After my miscarriage was handled medically, the effect on my mental health also needed attention,’ Ms Reilly wrote.
‘But no follow-up appointment was offered, and there was no acknowledgment of the intense emotions that rock many women who have miscarried.’
Sadly, Ms Reilly’s experience may also be happening here in Australia, Dr Nicole Highet, Doctor of Psychology and the Founder and Executive Director of COPE (the Centre of Perinatal Excellence), told newsGP.
‘At the moment, I’d have to actually agree with the article that there is little support,’ she said. ‘Our own research, and that of many consumers, reveals that women do not feel that they received the emotional support that they needed at the time of experiencing a miscarriage.’
Dr Highet is quick to note this does not necessarily relate to GPs specifically – but encompasses health professionals more broadly. She believes there is a sound explanation for this situation.
‘Often health professionals view [miscarriage] in the context of something very physical, what’s happening physically, but there are not so many links to emotional support,’ she said.
Dr Highet said this may stem from mistaken beliefs surrounding early pregnancy loss.
‘Quite often there’s a perception that because it’s common, it’s not that serious, it’s just a normal process,’ she said. ‘And often the emotional and psychological impact hasn’t really been recognised.’
Dr Wendy Burton, Chair of the RACGP Specific Interests Antenatal and Postnatal Care network, has a different perspective on the situation in Australia.
While saddened by Ms Reilly’s story, she said it would be unlikely for women in Australia to be unsupported following pregnancy loss.
‘We actually have better systems in place here in Australia,’ she told newsGP.
‘For example, Medicare has the three visits for a psychologist that you can use for pregnancy-related matters … and they can be used for women who had a pregnancy-related loss, or a variety of other things.’
Dr Burton said her local tertiary centre also follows up with phone calls and letters after seeing a patient who has experienced pregnancy loss, proactively asking her to consider referring the patient for further care.
The NSW Department of Health states all health professionals ‘must provide support, follow-up and access to formal counselling when necessary’ after a pregnancy loss. However, it concedes that ‘unfortunately this does not always occur’.

Dr Nicole Highet believes the trauma of miscarriage is often exacerbated by lack of empathy.
Dr Highet believes it may be common for women to slip through the gaps during this emotionally turbulent time. She believes GPs play a key role in helping address that issue.
‘The number-one thing is to be aware and be mindful not just to focus on the physiological side with the woman,’ Dr Highet said. ‘It’s really important that GPs acknowledge the loss that the couple is experiencing, and be aware that those reactions might be very different from one couple to the next.’
Not only will this help a woman feel heard, Dr Highet said, it can also impact on how she recovers in the aftermath.
‘The trauma of miscarriage is often exacerbated by the treatment or lack of empathy by health professionals,’ she said.
‘So it’s really important that health professionals acknowledge [a patient’s] loss, saying simply that they are sorry this has happened.’
Dr Highet said GPs should also ensure women receive adequate follow-up.
‘Following up and checking in with that woman, just to see how she is coping after the loss and making sure there isn’t ongoing anxiety or depression in the weeks after the miscarriage,’ she said.
Such support needs to continue in subsequent pregnancies by ensuring psychosocial screening is taking place, which can detect signs of anxiety and depression that may have stemmed from a previous miscarriage, Dr Highet said.
While concerned about the possible lack of emotional support, Dr Highet said there are a number of resources available to help guide women following a miscarriage. These include her own organisation, COPE, as well as Red Nose, SANDS and Pink Elephants.
Dr Burton has also addressed these issues on her blog, Maternity Matters, which includes guidelines for clinicians for dealing with the psychological aspects of dealing with perinatal bereavement.
While she is pleased to report that Australia has systems in place to help women emotionally after a miscarriage, Dr Burton said they are not foolproof.
‘I’m absolutely sure some women won’t receive appropriate care, because it depends on who you see on the day,’ she said. ‘But we have systems in place.’
Such systems may have made a significant difference to Ms Reilly’s experience.
‘Nothing can take away the pain of a miscarriage,’ Ms Reilly wrote.
‘But recognition of the known mental health consequences by all medical providers is an important start.’
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A.Prof Christopher David Hogan   25/02/2020 2:01:30 PM

It is nice to see a proliferation of resources but of course as usual as it should do, the main burden falls on GPs.
As a father, I can definitely say that it is the couple that mourns, not mothers alone. We have four children but my wife had 5 pregnancies. Many is the time after that miscarriage when I found my arms empty, holding a baby that was not there. I mourned not for a lump of cells but one who might have been. I will always be grateful to those who supported us.