Emergency Rooms Must Get Better At Supporting Pregnancy Loss

Up to 25 percent of known pregnancies end in miscarriage. For many women, the experience of a miscarriage is hard on their body and their heart. Intense sadness, disappointment and broken dreams accompany the physical pain of the loss. The emergency room is the last place most people want to be when they’re losing a pregnancy. Unfortunately, our bodies don’t always wait for standard OB office hours to betray us.

My first miscarriage started in the bathroom at a funeral home. When I walked into the service, I was pregnant. When I left, I wasn’t. It felt like a cruel and ironic place to lose the baby I desperately wanted. Everyone around me mourned the life we were there to remember; I was devastated by the loss of a life everyone would soon forget. It was horrible timing.

I’m not the only one whose body didn’t wait for a convenient time to end a pregnancy. Many women find themselves dealing with the loss at a time when their only option for medical care is a hospital emergency room.

In an article for Parents.com, writer Risa Kerslake explores the problems with the way many emergency rooms handle pregnancy loss. A Minnesota woman named Kaylee Allen shares that she went into the ER for a first trimester miscarriage. For over an hour, she sat in an ER room, bleeding onto large bed pads, assisted only by her own cousin. She was largely ignored by the nursing staff, until a doctor finally came in to confirm her miscarriage

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According to the article, “The ER is a terrible place to receive bad news.” And many doctors know it. Dr. David Gatz, an emergency room doctor in Baltimore, acknowledges, “As routine as a concern for miscarriage may be to the emergency department, this is a major moment in this individual’s life.”

We can’t totally blame the ER staff for failing to handle our emotional medical situations with the level of gentleness that we need. They see hundreds of life-altering emergencies a day. They also have to handle situations that don’t actually require emergency medical care — upwards of 5 percent of ER visits are completely non-urgent.

It’s necessary to treat a woman who loses her pregnancy with gentleness and understanding, no matter where she receives her care.

It’s a lot to ask. I can only imagine how hard it must be for emergency room doctors and nurses to let themselves feel deeply for every patient. It has to be one of the most draining parts of an already difficult job.

But it’s still necessary to treat a woman who loses her pregnancy with gentleness and understanding, no matter where she receives her care.

Anita Catlin, R.N., Ph.D., has been researching and developing guidelines for post-miscarriage care in emergency settings at Kaiser Permanente in Santa Rosa and Vallejo, California. She warns that adequate medical care after a loss isn’t always enough. We need to address the mental toll of pregnancy loss in the ER, as well.

“If grief is addressed, patients can avoid mental health issues, such as anxiety and depression, that are also commonly seen when women and families are unable to process these losses,” says Catlin. “If left untreated, these can lead to long-term mood disorders, future perinatal complications, and even thoughts of suicide or self-harm.”

So, what can emergency rooms do to take better care of women during pregnancy losses? In addition to following some of the newest guidelines suggested by the Emergency Nurses Association, more hospitals could take a cue from Tristar Centennial Women’s Hospital in Nashville, Tennessee

Centennial has a dedicated women’s ER, staffed by OB/GYN doctors and nurses. It is a lifesaver in situations like miscarriage and other gynecological emergencies.

Just a few days before Christmas, I went to Centennial Women’s Hospital to have a D&C for a missed miscarriage. I desperately wanted my pregnancy, and I already felt a profound love and connection to my tiny baby. When I arrived at the hospital, I was deep in grief. My husband had to do most of the practical things, like signing us in and providing insurance information.

Every person who knew why I was there offered me their condolences, and acknowledged my feelings of loss and pain as valid. Whenever I began to cry, every member of the staff was tender and kind to me, encouraging me to take all the time I needed. The atmosphere was almost reverent in my room. Everyone knew I was mourning, and they respected my deep sadness.

The procedure itself went well, but I had some minor complications afterward, and had to return to the emergency room.

When I returned to the ER to address the bleeding, the staff again acknowledged my grief. The doctor I saw told me he understood how scary it must be. He assessed my blood loss, told me what to do, and assured me that I was going to be okay. The nurse who helped me check out told me when to return and what I could expect moving forward. She encouraged me to come in if I started to feel anything close to concern. I felt respected and supported the entire time.

Conversely, a mom named Jolene Shasky went to the ER for heavy bleeding after a D&C and was “told to take a medication that would pass the remaining tissue from her body but wasn’t given any information on what to expect from it, both physically and emotionally.”

My compassionate, positive ER experience should not be the exception. Pregnancy loss might be a common medical occurrence, but for many women it is a profound, traumatic loss. It comes with whole range of emotion. Even if a hospital doesn’t have a dedicated OB emergency room, taking care of a woman’s mental health during a miscarriage should be as much a priority as her physical safety.

I have huge respect for doctors and nurses who care for our bodies in our most serious medical situations, but even the very best care providers can benefit from taking the time to give miscarriage in the ER some more thought. If they can evaluate ways to integrate more emotional support with the physical miscarriage care, thousands of women a year would benefit greatly.

Adequate medical care after a loss isn’t always enough. We need to address the mental toll of pregnancy loss in the ER, as well.

It could be as simple as asking a miscarrying woman how she’s doing. If a woman expresses that she is handling her loss without a lot of grief or pain (a totally valid and not uncommon response), a matter-of-fact approach is appropriate. For those of us who feel our losses deeply, careful emotional care is crucial.

“[Doctors addressing the emotional side of miscarriage] wouldn’t make the loss easier,” says Shasky. “But it would really have helped to have somebody who cared. Most people I know who’ve had a loss, it’s a been a big deal.”