Talking about miscarriage Ruth Bender Atik The Miscarriage

Talking about miscarriage Ruth Bender Atik The Miscarriage Association Early Pregnancy and Emergency Gynaecology Joint RCOG/AEPU meeting 18 March 2016

Declaration of Interests The Miscarriage Association is a charity registered in England & Wales (1076829) and in Scotland (SC 039790). It is funded by a combination of donations, grants, sales and fees. RBA represents the charity on the executive groups of the Association of Early Pregnancy Units and the Early Pregnancy Clinical Study Group; and currently serves on Trial Steering Committees for the PRISM, TABLET, RESPONSE and AIMS trials. There are no conflicts of interest.

A non-viable … like a heavy period That’s fine – all the products have passed It’s my baby … like labour It’s NOT fine. “Products”? ?

Possible feelings This woman/couple • Relief • Regret • Acceptance, moving on This pregnancy This loss

Possible feelings This woman/couple This pregnancy This loss Relief Regret Acceptance, moving on Shock Confusion Distress Grief Anger Denial Seeking reasons Guilt Blame Anxiety: about trying again when pregnant

Language & terminology Should be: • • accurate clear understandable sensitive Non-viable Products Blighted ovum Incompetent cervix Evacuation/Evac Fetal pole Molar Baby Fetus Embryo Pregnancy Tissue

Accurate Information “Nobody told me what it would be like” “All these [management] methods are unhappy experiences to go through. But if you feel informed with the correct information then at least you have some control of a situation where you feel horribly out of control. ”

Good care… Kindness, compassion, empathy in this pregnancy and the next. “I couldn’t enjoy it – I was anxious all the time and all I got was ‘no need to worry, everything’s fine’. I’m four days overdue now and I want this baby out NOW. Until he’s here I’m still worrying. ”

Others are talking too It’s God’s will… Nature’s way There must have been something wrong with it At least it happened now At least you have your daughter You’re young – you can try again

Talking about miscarriage Remember it’s not the same for everyone Consider the possible/likely impact Be aware of the effect of shock/distress Mind your language: • Think how you’d want this said to your partner/sister/best friend/yourself • Explain terminology and avoid the worst offenders • Echo/reflect the patient’s language: baby/pregnancy/fetus etc • Be clear, accurate and honest • Offer written information where possible – if it’s good! • Remember the needs of patients with barriers to communication Signpost to next steps: within the NHS and beyond it.

www. miscarriageassociation. org. uk