Friday, October 24, 2008

Is Doctor Insensitivity After Miscarriage A Universal Problem

There is one place I hate going while I am pregnant and it is my obstetrician's office. And going there while I am having a miscarriage is something I will no longer do if I am miscarrying before eight weeks. I thought that I was the only one who couldn't deal with all the happy moms to be. I've actually asked to have an appointment at times when they aren't doing so many OB checks, been told ok, only to show up to a waiting room full of pregnant women. I have sat in the waiting room crying in full view of the receptionist and nobody asked me if I wanted to wait in the back. They never even offered me a Kleenex. The receptionists just sat there pretending not to see me. I had to tell them to find me a room or I was leaving to get them to do anything.

(And it doesn't help that I also live on a block where there is a full fledged baby boom going on. For a while I even hated stepping out my front door. The only time I would go out into my front yard was to get into my car.)

But I came across this article from the UK's Times Online. Doctor insensitivity seems to be a problem faced by all miscarrying women.


Belinda Benton's second pregnancy was going swimmingly - or so she thought - until she went to hospital, at 12 weeks, for a routine ultrasound scan. “On my way to the appointment I realised that I was bleeding,” she says. “When I got there they said they would go ahead with the scan and see what was happening.”

When the ultrasound equipment was switched on, says Benton, “there was just silence. No one said anything until I said, ‘There's nothing there, is there?' And the doctor burbled and eventually said, ‘No, there's no baby'.”

At least she didn't have to deal with an ultrasound tech who wouldn't say anything at all. If you are having an ultrasound and they won't turn the screen in your direction, it is probably not good news. That is something else I have learned. I know that I can't be the only person who has wanted to see their baby one last time.

For Benton and her partner, the loss of their longed-for second baby was a tragedy - the scan picture showed that the foetus had stopped growing at six weeks - but there was scant sympathy from the hospital staff.

“No one offered any condolences or said they were sorry for our loss,” she remembers. “We were terribly upset, and we had to leave the same way we'd arrived, walking through a waiting room full of women waiting for scans. I felt awful, and the last thing these people needed was to see our devastated faces.”

Benton was told that she could have her uterus emptied surgically - “evacuation of the retained products of conception” or ERPC, in hospital parlance - or she could go home and miscarry naturally. “I asked how bad that would be and they said that it would be like a heavy period, so I thought I'd go home and wait for that,” she says.

In fact, the next few days were agony. “It was horrendous,” she says of her miscarriage three months ago. “It was like a birth. I had painful contractions; it was labour. I almost went into A&E

I have had several miscarriages and let me tell you something. Yes, a miscarriage before 6 or 7 weeks may be like a heavy period, but after that it can be extremely painful. My doctor told me it could take a while and gave me some pain killers. I have given birth twice without having an epidural, and having a miscarriage late in my first trimester hurt almost as much. And there is really no where to turn. If you go to labor and delivery when you are having a miscarriage they often send you over to the emergency room. That is what happened to me when I had my first miscarriage at six weeks when I started miscarrying after my doctor's office closed. I waited over an hour (I know that isn't long in emergency room time, but still.) And then I had to wait several hours in an examining room for someone to come examine me. They rarely came to see about me, and no one even offered me a Tylenol for the pain.

British women are posting about their experiences over at Mumsnet.

“We took up the campaign because we were shocked by the many tales of what can only be described as heartlessness,” says Justine Roberts, co-founder of Mumsnet. “Of course miscarriage is painful and there's no getting away from that, but we feel that a few simple changes could make a big difference to the level of trauma that miscarrying parents undergo.

“For example, some women have told us how they were left, while miscarrying, in antenatal clinics and/or on labour wards, surrounded by pregnant women and pictures of babies. It's very distressing for that to happen, and it shouldn't be happening."

Another thing that has come up on Mumsnet is that doctors' offices and midwives calling to ask why the patient didn't show up for an appointment or sonogram. Can you imagine that happening? I think I would go strangle someone who did that. It's like rubbing salt in the wound. If that's what you get with managed care they can keep it.

Mumsnet has come up with 10 recommendation for the National Health Service (and doctors everywhere should try following them).

1 GPs, early pregnancy units (EPU) and A&E staff should be trained in communication techniques (including things not to say to women who are miscarrying).

2 Access to ultrasound scanning facilities in cases of suspected miscarriage should be easier.

3 Women undergoing miscarriage or suspected miscarriage should be separated from women having routine antenatal and postnatal care, and women terminating an unwanted pregnancy.

4 Waiting times, especially for women who need surgery, should be kept to a minimum and women should not have to wait in antenatal or labour wards.

5 The surgical procedure “evacuation of retained products of conception” (ERPC) should be renamed to be less confusing and upsetting.

6 Women having a miscarriage should have the different options explained to them: “natural” miscarriage; medication to speed up the natural process; and surgery.

7 Where miscarriage occurs in hospital, doctors should discuss with the parents what they wish to happen to the foetus (ie, it should not simply be disposed of routinely).

8 Follow-up appointments and/or counselling should be routinely offered after miscarriage.

9 Information about pregnancy and miscarriage should be held centrally so that all pregnancy-related appointments can be automatically cancelled.

10 Consideration should be given to routine blood tests for any conditions that could cause miscarriage.

I think that #10 could help prevent a lot of PCOS miscarriages. I only found out about PCOS after I mentioned to my son's endocrinologist that I kept having miscarriages. My gynecologist never even mentioned it. She kept telling me something was probably wrong with the babies' chromosomes. I think that I probably would of had a baby by now if I had simply been taking Glucophage to deal with my insulin resistance.

I also think that doctors only want to deal with the happy outcomes of pregnancy. When you have a miscarriage people think that you just should move on because "you can always try again." I no longer tell people that I was pregnant or have had miscarriages, because that very phrase makes me want to slap their face. But it's nice to know that I am not alone in what at times feels like overwhelming grief after a miscarriage.
Also of Interest:
Where To Find Sperm Donors With Adult Photos
God Really Does Hate Me
Future of Sonography
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