that’s terrible

Then what was it, a grape?

A psychiatrist told someone to tell me not to get to know my daughter (with anencephaly) because she “wasn’t really human.” I want to know what they’re teaching in genetics nowadays, because the product of a human egg and a human sperm should be human offspring.

that is a punch to the nuts offence. how dare he???

That is FOUL. Reminds me of my early miscarriage, when I still had a shred of hope that the pregnancy was okay…my dr waltzed in with the second day of hcg level tests, GRINNING like it was Christmas morning. My hope rose up, and then he said “Yeah, you’re miscarrying.” I thought I was going to throw up, he had me so freaked out. Bastard.

Either these doctors are just completely without a soul, or they think they are trying to make the mother feel better. Either way, they really need to train these people better to deal with such things.

There is a whole lot of creepy lack of understanding and compassion about miscarriage–or grief in general, for that matter. I glanced at a “secrets from two L&D nurses” book from the 80′s, and it said “If your baby is going to be stillborn, you will be heavily sedated.” In other words, because WE don’t want to deal with your grief, we’ll drug you so you can go home and then deal with the double whammy of losing a baby and not being mentally present to say goodbye. Blech.

this makes me so very sad. i miscarried in june and i am having another one as i type this. that complete lack of compassion and calousness is just horrible. it makes me glad that i will be going with a midwife and a home birth when i finally get a sticky pregnancy.

Just reading this makes me want to cry. As a matter of fact, I am crying. I miscarried at 13 weeks. On the u/s that confirmed my miscarriage I saw a very clear image of a still baby. It was devestating. To have someone tell a pregnant woman it wasn’t really a baby is heartless and cruel to the extreme.

I had several people say comments like this in some lame attempt to make me feel better. My mom even suggested that I needed to go on antidepressants because I was still upset about it a week later. Hello! It was normal grief, not depression.

My heart goes out to the mom that this was said to.

My heart also sincerely goes out to the mother than heard this. How awful. I sure the doctor probably thought this was an attempt to make her feel better (or maybe him/herself, and emphasis on “make”) but… what a terrible bedside manner. You can’t brush off grief like this with such a complete lack of sensitivity. And not out loud.

Ugh, this makes me want to scream/cry/punch someone.

When I called my former MedWife during my 12 week miscarriage to ask if the amount of pain I was in was normal, she had the nerve to ask me “Why are you crying so hard?” Hmm, maybe it’s because I’m losing my baby, in an enormous amount of pain, on Christmas day. Idiot.

There needs to be lessons in COMPASSION!!!

I’m not trying to bring up a debate, and I’m not trying to diminish how this mother felt when this doctor said this, but in today’s world, doctors don’t believe they are babies until they are born. It goes back to the idea of when a baby becomes a “baby” vs. being a “fetus” In his mind, he actually probably believes it wasn’t a baby, so in his ignorance, he spoke words to a woman who felt, in her heart, that it was a baby. I hope this woman has some people in her life who know and realize it was a baby to her and can help her through the callousness of this doctor.

There are no words…
There was a baby in there, Mom. And he or she will always be your baby.
Doc, sometimes silence is better than words.

I had a nurse say this on the phone when I had a second miscarriage in a row. I reported her to my OB and I really appreciated that my OB said, “but it was your CHILD.”

The lack of understanding in medical circles is frustrating to me. I think more needs to be done to train these people. A mom is not “depressed” or “obsessed” when grieving a child, she’s in a natural state of motherhood. The way a woman is treated when miscarrying/after miscarriage goes a long way to helping her begin healing. Just like the way she’s treated in birth…these moments and comments stick for life.

I lost my BABY at 4 weeks 6 days and had to flush it down the toilet. It was gut wrenching. My children have been my children before they were even conceived, so there’s no saying that wasn’t my baby. I’m sorry to anyone who’s been told otherwise at any stage of pregnancy, no matter the health of the CHILD.

Hell, it was heartbreaking for me when I had my chemical pregnancy. There are a lot of hopes and dreams that come with a positive pregnancy test for many women. To not acknowledge that a loss was suffered for any women who wanted a baby that turned out not to be is cruel.

This was a horrible thing to say. Talk about compounding the woman’s grief! Anytime anyone tries to make someone ‘get over’ grief prematurely, or explain why the person shouldn’t be grieving, its just going to add guilt and shame to the equation (even if the person logically knows their feelings are perfectly normal and appropriate!).

Telling someone that they have lost a baby is the hardest part of my job. I recognize that as soon as most woman knows they’re pregnant, the baby very quickly becomes real to them and plans start being made and its life mapped out. I have been amazed at the emotion associated with the loss of even an undesired pregnancy, so clearly a planned pregnancy loss can be devastating.

I always try to make it absolutely clear what the situation is, without using any euphemisms, then expressing my sympathy for their loss.

After this I stay in the room and allow the family to grieve, but try to avoid going into details about options, other than to let them know that nothing needs to be done emergently. (Similar to getting a bad diagnosis like cancer, little is heard after that first word.) I let them know I am available if they need to reach me, and schedule an appointment for the next day.

Are there any words that would be particularly helpful when informing someone of an inevitable miscarriage or fetal death? (From the above comments, it is pretty clear what not to say.)

Appreciate your input, as it will help me with other women down the road.

If you don’t know what to say, it’s better not say anything at all. Even telling the parents that you aren’t sure what to say is better than using some cliche phrase that is likely to hurt them at this fragile stage.

Dr. Dorn,
It sounds like the way that you handle telling a woman that she is miscarrying or that her baby will be stillborn is very appropriate. There is little that you can say that helps, but simply acknowledging the loss of the baby and being available when the woman/family is ready to start asking question and saying “I’m sorry” is about all you can do. Also, be sure that your office staff/nurses know so that they aren’t joking with each other and laughing around the woman. It’s hard to hear people being happy when you are having the worst day of your life. I lost my son at 26 weeks and when I gave birth to him, I had an amazing doctor who spent as much time explaining things to me (and then to my husband when he got there because I couldn’t remember anything). My nurses were amazing and compassionate.
I think a really important thing to know is what not to say. From the time that woman saw two lines on that home pregnancy test, she has been dreaming of this child and of being a mother and when that child is lost, no matter how early, all those dreams are lost too. No woman wants to hear that the child that she loved so much was not actually a baby, or that it was God’s plan, or that she is young and can have another one. Thank you for being one of the doctor’s that helps me put my faith back into OB’s and for caring enough to ask how to handle the situation.

I was just given a little piece of paper that explained in cold black and white terms what to look for to seek more treatment and sent home. No words of sympathy, just the medical people trying to stay away from me.

When I nearly lost my second daughter, it was different. I was told that they’d do nothing to save her, because I still had 3 days before I was 20 weeks (when they would try to stop labor), but the doctor actually took my hands and gave me honest, heartfelt sympathy. She didn’t offer platitudes or try to avoid my emotions, but acknowledged my fear, especially since I’d lost two before. Thankfully, that pregnancy didn’t end there, but I don’t understand why I couldn’t have the same treatment for the baby who actually died when I went in. With my second miscarriage, I didn’t even bother going in. There seemed no point with it happening so early, considering.

Dr. Dorn,
Since we have a doctor reading this now, can I ask a question?
I’m curious, why do some caregivers treat emotion and pain so lightly? Don’t they realize that emotion and pain (good kinds AND bad kinds) are part of pregnancy?
It sounds like you didn’t lose your heart when you took the oath, and I thank you for that, but maybe you can tell us why some of your colleagues do?

Dr. Dorn,

My OB said very kind and compassionate things when I had my first miscarriage. The problem? She started in on the same speech when I had my second miscarriage and both my husband and I realized it. I would caution any physician to refrain from formulating a speech that is whipped out for the occasion. I think the best thing you can do is attempt to understand what a woman is going through and then speak from the heart to each woman even if its a simple apology. I wrote something recently intended for people who had not experienced a miscarriage but knew someone going through it. A lot of women I know have used it to discuss their losses with family and friends. I hope it helps: http://connectedmom.blogspot.com/2010/02/truth-about-pregnancy-loss.html

My daughter was stillborn last March when I was between 20 and 25 weeks, and I didn’t know I was pregnant until I ended up in the ER with blood pressure of 220/110 and severe back pain (I had HELLP syndrome). My nurses and doctors were wonderful. Every time they asked how I was doing, they also asked my boyfriend how he was doing. One of the doctors in the ER told me “You aren’t a bad mom just because you didn’t know you were pregnant.” This line didn’t mean much at the time, but was so important to me as I dealt with grief and guilt in the months following. My doctors and nurses really included my boyfriend in the experience, since even though he was not a patient he was still a parent experiencing the loss of his child. They answered every question we had in detail, and regularly asked if we had any questions.

One suggestion I have is to make sure that ALL staff is aware of the situation. Though there was a sign on my hospital door (with a photo of a fallen leaf, which I really like) to let people know, I still had a phlebotomist wish me luck with my baby, a hospital volunteer bring me a toy for my baby and a hospital chaplin ask when the baby was due (a CHAPLIN! Her only job is to be sympathetic! Not to mention that my records indicated that I did not wish to speak to any religious figures about my experience while in the hospital.) When I told her that my daughter was stillborn a week prior, she asked if she could stay and pray with me. I said no.

I am currently in nursing school and hoping to work in th OB Special Care Unit where I was a patient so that I can help provide the passionate care that I received. I truly believe that the treament I got helped so much in dealing with my loss.

Thank you so much for asking how to deal with this delicate situation properly. It will never be easy, and there is no “right” way to do it, but if you are sincere and sympathetic it will mean the world to the grieving family.

Sasha: The best thing to say is “I am sorry for your loss.” There’s not much more than that. Because even if the mom hasn’t attached to the idea of *baby* yet, it is a loss of *potential*, of *possibility* – loss is loss.And I think it’s lovely that you care so much about your patients. It’s nice to know that when we need a doctor there are still good ones to be found.

I agree, with my blighted ovum pregnancy (lost at 11w), my DH and I were not so much grieving the loss of a child…as it never even reached the embryonic stage of development, and there was nothing in my uterus except placenta…we were grieving the loss of potential, the fact that we had thought we were pregnant for so many weeks, etc.

The nicest thing said to me was, “I’m sorry this happened to you”. I had phoned my Dr’s office and her assistant said that to me after she booked my appointment. My doctor was very kind and simply said that she felt the best thing we could do to heal, since she knew we wanted another, was to resume trying.

Also, if you can, avoid having her close to other pregnant women or babies, by either having her in a hospital room as far as possible fromt he nursery, or letting her leave your office through a side door. Some women just can not handle that.

Johanna: I’m thinking of a few more things reading other posts. When she has follow-up appointments, arrange somewhere for her to wait other than in a waiting room full of pregnant women and happy new moms with their babies. A week after I delivered I had an appointment and sat in the waiting room sobbing at the cooing noises coming from a pink stroller across the room, until my boyfriend told the receptionist that we would be in the hallway when the doctor was ready. If possible, try to schedule her appointments in a room where she won’t hear a crying baby (a room next to offices or other pregnant women, not new moms).
If the baby is stillborn, let her hold the baby and encourage her to name him/her. She should spend as much time as she wants the her child, as should her partner or any other family members (it was very important for my mom to grieve the loss of her grandchild as well.)Refer her to support groups or an individual counselor with training in grief counseling. Also, find out if there is a Now I Lay Me Down to Sleep photographer in the area (nowilaymedowntosleep.org). These professional photographers are trained in taking beautiful photos of “sleeping babies” which are a great tool for healing when the parents are ready. I so appreciate the experience I had with my photographer.

YES, YES, YES to all of this!

I try to picture myself in the patient or family’s shoes and think of what I would like someone to say to me in that situation. (I’m a nurse.) Try to keep it short and sweet and let them talk about it if they want to, but don’t pressure them to talk about it if they don’t.

From the second we pee on the stick and a plus sign appears it’s a real baby to us and we are attached! It’s not JUST the proper formation of a human life that makes it real – it’s the hopes and dreams you have for that life the second you know you are pregnant.
I’ve suffered a loss through a 31 week stillborn, a 13 week blighted ovum loss and a 5 week miscarriage and they all were very painful and I was attached to each one of them.

My best advice is to never downplay it.
A loss is a loss no matter the circumstance. It’s hard and we need compassion. Even if it’s a hug and a heartfelt “I’m so sorry”. Never dismiss it as anything but a horrible loss.

Dr. Dorn,
I so appreciate your honesty and sympathy in trying to help your patients in a difficult time. I think doctors are trained to take a step back in the name of objectivity and many seem to take it too far and become clinical as a result. I have lost 3 babies after 16 weeks and it just is hard. You are right to think that even in an unwanted pregnancy moms get rather attached rather quickly. Never downplay this attachment. Heartfelt sympathy, honesty, humility, eye contact and extra time really help the wound heal. Your personal attention to the details might be beneath your expertise but it will really go far toward healing. An acknowlegement that you really don’t know what to say even with all of your experience is ok too. A few thoughts in addition… Is there really any reason beyond convenience to rush things? I was told to head straight to the hospital with my first 2 where I was induced with cytotec (don’t get me started) and it seemed like there was a dire need to have the baby delivered immediately, though when researching it myself I only came up with potential complications that didn’t seem to really happen much. With my 3rd I decided to wait it out until the baby came on its own. It took 5 days and was a beautiful home delivery, though I hemmoraged badly and wished I could have had the private home delivery at the hospital- just me and my husband. The extra time carrying my baby was very sweet, even though the baby had died- an option of a little more time would be sweet. The way the docs and nurses treated me with my 3rd loss made me decide to wait. I had Kaiser insurance and they wouldn’t even let me see the “viability of the fetus” for myself (never use those words- its a baby). I wasn’t told that was what the ultrasound was for, they said they were checking dates, and I was in shock when I figured it out. I had to plead with the tech to let me see the screen (this would have been baby #8 so I know what to look for) but she would barely turn it. After all of that it was a matter of a calling chain to hear from the impersonal nurse that I needed to schedule a D&C that afternoon if possible. I was not even sure the baby had died as it felt as though the baby still it was moving (contractions maybe, I think) and no one would let me see an ultrasound for myself. Instead of really listening to my heart they all implied that I was in denial which further added to the pain. My previous OB who had been so wonderful through the other 2 losses was even cold about it.
A few things helped me considerably with the first losses. The first was unlimited ultrasounds. My OB was great about going over and over again with the ultrasound to make sure, as was the hospital. It was very reassuring. Another thing that helped was the nurse who was sweet to hold my hand. Just a little thing really made me feel not so alone, even though my husband was there with me. At the hospital both times they had a little outfit that they put the baby in and took pictures and we were allowed to have as much time as needed with our babies. I would try as much as possible to shield a mom from the humiliation of a resident assisting. Both hospital deliveries they seemed to see the process as a science experiement instead of a heartbreak. I realize they are learning but perhaps you can give the resident a demeanor briefing before they enter the room or open their mouths. Your patients will love you for thinking of them as a heart and soul that you are taking care of and not merely a body. The body fares better if the heart is treated well and that goes for any type of delivery. Your concern is truly refreshing and very touching. Thanks for wanting to listen.

There are some really good responses here. And while I’ve never experienced a loss in pregnancy, I’ve come very close more than once.

One thing I can tell you, if you wouldn’t say it to your wife or daughter, please don’t say it to a patient. That should give any reasonable doctor simple guidelines as far as what to say … it all depends on the patient, really, because words that might be comforting to some might not be to others. But if you make an effort to show genuine compassion that alone is beyond helpful, I’m sure. It is much appreciated that a physician would actually be on this site asking for advice, and I hope that the information you get here can help you and your patients.

I do wonder if physicians receive any kind of training in residency as far as a psychology course, anything? regarding how to relate to patients about grief, etc. Especially when you’re in a field that could mean potential loss, emotional trauma, etc.

Hi,

Let people grieve, let them know it is ok to cry. They may feel guilt, anger, sadness. These feelings are all ‘normal’ and real and ok. Let them know it isn’t Their fault.

When I had my son the woman next to me was having serious complications, as the doctor was informing her she started to cry. The doctor got up and went and called a nurse! The doctor didn’t return for a few hours! That was a disgrace. Stay with the patient, if you can’t deal with emotion you are in the wrong career.

I just checked back on the forum and I am overwhelmed with the response. Given the rate of miscarriage (up to 1/4 pregnancies), virtually all women will be touched by this in some way, and this outpouring reflects that.
I think these comments should be mandatory reading for OB residents. Fortunately I had a superior chairman (Daniel Edelstone, now at McGee in PA) who taught us much in this way and I have him primarily to thank for pointing me in the right direction.
To answer Sheva who asked why some physicians treat this so lightly, my feeling is that they themselves are struggling with emotions, dealing with death by avoidance.
I can’t tell you how many times I have been in the middle of a mundane morning, when a patient comes in with a little spotting and you go to reassure her with an ultrasound and BAM – all of a sudden you’re about to tell someone her baby has died. Only through experience have I learned to center myself, and turn to face a woman who’s day I am going to ruin and whose world I am about to shatter.
Every time there is a feeling inside me of just wanting to escape the situation, and the awful knowlege that I am the only one who must do what comes next.
So I think what you all have witnessed are simply manifestations of our own frailties and fears, and not so much the pure callousness that it seems to be. Most of us entered medicine to heal and prevent death, and we often see this as some failure on our part, at least emotionally.
I hope this gives some insight into why we act so appallingly sometimes, though it is not offered as an excuse.
I really appreciate the feedback which is clearly so heartfelt and will save these and any further comments for future reference.
Be well.

Hattie wrote “Is there really any reason beyond convenience to rush things?”
This may have been rhetorical, but my answer in almost all cases is no. Unless a woman is hemorrhaging or is septic, there is nothing that NEEDS to be done right away, except spending time with her loved ones. Nature has been dealing with miscarriage for eons, and does a good job in most cases. I believe there is a myth in medical circles about a high potential for infection and excessive bleeding. That and an occasional desire to avoid a 3 AM trip to the ED.
Like homebirth, few of my colleagues have had the opportunity to witness the natural process, sans intervention, and therefore lack confidence in the body’s ability to take care of itself.
I have had many patients who have opted to wait for miscarriage to occur in its own time, and have usually felt more in control, awful though it may be. I feel my job is to prepare them for what to expect and let them know when they should seek my help. Others want to move on ASAP and these women often opt for a medical induction of the process or a D&C. Being able to have a choice is probably the most important thing in my opinion.
Patients need to realize that the have the autonomy to decide what is best for them and not be afraid to say no or wait if it doesn’t feel right.
Hope this helps.

One last thought about the original post. I believe what the doc was trying to do albeit awkwardly was to comfort the patient by trying to explain that she had a blighted ovum in which a baby/embryo never formed. I’m sure the feeling by the physician is that the patient might feel relieved about this, but it doesn’t take into account all the expectations that are formed when the pregnancy test come up positive. Sounds cruel and heartless out of context, but I believe the intention was benevolent.
Some who have posted above indicated that they felt relieved to know this, but that feeling is certainly not universal and the loss must never be underestimated, even in the earliest of pregnancy losses, such as the early pregnancy test prior to a 1sy missed period, which then comes on.

Dr Dorn,

As a midwifery student it is so easy to feel calloused about the medical system today. I teared up reading your point of view when announcing a miscarriage. I’ve seen one woman miscarry and it was a heartbreaking experience to witness. Thank you for having a heart. MDs like you will make all the difference.

Dr. Dorn,

I wish I lived closer to you! I experienced a complete molar pregnancy, and after the ultrasound tech told me this (at 8.6 weeks) they sent me back out to the waiting room to sit. I had to sit there for what felt like forever while i was waiting on a chest xray. I was in tears and had people staring at me. I wish my doctor would have thought to put me somewhere else and spend some time with me explaining what just happened. It wasnt untill after the chest xray that everything was explained to me. For over an hour, I thought I had cancer!

After my D&C I had to do months of daily and weekly bloodwork (I know you know this, but the other readers may not). The nurses were excellent in this. I never had any of them say “congrats” or anything about a baby. They all seemed to read my chart and know that the hCG test I was doing was NOT for pregnancy, but to confirm the molar was not re-growing.

I only wish my doctor would have been as good as his staff in handling this!

Dr. Dorn,

Thank you so much for your response to these comments. If more ob/gyns in hospitals today would share your honesty and transparency with their patients, it would go a long way towards healing the Birth Crisis we’re in.

Dr. Dorn.
Thank you so much for asking about this. It really heartens me that there are doctors out there that care so much.

One thing that my own doctor did was during my ultrasound he waited a little bit when the image of the still baby came on the screen before saying anything. In that minute my heart soared with excitement at seeing the baby and then I quickly realized on my own that there was no movement and no heartbeat. Maybe in that minute he was trying to think of what to say to me, but what he said was perfect and sincere. “I’m so sorry, there is no heartbeat” He and my midwives encouraged me to cry and to grieve. He went over the process of a normal miscarriage and what I would expect.

Unfortunately I ended up needing an emergency D&C and a blood transfusion and I transfered to the ER and to care providers that were less experienced in dealing with grief. So while my regular care providers were compassionate, the people in the hospital were not. Maybe it was the “D&C” and “missed abortion” labels on my chart. I was only shown compassion by two individuals while I was there. The OB who did my D&C and the nurse in post-op. Everyone else was extremely rude and acted like I messed up their day by losing my baby. One nurse had the gall to argue with me about how much more tired she was than I after I hadn’t slept for 3 days, lost my very wanted baby, lost half my blood supply, was made into a pin cushion by a student nurse practicing his IV technique, Doogie Howser practiced using a speculum on me, I had emergency surgery under a general, and was kept up the whole night by my room-mate in my semi-private room.

One of the most beautiful things anyone has ever done for me was when my sister pulled me aside the night before my baby shower for my son Luke (I was 6 months along with him, conceived only two months after I had either an early ectopic or a missed miscarriage). The first time, I had been so sure I was pregnant with a girl, and the next, that I was carrying a boy. So when the ultrasound confirmed a boy the second time around, I felt confident that I had guessed right about my first one that I had named Joy…Hannah Joy. Well, that night my sister gave me a beautifully wrapped gift and told me that, with the shower for Luke the next day, she didn’t want me to feel like Joy was left out or forgotten in the flurry of celebration for her brother. The gift was a Willow Tree figurine, of a baby being cradled in the arms of an angel.

It meant so much to me that someone else loved and missed my baby. I have a baby shower gift for a baby I never got to hold. And all the while I was pregnant with Luke I dreamed about a beautiful little dark-haired girl. I never put it together until just now, writing this, that the baby in the angel’s arms has brown hair, too.

A grieving mom is a grieving mom, no matter how long her baby lives, no matter how many others she has. A doctor or nurse (or family member or friend) who respects that helps her deal with the pain, makes her feel less alone, validates her grief and her baby’s worth. And helps her heal.

Dr. Dorn…one thing I’d like to reiterate from another comment: a word to the father or whoever the mother’s chosen to have with her, would be invaluable. Let that person know that grief is normal and pretending like nothing happened is cruel and unhealthy. That their job is to support the grieving mom and to listen, and to share with her their own grief or at least their sympathy. That they may need to be protective of that mom while she grieves (or while they grieve together) and that there is help available if they need it. That they’re not alone. Some sort of handout with further information, contact info or links to groups that help parents deal with loss of this kind might be helpful too. And I love the gentle, wait-and-see attitude you take towards miscarrying, and the idea of multiple ultrasounds. Thanks for what you do.

If you can tell ladies the WHY behind the death of their baby, please do so. They agonize over not knowing and blame themselves.

Thanks for the continued responses. These are extremely helpful insights.

my doc said the exact same thing to me when i m/c during my first pregnancy. what made it even worse was she was a woman. >:(

A dear friend of my recently miscarried–it turned out there was no fetus, but everything else was there… so it LITERALLY is possible for there to not REALLY be a baby being miscarried.

Dr. Dorn, I have something NOT to do. I had a pregnancy that had slowly rising HcG, so I was tested every couple of days. I started bleeding after being tested on a Thursday, but wasn’t told that my levels were falling until the following Monday. It was a terrible weekend not knowing if I was miscarrying or not. If you see that someone’s levels have fallen, please PLEASE call them as soon as possible!