By Jennifer Potter
Many wonderful events happen at a hospital that cares for women and babies, but we also regularly experience tragedy.
My hospital cared for nearly 400 women who miscarried last fiscal year, and 300 the previous fiscal year. I have met with over 500 of those women in the last two years. The patient might have just learned that she is miscarrying and still be in shock. She might be several weeks into her miscarriage and on site for surgical intervention. (The state of Pennsylvania defines a miscarriage as a pregnancy loss up to the 16th week of gestation.) Our goal is to have a chaplain see each miscarrying patient on site to provide initial care and anticipatory guidance for bereavement. I then do a follow-up phone call one to two weeks after she has come through our facility. When needed, I will follow up again one to three months later, if there is a history of depression, a compromised support system, or a lack of coping skills.
I began my work as a chaplain with some good evidence-based training. We use Resolve Through Sharing for bereavement education, a two-day training for care providers. Through that training, I learned an important statistic: 75% of women experience miscarriage as a loss of a baby, and 25% experience it as a medical event. Three-fourths are grieving a life that they have begun to envision. Plans were already well under way. In the remaining one-fourth, the pregnancy ended before attachment occurred. This does not mean an absence of dreams, plans, hurt or grief. It does mean that the grief is different and will need to be addressed differently. For example, to use baby language with our patients who view the miscarriage as a medical event might be confusing. To not use baby language with those who are grieving the death of their child would be offensive.
One of my first tasks is to listen and assess how the miscarriage is being felt. I pay attention to the language used by the patient and her partner, “baby” being the most obvious. I ask how she is making sense of the miscarriage. I try to learn who or what helps her through a difficult time. What are the needs and how might they be addressed on a spiritual level?
Grief can be significant, and while it is individualized, there are several ways to support people. The four areas I regularly explore with patients who have miscarried are:
- Core beliefs that are being challenged by the miscarriage
- Coping strategies
- Support system
Each of these is fertile ground for providing spiritual care. And they are all part of the healing process. Some people comfortably navigate these topics, and our time together is spent identifying the resources already in place. For others, each step is a difficult one. Coping skills and support may be lacking. Self-care may be nearly non-existent. In these cases, I assess and help identify one area to focus on and strategize with my patient about how to meet that need.
In early pregnancy loss, the patient often has a greater attachment to the pregnancy than her spouse or partner does. While the patient is openly grieving, the partner might be sitting next to her looking a bit shell-shocked. Some men confess to feeling confused by the grief their partner is experiencing. Or they feel grief, but less intensely so. Sometimes a miscarriage is the most challenging situation a couple has had to face together so far. I engage both patient and partner to assess how they are navigating the miscarriage as a couple. I normalize the differences they may be experiencing. I encourage ongoing communication and I look for areas in which they might connect. The goal is to invite each person to engage in that shared space, to hear and be heard. Spiritual care is so often about making the invitation to engage another, and stay present for what happens next.
Miscarriage can be physically traumatic, lasting for weeks in some cases. Patients tell me that each day of bleeding is another reminder of the loss. Some patients pass an embryo that is recognizable, which might happen at home with very little warning. Caring for these patients requires an understanding of her full miscarriage experience when she is willing to share it. Helpful questions include, “When did you first learn of your miscarriage?” “What has the experience been like for you?” “What were some of the more difficult aspects of this journey?” Listen to her experience and look for ways to support her and her partner.
I believe one of the most impactful ways we can provide spiritual care is to normalize the presence of grief. Only once have I met someone whose grief exceeded what is to be expected. That patient had a history of depression, was hospitalized with suicidal ideation two months after her first miscarriage, and was now suffering another miscarriage. She clearly needed mental health counseling. While I believe all can benefit from therapy, most of us can work through the grief and loss we experience. We just need the time and space to do so, with some tools to help. Chaplains are able to provide companionship and reassurance. The spiritual care we provide can make a big difference in a person’s ability to grieve and heal. Loss felt in miscarriage can be challenging because of the wide range in which it is experienced. Normalizing the experience may be a huge gift.
Jennifer Potter is a staff chaplain at Penn Medicine General Health’s Women and Babies Hospital in Lancaster, PA.