Creating a Family: Talk about Adoption & Foster Care

Coping with Pregnancy Loss and Miscarriage

March 05, 2021 Creating a Family Season 15 Episode 10
Creating a Family: Talk about Adoption & Foster Care
Coping with Pregnancy Loss and Miscarriage
Chapters
Creating a Family: Talk about Adoption & Foster Care
Coping with Pregnancy Loss and Miscarriage
Mar 05, 2021 Season 15 Episode 10
Creating a Family

Have you or someone you care about experienced a miscarriage or stillbirth? We talk about coping with pregnancy loss with Dr. Poonum Sharma, a Licensed Psychologist specializing in reproductive issues. She is a long term member of the Mental Health Provider Professional Group at the American Society of Reproductive Medicine.

In this episode, we cover:

Miscarriage and Stillbirth Statistics

  • Distinction between a miscarriage and stillbirth. A stillbirth is the death of a baby before or during delivery. Both miscarriage and stillbirth describe pregnancy loss, but they differ according to when the loss occurs. In the United States, a miscarriage is usually defined as loss of a baby before the 20th week of pregnancy, and a stillbirth is loss of a baby at 20 weeks of pregnancy and later.
  • About 1 pregnancy in 100 (1%) end in stillbirth, and each year about 24,000 babies are stillborn in the United States.
  • For women who know they’re pregnant, about 10 to 15 in 100 pregnancies (10 to 15 percent) end in miscarriage. As many as half of all pregnancies may end in miscarriage. We don’t know the exact number because a miscarriage may happen before a woman knows she’s pregnant.
  • Most miscarriages happen in the first trimester before the 12th week of pregnancy. Miscarriage in the second trimester (between 13 and 19 weeks) happens in 1 to 5 in 100 (1 to 5 percent) pregnancies.
  • The primary cause of first trimester miscarriage is chromosomal abnormalities.

 The Grief Process

  • Factors that may impact grief:
    • How long a woman or couple has been trying to get pregnant.
    • Timing in the pregnancy of the loss.
    • The number of miscarriages or pregnancy losses she has experienced.
    • The cause of the miscarriage or lack of an explanation?
    • Patient’s age.
    • If she has existing children. Secondary infertility.
    • The ability to talk about the loss to family and friends.
    • Temperament of the patient and her partner.
  • Pregnancy loss before others know about the pregnancy.

Helping Patients Cope

  • How can those around the woman or couple support them during this time?
  •  How to share the news.
  • How can nurses help patients cope?
  • What are the symptoms of compassion fatigue that infertility nurses should be aware of.
  • How can nurses prevent or cope with compassion fatigue.

This podcast is produced  by www.CreatingaFamily.org. We are a national non-profit with the mission to strengthen and inspire adoptive, foster & kinship parents and the professionals who support them. Creating a Family brings you the following trauma-informed, expert-based content:
·         Weekly podcasts
·         Weekly articles/blog posts
·        Resource pages on all aspects of family building 

Support the show (https://creatingafamily.org/donation/)

Support the show (https://creatingafamily.org/donation/)

Show Notes Transcript

Have you or someone you care about experienced a miscarriage or stillbirth? We talk about coping with pregnancy loss with Dr. Poonum Sharma, a Licensed Psychologist specializing in reproductive issues. She is a long term member of the Mental Health Provider Professional Group at the American Society of Reproductive Medicine.

In this episode, we cover:

Miscarriage and Stillbirth Statistics

  • Distinction between a miscarriage and stillbirth. A stillbirth is the death of a baby before or during delivery. Both miscarriage and stillbirth describe pregnancy loss, but they differ according to when the loss occurs. In the United States, a miscarriage is usually defined as loss of a baby before the 20th week of pregnancy, and a stillbirth is loss of a baby at 20 weeks of pregnancy and later.
  • About 1 pregnancy in 100 (1%) end in stillbirth, and each year about 24,000 babies are stillborn in the United States.
  • For women who know they’re pregnant, about 10 to 15 in 100 pregnancies (10 to 15 percent) end in miscarriage. As many as half of all pregnancies may end in miscarriage. We don’t know the exact number because a miscarriage may happen before a woman knows she’s pregnant.
  • Most miscarriages happen in the first trimester before the 12th week of pregnancy. Miscarriage in the second trimester (between 13 and 19 weeks) happens in 1 to 5 in 100 (1 to 5 percent) pregnancies.
  • The primary cause of first trimester miscarriage is chromosomal abnormalities.

 The Grief Process

  • Factors that may impact grief:
    • How long a woman or couple has been trying to get pregnant.
    • Timing in the pregnancy of the loss.
    • The number of miscarriages or pregnancy losses she has experienced.
    • The cause of the miscarriage or lack of an explanation?
    • Patient’s age.
    • If she has existing children. Secondary infertility.
    • The ability to talk about the loss to family and friends.
    • Temperament of the patient and her partner.
  • Pregnancy loss before others know about the pregnancy.

Helping Patients Cope

  • How can those around the woman or couple support them during this time?
  •  How to share the news.
  • How can nurses help patients cope?
  • What are the symptoms of compassion fatigue that infertility nurses should be aware of.
  • How can nurses prevent or cope with compassion fatigue.

This podcast is produced  by www.CreatingaFamily.org. We are a national non-profit with the mission to strengthen and inspire adoptive, foster & kinship parents and the professionals who support them. Creating a Family brings you the following trauma-informed, expert-based content:
·         Weekly podcasts
·         Weekly articles/blog posts
·        Resource pages on all aspects of family building 

Support the show (https://creatingafamily.org/donation/)

Support the show (https://creatingafamily.org/donation/)

Please pardon the errors.  This is an automated transcript.

0:00  
Welcome, everyone to Creating a Family Talk about Infertility. I'm Dawn Davenport, your host and the director of Creating a Family. You can get more information about creating a family as well as accessing all of our resources at our website, creating a family.org. Today we're going to be talking about coping with pregnancy loss and miscarriage with Dr. Poonum Sharma. She is a licensed psychologist specializing in reproductive issues in San Antonio, Texas, and she is a member of the mental health professional group at the American Society for Reproductive Medicine. Welcome, Dr. Sharma. Thank you so much for being with us today to talk about what you and I both fingers. It's such an important issue pregnancy loss and miscarriage.

0:46  
Thank you, Dawn. I'm really happy to be here and to talk about this really important topic.

0:52  
All right, part one, miscarriage and stillbirth statistics. The distinction between a miscarriage and stillbirth is is is a lot in timing. A stillbirth is the death of a baby before or during delivery. Both miscarriage and stillbirth describe a pregnancy loss, but they differ according to when the loss occurs. So in the United States, a miscarriage is usually defined as the loss of a baby before the 20th week of pregnancy. And a stillbirth is a loss of a baby at 20 weeks of pregnancy or later. So about one pregnancy in 100 ins in stillbirth and each year if you want to kind of have a rough estimate of numbers is about 24,000 babies are stillborn. Again. This is a stat for the United States. And for women who know they are pregnant, about 10 to 15 in 100 pregnancy so that'd be 10 to 15% into miscarriage, and as many as half of all pregnancies may end in miscarriage. But we don't know the exact number because a miscarriage may happen before women even though she's pregnant. And we'll be talking more about that later. And most miscarriages happen in the first trimester before the 12th week of pregnancy. miscarriage in the second trimester between the 13th and 19 week of pregnancy happen in one to five in 100. So one to 5% of pregnancies and the primary cause of first trimester miscarriages, chromosomal abnormalities.

2:29  
Part Two, the grief process. In part one, we talked about how common miscarriage and stillbirth are in the United States. In part two, we will be talking about grief.

2:43  
Dr. Sharma, what factors impact a woman's grief and how she responds to a pregnancy loss, be it a miscarriage or a stillbirth?

2:58  
Well, I mean, there's many factors. Of course, starting with who she is, as a person, her personality, and you know how she copes with stressful situations in general. But also in this situation, how far along she is in the pregnancy, how the pregnancy loss happened. You know, I've worked at a number of patients where the pregnancy loss itself was very traumatic, because they were alone and didn't have the support they needed to deal with, you know, the medical situation that they were being faced with. So those kind of factors can have an impact. Also, I do quite a bit of infertility work. And sometimes just how long someone has been trying to have a baby, if if there have been multiple losses, one after another, you know, sometimes it can feel like just too much. I mean, I've worked with some women who've had, you know, 10 losses in a row or something along those lines, and very different from somebody, you know, he's had one I mean, they're both losses, and they both emotionally are tough. But the process of picking yourself back up and going at it again, makes it challenging. So those are a few of the things that I can think of off the top of my head. Do you think it matters, how grief is processed and how a woman grease depending on the timing and the pregnancy of the loss, be it a early trauma for early first trimester loss versus a something further along or even up to a stillbirth?

4:29  
Yeah, that's a really good question. I think it has a lot to do with the connection a person has to the pregnancy. I often find especially with the first time people have a miscarriage is often much much harder because it's a lot more connection to the pregnancy, a lot more excitement, hope. And so there's a lot of focus on the pregnancy result and when you go to a fertility clinic, you know, you may end up with a positive test, then, you know, the pregnancy may end very shortly thereafter, and

5:00  
They call it a chemical pregnancy. And yet for the person, if they're focused and very connected to the pregnancy already, that is a loss and they experienced, it can be devastating. So and then, of course, as the baby develops, most people will start to, at some point start to connect with the baby itself. And some people will even name the baby that will have, they'll be certainly thinking about what the baby's gonna look like, they may be talking about names and all those kinds of things. So the more you're going down that path of connecting with this baby that's growing, then, of course, the harder the loss is on the back end. And so what I find is that if someone's had a miscarriage one time, and they're trying to get pregnant again, there's often like a huge sense of caution. Because they don't want to get connected, really don't want to get wrapped up in it until they have a better sense of of being a pregnancy that will come to term. How does the patient's age play in I mean, we know that women are the older a woman is hurt, the greater her chances of having a miscarriage, but but also, the less time she has to try again. And the greater the likelihood that the next pregnancy might also end in miscarriage. So how do you see a patient's age influence the way that and of course, all this is so independent, because we all humans are so different? But how if you can make some generalizations about how age might play into the grief process?

6:27  
Yeah, it depends, if she's using your own eggs, and of course, h has a whole other sort of biological implication there. And then the risks of miscarriage go up as they age, right. So if using an egg donor, then it's a little bit different, even if you're older, you may have a different experience. So, you know, I think age can it can be a positive in the sense that a person may have already lived through other difficult times in their lives. And so they may actually have more skills to cope with the grief that follows. But that this is where it becomes very, very individual, I mean that you can have somebody who's 50, who's never really learned how to process loss, you can also have someone who's 25, that came from a background where you know, losses or other emotional situations were handled very openly. So they're going to be a lot more able to navigate the difficulties that come up with miscarriage or other pregnancy loss. And use as you pointed out, as your first statement, a person's temperament some people are better able, are more resilient in general. So I think that that also, as you say, that's that's irrespective of age. What about women who are experiencing miscarriage or pregnancy loss, but already have children or a child already? secondary infertility is an area that, that I think that we that women who are experiencing secondary, I should say couples who are experiencing secondary infertility often feel one foot in and one foot out of both the the parenting world and the infertility world. And I think it's a, it's a particularly lonely place to be. But I in specific in this question, is the existence of children because at least you know that you're going to have the parenting experience, does that often act as a buffer, or the desire to provide your child with a sibling adds greater grief? And because you're disappointing, not only yourself, but your child as well. You know, I think what can really add to pain is other people looking at you and saying, you know, you already have a child. So Isn't that great? You know, as you're right, yeah. Why are you complaining? Exactly, that's actually more what it is. Because I think when people come in for counseling around this is because they really feel so alone. And they feel a sense of shame sometimes, like, like, maybe I'm not allowed to have these feelings, you know, because I already have a child, right? Or someone else maybe doesn't even have a child. So maybe my pain, you know, I shouldn't be so overwhelmed by this. And yet, you know, your pain is your pain. And well, yeah, I say that a lot. Your pain is your pain, though, can't really compare to anybody else's pain, and you have a right to it and a right to, you know, have someone listen to that and honor it. Yeah. Well, I also think that whether this is the whether this is accurate, in reality, or not really doesn't matter. But I think a lot of people feel the pressure to provide a sibling. And so for their child, and yeah, so the the feeling of experiencing a loss, then, then you're you're denying your child something that you value, or you and you think that they will value? And I think, but I don't as you say, I don't think that the world necessarily acknowledges that.

9:49  
Yes. And you're absolutely right. I mean, I think that many times when people are motivated, have a second child, they are also thinking about the first one and, and, you know, they have a sense that I'm not going to be for him.

10:00  
Forever, and I want my child to have somebody else in the world that really can be a big driver. And so when they're not able to achieve that, there's not only the loss itself, but there's also the fear of that system still sitting there, my child alone, you know, what if they don't have anybody to navigate life with? So, you know, I think both so sad. So feelings are a very real, need to be acknowledged. And we either they have, they themselves have strong sibling connections, or they have an idealized version of what that would be. And therefore, that also adds the pressure. And and again, I think it makes it all the harder that because they have when they don't feel that they can own and have the right to be overwhelmed and sad by this loss.

10:46  
Yeah, exactly. That's exactly how many people feel they're often questioning that. Do I have a right to these feelings of sadness? Do I have a right to grieve? Because I at least I have one child. Yeah. I mean, my answer is always. Yes, you do. Yes. Yeah. We've anything? Yeah.

11:05  
So if Do you see the grief process play out differently? If a woman or a man has others in their life that they can talk to about this experience and about the loss, family, friends, whomever? Or is it really not so much matter if they are able to talk and process it with somebody?

11:28  
I think that you're pointing something really critical analysis, I mean, brief, often, there's a massive social component to it. And one of the things I see when people are dealing with miscarriage, especially before the pregnancy was known to everybody else. And it can just feel very invisible with their loss. Right. And, and so having other people acknowledge the law suffer comfort around, it can be really healing, it's extremely revealing, which is why we have so many rituals around grief, you know, when someone dies, and we have funerals, we have memorial services, you know, we send cards we buy, you know, we give people food, and, you know, so many cultures in the world have, like I was, my dad died, you know, about a decade ago, I remember my mom, I was like, there's a whole year of mourning, you know, I'm of Indian background. And so there's all these rituals for years. So that social component is really important. And if you have people that you can literally just kind of show up and, and express how you feel without having to screen that without, you know, a person that you feel really safe with or who you don't feel judged by. That's very, very healing, for sure. That's what therapy essentially is, you know, it's a safe space to come and do that, when people don't have that in their own lives, or there's not enough of it. And they often find their way to a therapist to provide some of that and create a space to process their loss.

12:54  
I was glad to raise the issue of pregnancy loss before others know.

13:00  
That is minimis miscarriages happened that way. And certainly in the infertility world, they do as well, that that it's very early, even before people have have mentioned to others. And that's a weird place to be because you're going through something that is huge in your life, assuming it is and most often it is. And yet, people don't know. So you suffer and you suffer alone or just with one partner? Yes, absolutely. And I think the same also happens, especially if it's before the pregnancies more obvious. If others minimize that last, you know, they may say things like, you know, well, there's probably some sort of a genetic issue. So it's probably, you know, better this happened, you know, probably for the better, or at least it was really early and those kinds of things. You know, I think people say those just try to comfort but they unfortunately have the impact of being that person feel like their losses is, is diminished in some way. You know, it's diminishes that experience for them, and then it causes them to retreat, then they're like, okay, I can't talk about this, you know, maybe I'm not supposed to be feeling all these feelings I'm having.

14:09  
And it also makes them resentful of the people who are sharing that information. Right, right, unhelpful information.

14:16  
Now, that's true. And this happens in all sorts of, you know, grief, right? And people don't always know what to say, and they're trying to be helpful, but they sometimes show up saying things that actually add to your pain knowingly.

14:28  
Okay, and we'll be talking about that in just a minute.

14:33  
Let me pause for a moment to remind you that this show is brought to you in part through the generous support of our partners. These are organizations and clinics that believe in our mission of providing unbiased medically accurate information to the patient community. We could not be doing what we do without their support and we thank them.

14:55  
One such partner is Reproductive Medicine associates in New York. They are a full service

15:00  
Fertility Center specializing in in vitro fertilization, egg donation, egg and embryo freezing LGBTQIA family building, reproductive surgeries and male reproductive medicine. highly individualized patient care is offered through 13 reproductive endocrinologist and fertility specialist and a urologist as well as a full support team. By combining the latest innovations in reproductive sciences with compassionate and customized treatment plans, RMA of New York is able to provide the very best possible care.

15:37  
Part Three, helping patients cope.

15:41  
When part one we talked about the statistics for miscarriage and stillbirth. In part two, we talked about the grief process. Now in part three, we're going to be talking about how to help patients cope with a miscarriage or stillbirth.

15:58  
So now let's talk about we've talked about some of the things that people should not say, let's talk about some of the common responses that you will hear. And I think it depends on the stage of pregnancy, but you will certainly hear and I'm repeating some that you just mentioned, it happens, it's very common, you're going to and you can try again, it's probably for the best, it wouldn't have survived, or the baby would have had all sorts of problems. So these are the type of things that people obviously that not obviously the type of things that people come out with and say, Why are those type of statements often not helpful? Maybe I should ask, are they helpful? Because they may be? Are they helpful for people?

16:42  
That's really the question, right? I mean, I think they may not be helpful, because we're kind of shooting in the dark. So I think it's always safest to just kind of when someone is grieving, or has gone through a difficult experience to just go in with an open mind. Knowing that you, you know, you really don't know how they're experiencing it, you really don't know. And I think we have to be very careful not to project our own feelings onto on that person or our own ideas on to that person. It's very important to kind of post them with an open mind and say, how are you doing? You know, I've been thinking about you. I know you've went through this very difficult thing. How's it going? They may be doing okay. I mean, that is a possibility. Yeah. Or they might not be. But I think that when you go in without a lot of assumptions about what it's going to look like it's it just gives that person room to be able to talk more openly about their real experience. Okay, so for those people who have someone in their life, who has experienced a miscarriage, and then I'm going to ask the same question for stillbirth. For those people who have experienced a miscarriage. One of the things you say is don't make assumptions and go in and your ask, how are you doing? versus us making assumptions on how they should be doing? Because she's pointed out? They may be thinking, Oh, well, you know, it's early on. I'm glad it happened early, not late. And I'm going to try again, you know, we'll start again next month. And you know, that that may be their that may be how they're coping and it's a healthy and they're doing well, but they may not be and so you don't want to present that. In earlier you mentioned that that one that we many societies, that probably all societies have rituals associated with the Greek with grief of all sorts. So what type of rituals can we do around something like a miscarriage because it's, you're missing something that's that that was that you don't have, you don't have a face, you don't have you don't you didn't know this, you knew them emotionally, but you knew them, you knew this the this potential life or this life, based on your own hopes, and not so much on the actual person that this would have been? So what type of rituals are helpful there?

19:00  
There, it depends on the nature, you know, the nature of the loss and how the person is experiencing it. But sometimes the ritual is actually just a couple doing some sort of rituals themselves. They, you know, people often have ultrasound pictures and things like that. I mean, I've had clients that have, you know, just sat engraved with those together, or they planted something or I've had a few clients have bought this actually even jewelry out there that kind of, you know, acknowledges the last something you can wear to remind you. So, I think that the key is to design a ritual that that actually feels healing to the people who are involved. Right. And of course, as you know, the farther along the pregnancy is those rituals become more formalized. Right, you have a stillbirth, there's usually a funeral that comes after that, but I I think the key is just to design and and, and ask them you know what would be helpful to you, and they may or may not want to the couple may or may not want others

20:00  
people to participate on that they may want to keep it to just themselves. Or they may want close family members who are also really excited about pregnancy and involved. So I think it is, it's really important to just follow the lead of the individuals that are dealing with the loss. And one thing I will mention that I have seen, so many women do, that they have found very helpful. And this is only for those people who like tattoos, but getting a tattoo that somehow memorializes the existence of this child, and has been very helpful for many women. And there are a number of designs available in all sizes. And all in everything you could imagine there are just so many options available. So that's something that is very helpful for those people who want to be tattooed.

20:50  
Yeah, that's right. That's a great way to market for somebody who wants that right. Once again, people may want to tattoo Some may not some may want something that visible, others may want it to be more private. So surely bad, acting, whatever that person needs. That's really what we're talking about. It's like identifying what is the need? And how can we help a person meet them? You know, and if it's a family member, those going through that? I mean, you can just really just say, is there anything you know, we can do to help you heal?

21:19  
Once again, open ended questions, more just exploring, and and just giving the message that I'm here for you, I care about you. And whatever you need, I'm going to support you in in meeting me. And I'm sorry, this happened. I'm sorry, your

21:37  
time is better just to say that and honestly, because I think sometimes people work too hard. And it's so much more powerful sometimes just to say, I'm just so sorry. You know, I it makes me sad to know that you're going through this. Yes. Yeah. And then I'm holding on. I am here in your pain. If you have that. That's what I'm here for just to be while you while you're suffering while you are grieving. Exactly.

22:02  
net, we've talked about miscarriage. And as you pointed out that as the pregnancy progresses, it becomes the process of grief becomes different, if only because other people know about it, you may have already showed. So there is more. You either have to tell people who haven't yet moved into stillbirth, I'm moving there. But in the second trimester, before the 20th week you're showing you have at that point, most people have told everyone in their life that they are pregnant, how does that change what others can do, because it seems like that makes it in some ways, it makes it better, because then at least people are acknowledging your loss, and you're not alone in your loss. But on the other hand, you then have to repeat it 1000 times it feels like so what can those around someone who is in their second trimester, and you already know about the pregnancy, anything different or anything that you would add for how they can help them cope?

23:04  
I think that as people know, they they will feel more responsibility to at least check in, I think it gets a little trickier to as as as the pregnancy becomes more obvious, because you may get a lot more support in people, because they know that you're pregnant, they know you've been through a loss. But you can also get more of the other side of it to maybe a co worker who doesn't quite know what to say to you. So they just don't say anything, you know, and they just avoiding you all of a sudden, or

23:36  
the person who it's along those same lines, someone else who just never ever even says anything about it, and you're interacting them with them on a daily basis, or somebody who says something that they're intending to be helpful, but it's not so helpful. So, you know, I think that's definitely the more visible the pregnancy is and you'll you'll get a whole range of responses to that and in that there'll be hopefully lots and lots of support that's actually helpful. And then there will be a sprinkling of things that probably aren't. But I do think we have such a deep deep need to be seen is hardwired human need. And so that acknowledgement is really really important.

24:19  
What are some of the rituals that we now know I don't think it has always been the case but with a stillbirth, what are some of the rituals that in the hospital and outside the hospital, we now encourage families to to partake in to help them grieve this loss. I

24:40  
think hospitals now actually do really wonderful job of allowing people to spend time with a baby after his past. There's even some people who do photography, you know, and I think do a beautiful job of honoring a very painful moment and capturing it. You know, I think it's they're trying to help. It's all coming

25:00  
Down to acknowledging that this was really a life that was here, right and marking that in some way. And so I find, you know, what the hospitals do these days in terms of allowing photography, allowing people to spend time holding the baby. I mean, those are really, really powerful healing experiences. Yeah, I do too. And as you mentioned, often a funeral is an is a part of that. And so then that that falls into our traditional grief and mourning rituals, which that we can move directly into. That's fine. All right. Now, I want to talk specifically for infertility nurses. And I want to start because often it is not always, but it often can be the infertility nurse who has the responsibility of sharing the news that the the the embryo is, or the zygote or the fetus is no longer viable. This is only in the first usually the first trimester losses as a infertility nurse involved. So let's talk some about that process of sharing the news that the test has come back. And the pregnancy is not viable. What are some things that nurses can do when they know they're going to be having to share this news? The first question I would have is, should this news be shared over the phone? Should you ask the patient and the patient to come in if the patient is in a partner relationships with the partner come in? Let's talk about some of the practicalities that can make it easier both for the patient? as well as for the nurse?

26:41  
Yeah, that's a really good question. The You know, when I counsel people who are expecting, you know, results from a pregnancy test, or, you know, or possibly expecting bad news from some medical procedure, it as much as you can introduce some element of control into the process is going to be helpful to the patient. Because none of us want to be blindsided, right. So they if there is some difficult news, it can sometimes be helpful just to give the person a bit of a heads up, hey, you know, I want to talk to you about something you know, when would be a good time versus just calling and then just not really checking in to see where that person is what's going on, whether they're alone, or somebody around and then just giving them news. So I think being very mindful of that, that you really need to kind of before you share any information, you really need to assess. Where's that person? Literally? Are they at work? Are they at home? Is their spouse around or not? So there's not a blanket answer in terms of how to do it. But more once again, like just trying to find out, you know, what's going on, then also trying to actually schedule time maybe to talk and you can even ask them, you can say, you know, would you like to talk on the phone? Or would you like to talk, you know, come to the clinic, would you like your partner to be there or not, I mean, sometimes they need to go talk to their partner first before they can make that decision. But anywhere we can help a person feel like they have some choice have have some sense of control that is going to help them feel better. But of course, if you're sharing this, if you're calling up and saying, I need to talk to you, would you like to come in? Or do you want us to talk on the phone? You do have anybody with you? You're already telling them, Marty? I mean, at this point they're in tell you is Yeah, yeah. But you're also getting into the weeds on it. So you gave him a chance to kind of contain themselves some and make some decisions, you know, they may, you know, decide to go home at that moment, and then call you back, you know, you're still giving them some some input into the process. That's right. I know some clinics ask before an IVF procedure is even done before an embryo is transferred. How do you want to receive the results, and I want it to be on the phone. And I do think that's really helpful to have this information in advance. But fewer of them deal with the possibility of after a pregnancy has been established, and is no longer viable. I guess you could go back and assume that the same information they would want the information shared in the same way. So you do have that if the information has been gathered in advance, you do have that as an infertility nurse to fall back on.

29:25  
Right? And usually, if there's a miscarriage happening, I mean, a person is coming into face to face contact with a medical professional, you know, that's helping them through that's often the case so you know, when they're there with you then of course, I mean, kindness, gentleness, being compassion, all those things, to help anybody when they're suffering. Definitely come in. You know, what I find a lot though is, you know, I've worked with several fertility clinics over the years, and I talked to a lot of nurses and I hear how much pain they feel as well when they're

30:00  
Patients are going through a hard time, they really feel it too. And so I think it'd be really tricky sometimes because you're feeling awful for them yourself as a nurse. And, you know, you're about to break this news to them. And, and you don't want to inflict pain. I mean, by definition, a nurse is usually trying to help you feel less pain and less suffering, I think it can be really hard to try to manage your own feelings about the loss and processing those a little bit before you like open things up for the patient. Because then you really have to stand in this space of supporting them 100%, you know, being about them.

30:36  
So if you're if you have if they are there in person, obviously, if there's a medical procedure, if something is this is not a test result of a lack of viability, or a if they are there, and less infertility nurses, but other nurses are often in the room when a heartbeat is found. So that then then you are then trying to just be with somebody in their in their pain and let them know and ask them how they want you to respond. How do you want me to be in here? Would you like some time alone with your partner? What would be helpful? That type of information? That be what you would recommend? Yeah, exactly. I mean, usually, you know what, when is an ultrasound going on, you're looking, you know, to see if their pregnancy still viable. Patient usually knows something's up, they can read people's faces, you know, and they often already knows something's up. And I think, and I think a medical professional going into a situation like that, where someone's coming in, because they're, you know, having spotting or something like they know, it's a possibility as well, they can mentally kind of prepare a little bit before they even walk in the room. But yes, that's right after you know, after it's clear that there is a loss or things are not looking good, you know, asking people what they need. That's always a safe bet, honestly, with a lot of this, you can just just kind of breathe, settle yourself and just, you know, let someone know, you care and say, what, what can I do to help you right now? You know, what do you need? And most the time people will tell you, I'm actually just telling you. That's one of the things of psychologists, I mean, I don't really I don't really I do a lot of exploring, I do a lot of what are your needs, let's talk about those. Because it does vary from person to person. As we all know that they're suffering, we're all helped by kindness and gentleness, and somebody's telling us that they care. That is universal. And I heard a woman who had gone in for tests, and it turned out that the pregnancy was no longer viable. And a nurse brought in a heated blanket and wrapped it around her and she said it was the single she this was years later. And she said even she said even to this day, I cry thinking of the kind of the compassionate, she thought that that moment to do for me. And, you know, it's a small act. But many years later, it was the thing that this patient remembered. Yeah, I can see that. It's just like a really warm hug. You know, I bet at some level, and just the kindness or somebody's thinking of your needs at that level. And I you know, I also I just want to add, I think as healthcare professionals, it's actually also okay, to let people see that you're moved. I think it's very powerful, you know, someone telling me a really painful story, I be moved to tears listening to it. But in that moment, they feel seen. I mean, they, they know that, oh, wow, this person gets how much this hurts. Now, so I think, you know, you don't want to be the one who's now crying, and they're taking care of you. But, obviously, but I think just letting yourself be human in that moment. I mean, these are these moments when we have lost when we're in pain. That can be very, very difficult moments, but they can also be times when you get a lot closer like to the healthcare professionals that are taking care of you because you know, you care, you know, they're standing there with you. And they're just with you in your loss. They may not be saying anything, but they're in the room. They're connecting with you as a human being.

34:12  
Why do you think that some medical professionals feel that they need to not show emotion, that it would be more helpful to just trying to treat this as a matter of fact thing and not show emotions? I, from my personal experience, I see that more often with doctors and nurses, but I would imagine it would go both ways. What is the mentality thinking there because they're not trying to be cruel? I'm assuming at that point they're trying to be what they perceive is helpful.

34:42  
Yeah, then maybe and I think it depends on the person and their own background, how comfortable they are with their own emotions. Sometimes people see that as part of being professional like I used to work in a hospital and sometimes I would be in my office I got someone call me to come and because there's

35:00  
Something on on and it was like some, you know, a patient was crying and, and so they were bringing in a psychologist but it wasn't you know, wasn't like it was something where if someone had just been kind and handed the person, this tissue would have been enough. But I think sometimes people don't know what to do. They're not trained about how to manage these kinds of situations. So. So unless they've got some good instincts, or they've had some good experiences and taking care of other people emotionally, they just might not know what to do. And so sometimes what you see on the healthcare professional, and it's just an awkwardness. Yeah. And okay, let's just kind of move on to the next thing, right? Mm hmm. But I do think that from an infertility nurse perspective, that developing this skill, or at least coming up with a grab bag of ideas of, of how you can respond, that would be helpful, is is a good strategy, because you know, that you're going to be in the position of, of helping people cope, either with a negative pregnancy test, or loss of a pregnancy at some point. So having some skills working on developing those skills would be helpful. Yes, absolutely. And, you know, the other piece of that is, sometimes we think we need to do something, you know, I think we look at the medical system, I mean, there's a lot of interventions, and then you look at infertility treatments, you know, during IVF, you don't know you Why so lots of things, that people don't do it, when you bump up against a loss, it's like, there's nothing you can do except for just kind of be with that person tend to their needs, take care of them. So it is about getting comfortable with just the emotional aspect of it. Because there's nothing you can do to fix the fact that this person had a loss, and it's painful. And so it's just, I think, learning how to just kind of be there without saying or doing tons. But being helpful in the sense of assessing that person's needs, right? I mean, even basic stuff, like, you know, encouraging patients to make sure you know, when they are going home, you know, make sure you're getting enough rest, you know, you're eating and drinking, and just making sure they have a little support around them, those practical things can be very, very helpful. But you know, we are made to heal, we are made to heal. And I think sometimes we forget that we feel like we have to do something when it's really we just need to be together with the person who's been hard. And we need to help them create an environment where that healing can happen. Because our bodies, our minds, they know how to heal this have to create conditions for that to happen.

37:40  
Does it factor in with some medical professionals, that that pregnancy loss is is also a failure on their part that their job was to help you get pregnant. And now you are not pregnant. So either they failed. One way to perceive that would be okay, I failed. And then they respond out of their sense of failure, which is almost always not going to be helpful for the person who is suffering the loss. Yeah, you're right. I mean, the health care professional may feel disappointed, right, they may feel just 22 that this doesn't work. They may be grieving at some level themselves as well. And so, yeah, it can be very, very tough, especially, I think most people that work with patients really care about their patients they want, you know, if a person comes in, and they want to get pregnant, but the healthcare professional wants that for them too. And, and so yes, they're also going through their own disappointment. And sometimes people cope with that by, you know, just being very, very Matter of fact about it, or trying to figure out what's the next thing we can do, they may get into problem solving mode,

38:49  
which is what helps them feel better, but it may not help the patient feel better, right? In that moment. You know, there may be a time for problem solving. I'm not saying it's a bad strategy. But you know, when someone's hurting, they often can't go there with you. So great segue into what I was going to ask is, oftentimes people do want to say, Okay, well, you know, we're gonna, you know, we'll get back on that horse, we're going to start again, we will, you know, let's come in, and let's talk about the next options that you've got. How when should the the problem solving, as you say, which is a perfect way of saying it? When should that start when somebody is either fresh with the news or even still grieving A month later, when how to approach how to move to the next. How do we help our patients move to the next step? If that's what they want?

39:38  
Yeah, I mean, I think that once again, check in so I know you've been through a really difficult time and, you know, everybody needs time to absorb, loss. Where are you guys? Do you feel ready to start to talk about next steps or would you rather wait, do you want to give me a call back when you're ready, you know, once again, checking in and letting them take the lead on that because I find especially

40:00  
was the infertility work? I do. You know, it's easy to keep the medical process going, Okay, well, we are one failed IVF. And okay, let's go back, oh, he had a miscarriage? Well, let's try again, you still have three or four embryos left, right. And yet, you can keep going on the medical end. But then there's the emotional process too. And people move at different paces, and the emotional process, sometimes, you know, they do want to, they're like, Okay, give me a couple of weeks and give me a month, we're gonna be back, and we're gonna, like, go on to the next cycle, or whatever it is. Other times, you know, they really can't move that fast. This may be somebody who has had other significant loss in their life, and they really do need a longer amount of time to pick themselves up. So you know, I think we need to be aware that those two paths can sometimes, you know, work operate at very different paces. And different patients have a different tolerance for how much pain they want to put themselves potentially through. It's also possible that they would decide I don't want to do this again. Yeah, absolutely. That's absolutely right. I think when when there is a moment like this, right, when you've experienced a loss, that's actually a time I always encourage people to take a little time absorb the loss, and then just pause and ask themselves, okay, what do I want to do next, versus just jumping on to the next thing? Because there's social pressure to do that? Or nobody's asking, right? A lot of times, people or patients are looking for healthcare professionals to lead the way and they'll just keep following, right. So sometimes, if the healthcare professionals aren't also pausing and say, Hey, you don't okay. I mean, do you feel ready to take this next step? Or do you feel like you needed time? You know, because we can wait, you know, there's no hurry here whenever you're ready, right? And sometimes when a nurse might say that, or doctor might say that, as a patient, I've got some permission, you know, to really my needs, or, yeah, I call it the infertility treatment, escalator. Because so often, once you get on, the next step is coming at you, and you either raise your foot to step on it, or you're gonna fall and that's oftentimes not from an emotional standpoint, the very best, we need to allow that that just because we as as our just because as medical professionals perceive that the next step is obvious and logical, and we will try again, doesn't mean that that's where the patient emotionally is.

42:26  
That's right, man. I think that's a great metaphor, as you were saying about the escalator. I thought, yeah, you could actually get off the escalator and take the steps. You could sit on the steps for a while if you want to. Exactly. But you don't want to go up those steps. You know, you just stay where you are. So it is about like getting out. This is the automated process, right? And much more conscious and mindful making a real decision about what's best for you. Yes, absolutely.

42:52  
And now I want to talk about compassion fatigue, because nurses, infertility, nurses, and all nurses often face a great deal of grief in their patients. Either we're an infertility nurse, it may be the failure to get pregnant or it could be a pregnancy loss. So what are some ways that that nurses infertility, nurses can vote? First of all, let's talk about what are some ways that compassion fatigue can display itself? How do we know if we're suffering from compassion fatigue.

43:28  
So compassion, fatigue tends to be kind of a more extreme version of burnout. I mean, you really just,

43:34  
you might notice, like that you're numb, and not as kind of compassion fatigue, the person is really trying to stay connected, but and emotionally, but not able to anymore. There's truly a sense of fatigue. So I think disconnection can be part of that. All the signs that actually show up with depression can end up there. He may not be sleeping very well, your appetites off, just may feel blah, about things in general, to feel like you don't have anything to give any more. You know, just to assist the change in how you feel at work. You just not, you're not that a professional that you know that you normally our you know, it feels really, really off from them. You might feel that you're not as emotionally connected with your patients. That's another symptom for some nurses. And the opposite could be true where you're feeling overly connected and not able to provide some distance. So both of those can be symptoms of compassion fatigue as well.

44:34  
Absolutely, absolutely. Right. That's right. So what can nurses do infertility nurses in specific to help them cope with sometimes a sad job because they are sitting with people in times of grief. So how can they take care of themselves to prevent burnout or compassion fatigue? Yeah, that's a really good question, Don, because you know, the health care environment has become increasingly

45:00  
challenging, I think for all healthcare professionals a lot more pressure on everybody to see more patients and, and, you know, large, especially larger fatigue clinics have such high volume that is humanly impossible to show up with tons and tons of compassion for every single person that walks in the door. Because we have emotional limits ourselves, right? We're not robots, so

45:24  
much as you're able to really setting some boundaries around, you know, when you leave work, like really leaving work, if it's possible to do that, which is hard. Unfortunately, clinics, they're open all the time, you know, at some level, but really taking time for yourself so that when you're not at work, what are you doing to refuel? What are you doing to get away from the job to actually connect with things that energize you that help you feel alive, even, you know, if you have an option to manage the number of hours that you work, that can be important part of boundary setting, even me as a therapist, I, you know, I have the same issue I am using, you know, part of how I do my work is I connect with my clients, I present as a human being. But there's a limit patient there, right. And so I only see a certain number of people that day. So if you have any control over how much patient care you actually provide, or even the nature of the care, I mean, some aspects of the job may not require as much emotional connection. Yeah, and the trade off somebody else for a little bit, do something a little bit more mundane.

46:31  
And, and if you are in a position that you can talk with the powers that be and receive this as an issue amongst the staff to raise it, and to realize that perhaps the it doesn't always have to be the same nurse who is calling and sharing bad news, or that the doctors may be able to do that with you know that they also step in to share some of that burden. Or that after you've had to do that for once or twice, you know, that you pass that on so that it's not so that you can protect your staff from compassion fatigue. Yeah, that's exactly right. And, you know, and then and some in the United States, I mean, this is a bigger issue, too. But you know, many of us don't take even the vacation that we've earned. And I think it's so important to just literally just get away from everything for a while. It just, you can go back and you know, get away and refuel and come back and you come back with a different perspective. So so much of it is about about day to day self care, but then in the bigger picture, also stepping away from work and going into other aspects of your life to refuel you, I also think connection app, or it can be another source of, you know, keeping things healthy, such a good point to make. And say you have I mean, sometimes if everyone's in a difficult situation together, it's so much easier to bearish, right. So making sure you're in a work environment,

47:56  
healthy and not too dysfunctional.

47:59  
That is such a good point. from having talked with many infertility nurses, I know that when they have people that they can confide in and work friends, it makes a difference, because that is somebody who knows exactly what you're going through. And they could have your back in ways that people outside who haven't experienced what you're experiencing witness it is such a good point. And also good for those who are managing infertility nurses to think about how do we create an environment that is supportive of each member, as well as our patients? Because if we support that nurses, ultimately that is in the best interest of our patients as well.

48:40  
Absolutely, absolutely. I mean, it's all about connection. And I guess that may be part of the theme today. It's all about connection, right? Yeah, absolutely. Well, thank you, Dr. Poon Sharma for being with us today to talk about pregnancy loss in miscarriage. It's a topic that we need to do more talking about. Let me pause here to mention that the views expressed in this show are those of the guests do not necessarily reflect the position of creating a family, our partners or our underwriters. Also, keep in mind that the information given in this interview is general advice. To understand how it applies to your specific situation. You need to work with your infertility or mental health professional. If you are listening and you haven't subscribed to the creating your family podcast, please do us a favor and subscribe. It helps us and it helps you because you will be notified about the upcoming shows. And it's easy and of course free. So go ahead, hit the subscribe button. Thanks for joining me today and I will see you next week.

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