THE HEALTHCARE PROFESSIONAL’S ROLE (2)

Positive contacts with health care professionals have an impact on how well these women can cope after the loss (7). The woman’s ability to experience wellbeing after a miscarriage is enhanced by her receiving care from a provider that is well informed about the common human responses to miscarriage (6). Even though first trimester miscarriage is under-researched and imperfectly understood (5), there is a lot the healthcare professional can do to maximise the health of his/her patient after a loss. This may be by simply recognising the uniqueness of each loss (3), even though the medical process is the same and the occurrence of miscarriage is very common. 

In addition to this, the health care professional needs to recognise that, to his/her patient, that miscarriage is more than simply a medical event and deliberately avoid the tendency to “medicalise” (and by so doing trivialise) her loss (5). Where the health care professional does not trust in his/her ability to offer appropriate counselling, by being observant enough to identify those who may need a referral, he/she will be delivering quality healthcare.

It is a well known fact that early miscarriage is a distressing experience (2) (4), involving a major disturbance of self-identity (5). Psychological reactions to stressful events can result in physiologic effects (8); the actual miscarriage could be a straightforward process with no risk of complications that may pose a source of concern to the health care professional, but the way the woman perceives and responds to the miscarriage may be dangerous to her health. Therefore, the manner in which the health care is provided in the aftermath has the power to influence her response to the health care system (7).

Most women know little about miscarriage until they experience it and the occurrence of miscarriage is usually shrouded in secrecy (5). Those entrusted with their care should know enough to empower these women (and their partners) to successfully navigate the journey of healing in order to maximise their health. 

REFERENCES

1.      Ekwegh U. Women and miscarriage: knowledge, attitudes and needs. Printed by the Miscarriage Support and Information Centre. 2008.

2.       Beutel M, Deckhardt R, von Rad M, Weiner H. Grief and Depression after miscarriage: their separation, antecedents and course. Psychosomatic Medicine, Vol. 57(6) pp517-526, 1995.

3.       Douglas K I, Fox J R. Tears of blood: Understanding and creatively intervening in the grief of miscarriage. In Bleuer J C, Yep R K, Walz G R. (Eds) Compelling Counselling Interventions. Alexandria, VA, VISTAS: American Counselling Association, 2009.

4.       Swanson K M, Karmali Z A, Powell S, Pulvermakher F. Miscarriage effects on couples' interpersonal and sexual relationships during hte first year after loss: women's perceptions. Psychosomatic Medicine, Vol. 65, pp902-910, 2003.

5.       Frost J, Bradley H, Levitas R, Smith L, Garcia J. The loss of possibility: scientisation of death and the special case of early miscarriage. Sociology of Health and Illness, Vol. 297, pp 1003-1022, 2007.

6.       Swanson K. Effects of caring, measurement, and time on miscarriage impact and women's well-being . Nursing Research, Vol. 48 (6) pp288-298, 1999.

7.       Abboud L, Liamputtong P. When pregnancy fails: coping strategies, support networks and experiences with health care of ethnic women and their partners. Journal of Reproductive and Infant Psychology,  Vol. 23(1) pp. 3-18, 2005.

THE TRIPLE-R MODEL: ROLE (1)

It is obvious that I believe it is our role, as healthcare practitioners, to identify the risk and resilience factors in our patients that present with a miscarriage. However, our role as healthcare professionals is not simply to identify those at high or low risk of a significant negative response to the miscarriage. In my study of women in Nigeria who had experienced a miscarriage, the doctors and nurses were identified as their second most important source of support, second only to their spouses (1). 

In order to identify the type of support required the healthcare professional needs to be able to distinguish between a normal grief reaction and a pathological reaction to the miscarriage. This can only be achieved if the woman is allowed to talk about the loss and her feelings about it. Essentially, a grief reaction will manifest as a preoccupation with and longing for what was lost plus painful recollections and reminders in everyday life (2) (3). A depressive reaction will manifest as symptoms in the woman: irritability, restlessness, lack of concentration, sleep disturbances and so forth (2); in other words, a preoccupation with herself.

Women will, more often than not, welcome any opportunity to discuss their loss (4). However, there are some that may find it difficult to do so, due to feelings of guilt and shame (5). It is therefore very helpful if the health care professional creates an opportunity for the woman to discuss the miscarriage and what it meant to her. Following a miscarriage, women may have a strong desire for recognition and validation of the loss, particularly from their health care providers, who can help them to explore the meanings of the miscarriage (3). 

It has been confirmed by empirical research that women who receive counselling sessions, which were simply sessions where the women talked about the whole experience of the miscarriage, were more likely to show a decline in overall emotional disturbance (6).

...To be continued