MUCH ADO ABOUT NOTHING?

As part of my online searches to discover new information about pregnancy loss research, coping strategies and management I stumbled upon an interesting thread of comments.

This comments thread was in response to a news article in The Guardian online. The article was about a lady who, after suffering multiple losses, decided to organise across the United Kingdom different commemorative services where people could come to say goodbye to their unborn babies. An opportunity, if you may, to have a “funeral” for the pregnancy loss and hopefully leave with some form of closure.

What sparked the debate was someone wondering if services like this would just make too much about an issue no one used to talk about in the past. Women would have a miscarriage, be it early or late or even have a stillbirth and the healthcare team would just pretty much clean her up and send her home. It seemed that this person was pining for such simpler times when people did not talk so much about their feelings and go on and on about the babies they lost.

The responses to this comment ranged from vehement disapproval: “you have obviously never lost a pregnancy!” (It turns out the person commenting never had, go figure!) to guarded support: “some women do take it too far”.

I do think times have changed. I think that the inevitable consequence of a society where women have a voice is that women will speak. At a time when, in the Western part of the world at least, women are educated, enlightened and empowered, people have to deal with the fact that these women will highlight issues that are important to them.

I have written already about the disenfranchised grief of pregnancy loss and so it should come as no surprise that I wholeheartedly support the idea of an avenue that permits women (and those close to them) to grieve.

I grant that there is a danger (in some circles) to talk this issue of pregnancy loss to death but from personal experience and from talking to others who have gone through it as well, there is a more present danger (especially where I come from) of not talking about it enough.

If, in Nigeria and other parts of developing society, we aspire to “promote gender equality and empower women” (MDG-3), then we need to find out and talk about the issues that are important to women – not just avoiding death but coping with life.

RESPECTFUL MATERNITY CARE

The Miscarriage Support and Information Centre is part of the White Ribbon Alliance and our June Action of the month is focused on respectful maternity care.

In their power point presentation designed for healthcare workers, they make a very valid point, a point that I am particularly passionate about.

“The concept of ‘safe motherhood’ is usually restricted to physical safety, but safe motherhood is more than just the prevention of death and disability. It is respect for women’s basic human rights, including respect for women’s autonomy, dignity, feelings, choices, and preferences”.

When having to manage complications of pregnancy such as early or late miscarriage, healthcare workers are often driven by a need to do what they feel is best to prevent death and disability. However, in caring for a woman during such a traumatic time, it is important to work with her and not just “for her own good”. It is important that she understands what is going on and why. It is important, for example, to respect her wish to not undergo a surgical evacuation even though you may feel it is the best option.

In the survey I conducted in Lagos, Nigeria of the 25 women who had experienced a miscarriage, 21 remember being treated with sympathy and understanding by the hospital staff. However, only 14 women felt that medical professionals were not to blame for the pregnancy loss. Why the disparity?

I strongly believe that these 11 who did not excuse the healthcare workers involved in their care are the women who did not understand what was going on, were not consulted, had nothing explained to them and had no choice in how the miscarriage was handled. Hence, they believe something was not done right.

When asked, in the same survey, about attributes in their healthcare professionals that were very important, “includes you in the choice of treatment” was not ranked very high by these women respondents. However, “tells you all that is going on and why” was ranked very important with “explains in words you understand” ranked highest of all.

As 2015 draws closer and closer, it is very important that healthcare workers and policy makers recognise that when we go beyond preventing maternal deaths and work towards maternal healthcare that is respectful of women’s feelings, choices and dignity we will not only “improve maternal health” but we will also “promote gender equality and empower women”.