BREAKING BAD NEWS

As a House Officer, while on call we had a lady rushed into theatre for an emergency CS due to foetal bradycardia diagnosed on the CTG (i.e. the heart rate of the baby was reading about 80bts/min when a normal heart rate for a baby in the womb should be between 110 to 160bts/min). It turns out that the CTG (an out-of-date model compared to what is used in UK and the developed world) had been picking up the mother’s pulse and we delivered a macerated foetus (i.e. the baby had been dead for a while and was already decomposing – sorry for the graphic details).
It was left to the consultant paediatrician to leave the theatre and tell the father how a baby would not be coming out and why (the mother was under general anaesthesia and so was unaware of what had occurred).
Different guidelines on the management of pregnancy loss suggest that the most senior member of the team should break the news to the woman/couple wherever possible.
However, this raises a question for more junior doctors on the frontline of care. If, for example, you are the Medical Officer on NYSC (national service in Nigeria) posting and you are the first and only person most patients would see, how do you effectively deliver bad news? What qualifies you to deliver bad news? Can empathy only be gained with experience? Is that why the more senior health professionals should deliver bad news? If yes, does this mean that we will inevitably bungle up the delivery of bad news until we learn how to do it properly?
Personally, I was always uncomfortable with miscarriage and pregnancy loss. I am ashamed to admit that when I went in to see the mother the next day on my House Officer ward round, I could not look her in the eye, I did not offer my condolences for her loss; I just said, “good morning” and checked her vital signs. It wasn’t till I had experienced a loss myself and conducted the survey that I realised how lonely and scary such an experience could be. Empathy can really go a long way to make a difference in such instances.
While preparing for my PLAB exams (in order to be registered with the General Medical Council in the UK), breaking bad news was one of the skills I had to learn. It is also a module in BMJ Learning for continuing professional development. This is a topic that was never discussed while I was in medical school in Nigeria.
I don’t claim to know the answers to the who, how, when or why of the delivery of bad news. But I know that no matter what level you are at as a medical student, doctor, nurse or midwife, “I’m so sorry for your loss” is easy to say: there’s no law against that.

COPING AFTER A MISCARRIAGE

A recent press release by researchers at the University of Michigan Health System confirmed an interesting fact: online forums can help women cope with pregnancy loss.

They surveyed over 1000 women on 18 different message boards and came to the conclusion that an important tool in dealing effectively with the loss is talking to someone who knows what you’re going through. A lot of family and friends are unwilling to talk about such matters: miscarriage, stillbirth and so on. It is an uncomfortable subject and many times, they do not understand the need to talk about it.

I personally know that the online forum specifically for women who had experienced a miscarriage on www.babycentre.co.uk was a lifeline for me. These women knew exactly how I felt and there was an abundance of cyber hugs and positive thoughts given and received freely between complete strangers united by loss.

In one of my posts, I shared Sarah’s story and she remembered that the first time she really felt like everything was going to be okay was when she was able to talk to a complete stranger that had also suffered a loss.

An interesting finding in this study was that the African-American population was significantly under-represented on these message boards even though they were statistically more likely to experience miscarriages and stillbirths than their Caucasian counterparts. I cannot assume to know why this is so but I am under the impression that in Africa, an online message board may also not work, even though there is internet access.

The key take home message for me is this: after a pregnancy loss, a woman will cope much better if she is able to talk to someone that understands what she is going through and is willing to talk about it with empathy and sensitivity.

SOURCE

Mary Elizabeth Dallas, “Online forums can help women cope with pregnancy loss”, November 4, 2011. Accessed from http://www.nlm.nih.gov/medlineplus/news/fullstory_118355.html  on November 22^nd 2011