After experiencing an early miscarriage, a 33-year old woman was referred to the Duke Family Planning clinic for care. At Duke, she was seen by obstetrician and gynecologist Beverly Gray, MD, who specializes in family planning and pregnancy loss. During the next several years, the patient had several pregnancy losses. However, blood testing and ultrasound failed to reveal an underlying cause.
In the interview below, Gray shares some insight and considerations for clinicians caring for patients with idiopathic recurrent miscarriage.
What factors affect how you approach care?
It all depends on what the patient needs when they come to us. From a clinical perspective, we offer miscarriage care both in the office and in the operating room. When we meet the patient, we assess physically and emotionally how they’re coping. For patients with recurrent pregnancy loss, we will typically do an evaluation, potentially referring patients to maternal fetal medicine or our Duke fertility clinic. Both of those areas have specialists who help care for patients with recurrent pregnancy loss. We also give patients with a history of recurrent pregnancy loss the opportunity to see us early on in their pregnancy. There is a lot of anxiety in early pregnancy for women who have gone through pregnancy loss, and offering early care can provide much-needed reassurance.
How can physicians help women experiencing recurrent miscarriage?
One thing we can do is dispel common myths surrounding miscarriage. There is a recent study showing that women believe miscarriage is relatively uncommon and, if they have one, they must have done something wrong to cause it. We are able to offer a lot of reassurance that miscarriage is very common—as many as 20 percent of first pregnancies end in miscarriage. We can also dispel the myth to relieve perceived guilt that women feel.
But even though most women experience a miscarriage at some point during their reproductive years, it’s still very sad and can be traumatic for some patients. We need to make sure we’re focusing not only on our patients’ medical needs but also their emotional needs. I think that’s especially important for women with recurrent pregnancy loss because it can be really scary for these patients to even think about getting pregnant again.
What have you learned from working with these patients?
The main thing I’ve learned is that patients are very appreciative when you make yourself available for questions. Helping patients cope with the emotional aspect of pregnancy loss is probably more important than we realize and often something we don’t leave enough time for—it’s easy to forget with a busy clinic schedule. Often when you diagnose a pregnancy loss, much of what you tell a patient doesn’t register because they’re hearing news that they weren’t expecting. So, when you give bad news, you need to give patients time to ask all of their questions and give them an easy way to follow up with you. We provide our patients with our clinic nurse’s contact information, so they can get in touch with her directly if needed. We also give our patients a lot of written information, so they have something to refer back to when they may have forgotten what we had discussed.
Helping patients with recurrent miscarriage can be emotionally intense for the physician as well. But it can also be incredibly rewarding. I was thrilled when, late last year, the patient introduced here had a successful pregnancy. I was one of the first ones to know every time she was pregnant, so it was wonderful to help her deliver a healthy baby girl.
