GPs can’t take away the pain of miscarriage, but they can direct parents toward help and support
As GPs we see women who have miscarried all too often, writes Dr Ursula Oetiker, and while we can’t always help directly we’re in a position to put them in touch with groups who can.
For some couples miscarriage is an isolated experience, for others it is recurrent. For some the loss comes early in the pregnancy, for others it comes a considerable way into the pregnancy. For most they have already imagined a time when they will hold their newborn baby, so losing it can feel as enormous as losing a baby at term.
Approximately one in four pregnancies ends in miscarriage. Parents' reactions vary: most feel a real sadness, some are distraught, and for some the loss remains a deep grief for many years.
A baby that is born with any sign of life, even if very short lived, is regarded as a neonatal death, whatever its gestation, and has to be registered at a registry office by a parent. The birth and the death are registered and certificates issued. If appropriate a post mortem may be held, and a funeral service may be arranged by the hospital or privately.
If there is no sign of life at birth beyond 24 weeks gestation, this is termed a stillbirth, and is registered as such. Again a certificate is issued.
Before 24 weeks gestation, if there are no signs of life, then this is called a miscarriage. Whilst all products of conception, whether ectopic or intrauterine, are disposed of in a respectful way, separate from other surgical specimens, there is no requirement to register this life or loss of it, there is no certificate issued.
Crucially there is no rite of passage to mark this loss for parents. This leaves many couples struggling to come to terms with their loss, to grieve, and to say farewell. They may be well supported by family, friends, their GPs, counsellors, charitable organisations, hospital units, but they don't get to say goodbye.
Miscarriage remains with most women an intensely private matter, which is much less readily shared, even amongst quite close friends, than other distressing life events. I'm not sure why this is, although it was true for me also. Years down the line it becomes easier to share, and it is surprising to find close friends have been through a similar experience.
Just last night at a party I talked to three girlfriends, all of whom had suffered early miscarriages that I was completely unaware of. One friend had had two. She has a 13-year-old daughter, but she would say she is the mother of three children.
It is extraordinary to me, that we feel unable to express these emotions when they are so important to us. Perhaps this is why parents, probably more mothers, find themselves with emotional or mental health issues years down the line. It is always a worry when bereaved patients appear to be doing so well soon after their loss, and often they are the ones who fail to move on in the longer term. It is such an important human need to grieve loss, however it is done.
In my local hospital there is a bereavement team attached to the obstetric and gynaecology department who offer support and counselling to patients. However I doubt this is a widespread practice. One event management agency, CCEM, is arranging services at cathedrals, minsters and churches across the UK this year, in partnership with the Miscarriage Association, which is the leading charity working in this field. The company directors have lost five babies themselves, so know first-hand the trauma of miscarriage. The 'Saying Goodbye' services will commemorate the children parents have lost to miscarriage, and help parents acknowledge their loss and say farewell.
The services are taking place on the following dates at the listed venues in 2012, but around 15 are planned for 2013.
· Exeter Cathedral, Exeter, Devon – Saturday 15 September – 3pm
· Edinburgh Cathedral, Edinburgh, Scotland – Saturday 22 September - 3pm
· York Minster, York, North Yorkshire – Saturday 29 September at 1.30pm
· Birmingham Cathedral, Birmingham, West Midlands – Sunday 28 October at 3.30pm
· St Martin's in the Field, Trafalgar Square, London – Saturday 17 November at 11am
· St Pauls Cathedral, City of London, London – Saturday 24 November at 5pm
· Bristol Cathedral, Bristol, Gloucestershire - Saturday 8 December at 3.30pm
· LLandaff Cathedral, Cardiff, Wales – TBC
GPs can refer patients via the Saying Goodbye website. I think if we have the chance to offer parents this opportunity, we will be surprised at how many mothers and fathers express a need for such a rite of passage.
Dr Ursula Oeitker is a GP principal in Kings Heath, Birmingham.