Monday, March 21, 2005

Not News for Anyone Who’s Experienced It

Perhaps one of the more disappointing moments for a newly pregnant woman is calling an obstetrician’s office to set up her first appointment. She proudly tells the receptionist she’s just found out she’s pregnant. The receptionist asks [all together now], “What is the date of your last menstrual period?”

The excited mother then gets scheduled for an appointment 10 weeks in the future.

Ten weeks! She has to wait ten weeks to learn about appropriate nutrition. She has to suffer through morning sickness with no professional advice or treatment for ten weeks. She has to wait ten weeks to have her pregnancy validated through official recognition by her doctor.

And if, like one in five women, the woman miscarries, she will likely wade through that with little or no contact with her doctor. I do not know whether this policy is intentional or not. For anyone who has faced pregnancy loss in the first trimester, however, it seems like a cruel plot.

A recent study of British professionals found that men and women alike rated a miscarriage as the hardest life event they faced. Infertility was right behind. It is the height of negligence for doctors (and midwives; at least in this area CNMs follow a similar policy) to leave their patients to their own devices until they’ve cleared the first trimester hurdle. I can understand that it might be a financial loss to spend time with patients, 20% of whom will not ultimately produce the payoff of a birth. But I cannot forgive it.

The emotional toll of miscarriage is huge, even when the physical cost is relatively low (to provide but one famous example, actress Kirstie Alley says her significant weight gain was fueled by unresolved grief from a miscarriage). By waiting until the first trimester – the time when most miscarriages happen – has passed before seeing patients, caregivers send a message that losses in that period do not matter. Women who miscarry in that window are not treated as mothers-to-be, but rather as bearers of doomed fetuses. Their pregnancies have not even been acknowledged by the medical community before they end.

This plays in to the long-lasting feelings of guilt, failure and shame that many women feel about their miscarriages.

I was pleased to hear one of our local homebirth midwife teams (and others I’m sure) begins caring for patients as soon as they are contacted by them. In fact, they consider it important to be in touch in the first trimester in case the woman miscarries. They treat that event with the reverence they would any other birth, plus some more because of the death entangled with it.

Usually women wait until they are five to seven months pregnant to make their initial doula inquiry with me. Only when we go over their reproductive history do I learn about the painful pregnancy losses in their past. I would like women to know they can hire a doula early so they have that additional support in the event of pregnancy loss as well a birth.


Blogger Dynamic Doula said...

One of my clients (now almost 30 weeks pg) and I started talkign when she was TTC. She concieved, and then discovered her hormone levels were not conducive to sustaining the pregnancy and that miscarriage was imminent. I was at her house working with her when she started bleeding. It was an incredible gift to be a part of that with them, and I'll never forget it. Her midwife and doctor did not want to see her either unless the miscarriage did not go 'well'- stopping when it was supposed to stop, etc. There was little emotional support from her doctor. A client I met with tonight shared with me a similar story about an OB here in town who never acknowledged that they'd lost a baby, only what to expect in the next few days, etc. No compassion, human connection, etc. I am hearing more and more stories like this, and have a friend who wants to encourage funeral homes to set up a special area for babies who were lost to miscarriage, to help women have a place to go and grieve where they won't feel like they're dwelling on it or have to deal with the feelings of their family or friends. I think it's a very wonderful idea.

1:32 AM  
Blogger doulicia said...

That is a great idea.

Your client was so fortunate to have someone with the "childbirth heart" go through the experience with her.

3:51 PM  
Blogger Sage Femme said...

I usually don't see people until around 10 weeks. But, I have never had someone go through a miscarriage alone....the ones that have always call me. :) I think that there is a difference, though, in that you're going to get a group of docs in the hospital, not an individual one, so early care isn't really going to make a difference.

Nutrition is hard until 10 weeks or so, too, because of nausea. I have women call me that haven't had their first appt that ask about remedies for morning sickness.

4:40 PM  
Anonymous Melissa said...

Hallelujah, sister. Though I did not suffer the pain of miscarriage, my first pregnancy was made much more stressful due to this policy at my former OBGYN practice. I experienced terrible morning sickness and higher-than-average doses of anxiety, fear, ambivalence. From a nutrition standpoint alone, at least one appt. during the first trimester is, in my opinion, absolutely vital. I never really did recover from this breech of trust early in the relationship with this OBGYN office (I don't say doctor because - also in line with the usual, impersonal standard of care nowadays - I never saw the same OB twice). I left at 6 months for the care of my midwife. She saw me no less than twice during my first trimester this time around - mainly just to address any feelings, issues, problems, concerns I might have early on. It makes me want to weep when I think of the difference in care between the OB office and my homebirth midwife. How stressful, how awful it was then - and did not need to be. ... I just wanted to add that I love your blog (which I found through MDC) and in particular found your recent c-section musings to be revelatory and very well expressed.

12:28 AM  

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