When a pregnancy issue is suspected
Aim to provide kind and empathic care and give clear information sensitively. Listen carefully to the words the woman and partner use and take those words and their fertility history into consideration when responding.
Women and partners tell us this can be a very distressing and shocking experience, whatever the gestation, although occasionally the news may not be distressing and may even be a relief.
What do we need to do?
- Some women’s initial contact will be with paramedics, GPs and triage staff. Acknowledge the anxiety they may feel, listen and communicate sensitively, keep to known facts and answer questions within the scope of your practice.
- Wherever possible, prior to speaking with the woman, familiarise yourself with her history and any previous pregnancies or pregnancy loss.
- When seeking consent from the woman for a scan or another examination or test, sensitively explain the potential need for a second opinion and/or repeat scan.
- Be aware that the woman and partner may be anticipating challenging news because of signs or symptoms, an earlier assessment, a letter or phone call (e.g. molar pregnancy) or a previous pregnancy. However, for many the news will come as a complete shock.
- Do not make assumptions about how the woman and partner feel about the pregnancy or the news – communicate empathically and follow their lead on terminology and language.
- If you suspect or identify a problem on examination and need to consult or confirm with a colleague outside the room, explain this before you leave the room. Be aware of your body language and non- verbal signals and be sensitive to the woman’s or partner’s reaction.
- Find a quiet and private place to deliver the news and/or to explain it further. This might mean giving the news in the scan room but explaining next steps elsewhere.
- If the woman is alone for the diagnosis, ask if she would like someone else to be present for further explanation.
- Share the known facts about the diagnosis and make sure the woman and her partner know what will happen next.
- Use clear, straightforward language. Avoid medical terms, abbreviations (e.g. ERPC) or euphemisms (e.g. ‘not in your tummy’).
- If the news is being given at an ultrasound scan, ask the woman and partner if they want you to show them what you have seen. Ask the woman if she would like to get dressed and sit up or prefer to see the screen while you explain the findings.
- If the diagnosis is unclear – e.g. a pregnancy of unknown location or of uncertain viability or a suspected molar pregnancy – explain the need for further assessment and acknowledge how difficult the period of uncertainty can be.
- If one or more babies in a multiple pregnancy dies but one or more is still viable, be sensitive to the feelings that the woman and partner may have. The continuing pregnancy or pregnancies may still be at risk and even if continuing, may be no compensation for the baby/babies that died.
- If the pregnancy is heterotopic – one ectopic and one intrauterine – and the intrauterine pregnancy is viable, be sensitive to the feelings that the woman and partner may have. Depending on how the ectopic is managed, the intrauterine pregnancy may still be at risk and even if continuing, may be no compensation for the baby that died.
- If you are giving the diagnosis of a molar pregnancy, ensure that you know whether the woman and partner are expecting this news (e.g. from a previous appointment, a letter or phone call). Be sensitive to the feelings they may have if they have already been coping with the diagnosis of miscarriage. Also be aware that molar pregnancy is uncommon and is a complicated diagnosis to understand.
- Give the woman and partner time to absorb the news, and answer as many questions as you are able to within your scope of practice.
- Reassure the woman and partner that sadly early pregnancy loss is not uncommon and it is very unlikely that the loss has been caused by anything they did or did not do.
- Give information about what happens next, provide written information, specific patient leaflets and a named contact with contact details - a template contact card is available.
- Offer a copy of the scan picture if there is one and offer to keep a printed copy in the notes if they would prefer.
- Check that the woman and partner can get home or to the next appointment safely and, if not, help them to think about other options.
- It is not uncommon for women to pass their baby/pregnancy while on the toilet. Bedpans or similar should be provided in women’s toilets in A&E, early pregnancy, gynaecology and maternity settings.
- Consider NICE guidance NG126 for further information.
There was a lack of empathy, everyone too busy but one nurse squeezed my hand and that small gesture was remembered and appreciated through all the turmoil.
I was asked by a nurse to keep the noise down, as there were other patients to consider. At A&E, there was no prioritising for patients with pregnancy issues, no compassion.
I was left in the waiting room at A&E for three hours with blood seeping through my clothes.
At A&E, although in great pain no one listened to me and I was sent home to cope. That pain was like being in labour but because no one had explained what could happen, the level of pain etc. I was not prepared and had to put up with it.
How will we know we have achieved our aim?
Women and partners will tell us they were treated with respect and kindness by staff and received clear information which was sensitive to their individual needs.
Staff will say they feel confident and competent in dealing with women and partners who exhibit any of a range of emotional responses to their situation and in giving clear information.
Go to Next steps - first trimester miscarriage
Go to Next steps - 2nd trimester miscarriage, ectopic or molar pregnancy