- Fear of failure and shame is an issue for many mothers-to-be. Here, your affirmations and good humor are helpful. Be very respectful of the patient’s interpersonal boundaries, both physical and emotional.
- Disempowerment is an inherent part of the patient experience; trauma aggravates this dynamic. Whenever feasible, shift some of your power to the patient by eliciting her wishes and offering her choices. Together, create a plan for delivery and postnatal care that reflects her desires. As you demonstrate competence and control, consciously deconstruct the image your patient may have of you as an infallible authority figure by selectively revealing a little of the personality behind the white coat.
- Feelings of isolation always occur with trauma. The bonds you cultivate with the patient during her pregnancy will alleviate this isolation, as will your message: You are not alone in this experience; we will deal with this together.
Other helpful practices
Allow the grieving couple space and privacy to ventilate and mourn any way they need to. This may include expressions of anger.
Listen silently and attentively even if you feel passive or uncomfortable doing so. Resist the urge to comfort the patient; even well-intentioned comforting can interrupt healing.
Validate the patient’s trauma. Be careful to avoid making the suggestion that you understand. No one but the patient can understand—suffering is always unique and personal.
Express a genuine and carefully worded sense of regret for the patient’s loss. Take care not to express personal negative feelings, such as those regarding a baby’s deformity. Your words may become permanently imprinted.9
Present any information and recommendations the patient needs in writing because, when a person is in shock, she may be unable to recall verbal messages. Also give written recommendations to one of the patient’s family members, if possible.
Avoid well-intentioned attempts to reassure a patient or to rationalize or offer premature hope. There is time for such things later.
Cultivate a referral network that includes social workers, chaplains, and psychotherapists trained to work with trauma victims, and when they are necessary, involve them as early as possible. Also familiarize yourself with local support groups and short-term cognitive group-therapy programs for grieving parents.10
Frame the gesture carefully if you feel the need to refer the patient to a psychotherapist or psychiatrist. It is better to emphasize to the patient that she has sustained a major trauma than to suggest there is something wrong with her. The latter will only add to her sense of personal failure and may trigger resistance or anger.
Take care of yourself! You need your own practices and rituals to sustain you in the work you do. Create your own network of support. Concentrate on expanding your resilience and strive to be comfortable with your emotions. If symptoms of burnout appear, seek help quickly.
The author thanks Amy Hyams and Anne-Marie Jackson, MD, for their assistance.
Recommended reading
- Bub B. Communication Skills That Heal: A Practical Approach to a New Professionalism in Medicine. Abington, UK: Radcliffe Publishing–Oxford; 2005.
- Herman J. Trauma and Recovery. London: Rivers Oram Press; 1997.
- Schneider J. Finding My Way: Healing and Transformation Through Loss and Grief. Colfax, Wisc: Seasons; 1994.