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Fetal Loss: How to Take Care of Your Body and Mind

Fetal Loss

This guest blog was prepared by Kensi L. Duncan, BSN, RN, RNC-OB, Women’s OR Team Leader, UAB Medicine Labor & Delivery & High-Risk Obstetrics.

‘Babies lost in the womb were never touched by fear, they were never cold, never hungry, never alone, and most importantly, always knew love.’ –Z. Clark-Coates

First of all, if you’ve lost an infant, I am so sorry. Your baby matters, no matter how big or small, and you deserve to know that. Fetal loss is the hardest part of my job as a labor and delivery nurse, and it is a difficult topic to talk about. No one wants to think that pregnancy is anything other than joyful, but unfortunately it sometimes is incredibly sad.

There are many misconceptions about miscarriages and stillbirths, so I wanted to give a nurse’s point of view on this delicate subject.

Why did this happen? Will it happen again? In most cases, we do not know what actually caused the fetal loss. The most common cause is chromosomal abnormalities, meaning that the baby was not growing correctly or had an incorrect amount of chromosomes that formed during fertilization. There is no guarantee that it won’t happen again, but losses in the first trimester (until 13 weeks) usually are a onetime event, and you should be able to get pregnant again.

What happens now? Your health care provider will talk with you about how you’d like to proceed. We understand that it is a huge shock to receive such sad news and that you may need time to grieve and process the situation. If your physician determines that you are stable, you may be able to go home to allow the baby and remaining tissue to pass on their own. If your physician determines that you need surgical intervention, you would be scheduled for a dilation and curettage (D&C) to remove the tissue. If it is not removed or only partially removed, you could become very sick, so it is important to always seek medical care if you are cramping and experiencing vaginal bleeding, fever, or chills.

How will my body change after a loss? Immediately after the tissue is removed from the womb, you may experience bleeding much like a period, which is normal. If bleeding increases or you have a clot larger than the size of an egg, call your doctor. For patients who have a loss at 20 weeks or beyond (sometimes a little earlier), there is a chance you will experience milk coming in to your breasts a few days after delivery. This is not something that is anticipated and can be very upsetting when it happens. The best thing to do is express just enough milk to make you comfortable and prevent you from becoming engorged (when your breasts are full of milk and tender), and it will stop after a few days. Make sure you do not bind your breasts; instead use cold compresses and cabbage leaves in your bra to “dry up” the milk. There’s a chance you could develop an infection in the breasts if the milk is not expressed, a condition called mastitis. This is characterized by painful swelling, fever, chills, and redness of one or both breasts, and it requires antibiotics, so contact your doctor if this happens. Some patients want to have their milk dry up very quickly, while others choose to pump their milk and donate it to a local milk bank to help those in need of supplementation.

Take care of your mental health. This can be a lonely journey that often is misunderstood, and there is more to this experience than just the physical toll it takes. There is an emotional journey that those who have not had a loss might not understand. It may take years to fully cope with your baby leaving the comfort of your womb too early, and that’s ok. It is ok to grieve, and it’s important for you to express your feelings in a healthy way. You can plant a tree in your baby’s honor, join a support group, or start a journal — sometimes just writing your baby’s name is comforting. We will offer you mental health resources, too.

As a nurse and member of your care team, I want you to know that we are here to give you excellent care. As a woman and fellow patient, I want you to know that my heart breaks for you. I recognize that this was more than a loss. It was plans, actual pain, hopes, doubt, isolation, fear, frustration, anger, and discomfort. Some days will be harder than others, and you will never forget your baby, but it does get better.

Click here to learn more about UAB Medicine Women and Infants Services, including information on support groups and how to donate breast milk.