Dr Librizzi is Chief, Maternal Fetal Medicine, Virtua Medical Group; Director, Women’s Medical Specialties, and Director, Clinical Trials Office, Virtua Hospital, Voorhees, New Jersey.
Ms Ilse is an author and President of Babies Remembered Consulting, Wintergreen Press, Baby Loss Family Advisors, and Baby Loss Doulas.
Ms Coyle is Manager of Perinatal Bereavement Programs and Facilitator of the HOPING/Unite Grief Support Group and Rainbow Babies Support Group, Virtua Hospital, Voorhees, New Jersey.
Delivering bad news to patients is a challenge for most ob/gyns. Whether it is telling a woman that she has an abnormal sequential screen, an abnormal glucose tolerance test, elevated blood pressure, or an abnormal obstetrical ultrasound, it is stressful for both patient and provider. In addition, what we intend to say may not be what is heard.
Those who practice obstetrics and maternal-fetal medicine are familiar with all the common complications of pregnancy, but fortunately, few of us have ever lived through one. We can cite best practices, optimally treat diabetes and hypertension, and even find “reasons” for these conditions in family histories. Regardless of evidence-based medicine (or even better, evidence-guided medicine) and despite the best of intentions, adverse outcomes happen. Physicians deserve training and practical preparation to give clear, kind, respectful care to families who have unexpected outcomes.
When a baby dies in miscarriage, stillbirth, or the neonatal intensive care unit (NICU), or when a life-limiting diagnosis is made, we don’t always know the best way to interact with families when giving the news, helping them plan for what is to come, or supporting those who must choose to either continue or end a pregnancy when a life-threatening condition exists. The emotional toll of caring for these families is great. To make matters worse, as consultants, we may meet couples for the first time when they are experiencing a crisis. For example, in one national survey, 75% of physician respondents reported that “caring for a patient with a stillbirth took a large emotional toll on them personally, and nearly 1 in 10 obstetricians reported that they had considered giving up obstetric practice” because of this emotional difficulty.1 The parents may experience a life-altering shock. “With stillbirth, families and physicians may experience complex emotions from simultaneous birth and death…because the cause of death is often not identified, physicians may blame themselves even for unpreventable losses…The finding that adequate training was associated with less guilt overall and less likelihood of having considered quitting obstetrics altogether suggests that better preparation may be an important strategy for coping.”2
Here we provide basic information to help increase your confidence and competence and examples of what to do, say, and not say. In addition we discuss timing and intentional messaging.