Dear Emergency Departments Everywhere

Dear Emergency Departments everywhere…

STOP SENDING WOMEN HOME WHO ARE HAVING A MISCARRIAGE!!!!!!!!!!!!!!

I really cannot stress this enough. It’s getting very old hearing the words, “There is nothing we can do, go home.”

Is that really all you have to say? Do you really thing there is nothing you can do? Let me explain to you the things that you CAN do because what you are doing is not enough and is definitely nothing. In the end, you are hurting so many more women emotionally and physically. And many of you have no idea that these women are being put at risk and readmitted for complications or seeking care elsewhere.

Here is what an emergency department can do when a woman is miscarrying:

1. Express condolences. Even if you think the woman is relieved or that this doesn’t matter to her (or to you), saying, “I’m sorry for your loss,” or “I’m sorry you have to go through this experience,” is perfectly appropriate.
2. Don’t rush. Families do not understand the administrative responsibilities of an emergency department. We don’t know how many people should utilize the room per day to operate at your maximum efficiency. So when you rush a family out of the emergency department, it comes off as you don’t care and that the experience wasn’t worthy of more time, compassion, and attention. And to be honest, your survey responses will be poor.
3. Don’t send her home. Let’s be honest here, no women should miscarry at home. She is giving birth and is at risk of hemorrhage and other complications but if a woman is going to miscarry a baby beyond 11 weeks, she should have the option of being admitted during the process. And let’s get more serious, if a woman is between 15-20 weeks, it’s insane to send her home to deliver her baby alone. Actually, it’s malpractice in my opinion.
4. If you have to send me home, send me with information. With how common miscarriage is, of course hospitals would be overrun with women delivering their deceased babies; however, you can’t just send them home with no information. That’s irresponsible and dangerous. Women need to know what the process is going to be like, feel like, and look like. Then they need to know how to manage everything from the pain to delivering the baby, to what to do with the baby. How about you give them a book? Something like “It’s Not Just a Heavy Period; The Miscarriage Handbook” would work wonderfully.  In addition, women should be sent home with a way to capture and preserve her baby. A miscarriage kit by Heaven’s Gain would be perfect.
5. Present options. What does a woman do with a miscarried baby? Women need guidance. Offer those options. Families can create memories such as photos, prints (even with tiny babies), and molds. Women should be offered bonding and memorial options. If you don’t know about any, learn. Cremation and burial are also options so do not forget to present them.
6. Offer testing. Women who lose a baby have a desire to know why. Women deserve testing even if you believe nothing will be revealed. If only 13% of families choose autopsy, no one can say with any certainty that information can not be revealed. This should be offered so this is another reason not to discharge a woman to deliver her baby at home. If she has to deliver her baby at home, testing can still be an option. Send her home with a test kit, such as the Anora miscarriage kit.
7. If you are hesitant to send her home, don’t. Do something. Admit her, run tests, monitor her and the baby (if still alive), and provide options and resources as mentioned above.
8. If the baby is still alive, do something. Imagine how you would feel like if you were sent home after your water broke or your cervix was dilating, knowing your baby was still alive, and being told there was nothing that could be done by a medical institution. Ever heard of the Trendelenburg position? Or how about an amnioinfusion? Admit this mother! The outcome may not change but you did something to try. Can you imagine the guilt a mother feels when she can’t do anything but everything within her is telling her she should have? Do something! Because there IS something that can be done in this situation.

This information is not hard to present or to find. The problem is, emergency departments just don’t have the information but with how common miscarriage is, they should. This is no different than having information and resources for heart attacks or suicidal ideation. It’s time that emergency departments take miscarriage seriously.

Hospitals do not believe women should be delivering their babies at home. They believe that homebirth is dangerous and all women should deliver within the confounds of the hospital, yet they have no problem sending a women home to deliver their dead baby or their baby that is too young/early for life saving interventions. This makes no sense. The risks you are concerned about are still there but the fact that her baby is dead changes everything and that is just plain sick (and this is just another blog topic).

While the goal should be to stop sending women home to hemorrhage on their bathroom floors only to be transferred via ambulance to the hospital in a fatal condition and to deliver their dead babies at home; your policies aren’t going to change overnight. So start doing this better. It’s imperative that you do. Women’s lives depend on it!

-Breaking the silence of first trimester miscarriage.