Mary Higgins: Breaking bad news in maternity care

IMG_0701There’’s one thing I really hate about my job, and that’’s a particular phone call. A midwife I respect will ring and ask can I come down straight away. A woman has presented because her baby hasn’’t moved in a couple of hours, and the midwife can’’t hear a heartbeat.

As I enter the room, there is a woman there, hopefully with someone, who looks up as I walk in. Her face tells a story—fear, hope—and what I say next will be remembered for the rest of her life.

I have attended many seminars and workshops on how to break bad news. I have read numerous articles and research papers. I have taught medical students and trainees how to care for women with pregnancy loss. And there are two truths that I have learnt over the years.

The first is that I am a novice at this, and will remain humble for the rest of my professional life—always willing to learn how to do this better. The second truth underlines the first: there is no right answer that is suitable for every family. Care needs to be tailored to meet the individual needs of each woman, each man, each grandmother, grandfather, sister, brother, friend, child.

The Miscarriage Association recently released a series of short educational reviews of communication at different stages of early pregnancy care: in an ambulance, the emergency department, and the ultrasound department. They are strong, powerful, upsetting, and thought provoking videos, with important teaching points. Firstly, to listen to the woman—and her partner—about what they need. The second is a harder lesson to learn.

As a medic I want to be able to stop miscarriages, make ectopic pregnancies move into the uterus, turn molar pregnancies into healthy babies, prevent congenital heart disease from ever starting, stop the neural tube defect, take away an extra chromosome, prevent preterm delivery, identify every baby that isn’’t tolerating labour, stop all neonatal infections. Many of us are actively working on education and research in these areas, but the research isn’’t yet at the stage that we can put it into practice. Some of these will inevitably lead to loss.

And when I can’’t fix something, the next thing I have to do is care. To hold a hand and listen. To make a cup of tea. To give people some privacy. To write out information to be brought home. To write a letter for work if appropriate. To keep people company. To say I am sorry this has happened to you, and that I recognise your loss.

I have watched midwives, both junior and senior, do this beautifully—medical colleagues who have shown their humanity in their care of bereaved women. I have listened to friends and family talk about their experiences of care. I wish to learn from what we do well in order to practise excellence. And I am not perfect at this, but I am trying.

Mary Higgins is an obstetrician at the National Maternity Hospital, University College Dublin.

Competing interests: None declared.