Obstetric Experience Assignment: Miscarriage
Ruchi Prajapati
October 9th, 2018
Davenport University
Obstetric Experience Assignment: Miscarriage
An experience that I had was when my cousin sister had miscarriage around 2 years ago. My sister and her husband were delighted when she discovered that she was pregnant. She went to the general practitioner and booked her future antenatal care. After 2 months later, she noticed a slight blood and booked an appointment immediately. They performed sonography to find out the reason for the bleeding. There was an empty sac which is called “blighted ovum”. My sister and her husband sat in a waiting room and watched other pregnant women. The doctor came and asked her to come to the office. The doctor said that they didn’t know exactly why she had miscarried or if it would happen again. The doctor recommended an “ERPC” only. They didn’t mention any other sources for help. She had to do a blood test to be sure that she wasn’t pregnant. The report confirmed dropping hormone concentrations. While she was in a lot of pain and bleeding heavily, she asked for painkiller but people working there didn’t give her medication. She was told to wait and sit in the waiting area. Finally, the nurse found a space for her to sit and gave her strong painkillers. No one asked her husband how he was doing. After that traumatic incident, my sister and her husband were so quiet, depressed, and anxious that they were not talking to other family members. My sister was crying spending days in her room and she was hardly went out of her room for 6-7 months. She was not eating properly or talking to anyone in the house. As a family member, we supported her and tried to talk to her such as we tried to watch a comedy movie, went out for a picnic, I was with her to stay with her all the time. After 1 year, she has started to talk and helped others on house work.

Miscarriage is defined as pregnancy losses prior to 20 weeks’ gestation or at a fetal weight of less than 500 g. Out of 20% of miscarriages, 80% of miscarriages occur before twelfth week of gestation (MacWilliams, Hughes, Aston, Field, ; Moffatt, 2016). A miscarriage can be a unique, traumatic and distressing experience in a woman’s life and may lead to grief, depression, anxiety. The etiological causes for miscarriages could be immunologic, genetic, anatomic abnormalities, endocrine disorders, infectious, heritable, acquired thrombophilias or environmental factors (Tavoli, et al., 2018). Women experiencing miscarriage need support and care from healthcare professionals and family. Qualitative studies indicated that a record of miscarriage could harm women and be associated with feeling anxious, development of psychological disorders, and affecting the quality of life in this population. The recurrent miscarriage experience increases depressive symptoms and risk of negative psychological effects such as pregnancy-related anxiety, depression, irritability, excessive fatigue, fear, sleep disorders and lack of concentration. (Tavoli, et al., 2018).
The miscarriage can cause effect every woman differently. The two main aspects to early miscarriage were identified as the physical and the psychological. The physical aspects are symptoms of pain, bleeding, blood clots, products of conception, lack of baby/fetus while psychological aspects include anxiety, fear, distress, grief, and depression (Robinson, 2014).
The healthcare professional support the women by understanding her emotional state and significance of the loss. Regular follow-up clinics for early miscarriage have found some benefits in some women. Providing information and a caring, sensitive approach are the two most important issues to women. A miscarriage is usually an unanticipated experience that inflicts bleeding, sudden intense pain, medical interventions, loss of control, and emotional responses that may lead to longer-term problems, it is important that the careful consideration should be given to the women in both the short and long term when planning care (Robinson, 2014).

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Complementary healthcare approaches are considered to alleviate psychological
distress among women in reproductive health care settings. It can be a natural product such as herbs or mind-body practice such as yoga, meditation to advance health and wellness. Complementary healthcare approaches may diminish stress signaling hormones and increase dopamine levels which is important in controlling mood, emotions, and anxiety. Mind-body approaches make people aware of their thoughts, feelings, and sensation without judgment which affects tolerance and help women to manage their psychological distress (Huberty, Matthews, Leiferman, & Lee, 2018). It may help to quiet the mind, be more present without judgment which supports to control emotions and help to cope with this traumatic event. The authors also mentioned that the complementary approaches were more common in women with depressive mood, miscarriage, premature labor, musculoskeletal pain, similar to NHIS data, 51.7% of pregnant women that were depressed were using complementary and alternative medicine (Huberty, Matthews, Leiferman, & Lee, 2018).

One other serious problem from the miscarriage is a risk for infection. The infection is 6% in high-income countries following surgical management of miscarriage while in low-income countries, the infection rate is 30% after surgery (Lissauer, et al., 2018). Infection can cause serious illness, death, and long-term consequences from pelvic scarring, increased rates of ectopic pregnancy, and infertility. To prevent the risk of infection, the standard practice is to provide information about hygiene and prophylactic antibiotics before and during surgery.
Care plan
The nursing diagnosis that would correlate with my experience would be anxiety related to unknown and unexpected outcome or symptoms. The signs of complications generate fear and anxiety in women. Their dreams about pregnancy and having a baby or becoming a mother become threatened and lost. Being unprepared and the symptoms not being what my sister expect to feel or see have an adverse effect on their wellbeing. Lack of information about miscarriage contributes to the distress. Receiving information is a common coping strategy. It is important to provide information the way women understand. Using medical terminology and insensitive comments can cause distress and lack of understanding. Moreover, it determines a lack of empathy and sensitive care. Women need information and answers of their pregnancy and what is happening to them. Proving information about pregnancy and their issues exhibits support and care for those women. Women having miscarriage need support and care from family and health care provider to cope with the loss. Interactions with people who had the same experience (family and friends) demonstrate some supportive care. Instead of treating my sister like she was just a patient and she miscarried, you should provide her a comfortable environment and help her to cope with her loss.

Complementary therapies such as yoga and meditation may decrease depressive symptoms. About 40% of women with a history of miscarriage informed using a complementary approach (Huberty, et al., 2018). You should make a schedule for the patient for complementary therapies by involving the patient also. Meditation for 5 minutes every day would help her to cope with the loss. Complementary approaches should be culturally sensitive and give some options to the patient to choose from different therapies. Prayer was the most stated complementary approach in women who had a miscarriage followed by yoga, massage, chiropractor, and meditation. You should provide information about these approaches such as doing prayer every day may decrease her anxiety, help her to calm her mind, distract from the loss, help her to find peace in prayer because, in her culture, prayer is the religious part for everyone and daily routine.

Another diagnosis would be a risk for infection related to surgical treatment and dilated the cervix. You should teach the women to clean the perineum after each voiding and bowel movement. They should be advised to take antibiotics to reduce complications such as sepsis, further operation, and death as well as subfertility, pelvic pain, and ectopic pregnancy.
While she was going through the pain and guilt, another nursing diagnosis would be situational low self-esteem related to the inability to carry a pregnancy successfully to term gestation. She needs family and friends to support her. It is important to gain her self-esteem and confidence back and tell her that it was not her fault that she did everything for her child. Make her comfortable by providing a safe environment where no one talks about her miscarriage and try to distract her. Make sure the patient has all resources that can help her to cope with her loss.

References
Huberty, J., Matthews, J., Leiferman, J. A., & Lee, C. (2018). Use of complementary approaches in pregnant women with a history of miscarriage. Complementary Therapies in Medicine,36, 1-5. doi:10.1016/j.ctim.2017.11.003
Indra San, L. C., Meaney, S., McNamara, K., & O’Donoghue, K. (2017). Psychological and support interventions to reduce levels of stress, anxiety or depression on women’s subsequent pregnancy with a history of miscarriage: An empty systematic review. BMJ Open, 7(9) doi:http://dx.doi.org.proxy.davenport.edu/10.1136/bmjopen-2017-017802
Lissauer, D., Wilson, A., Daniels, J., Middleton, L., Bishop, J., Hewitt, C., . . . Coomarasamy, A. (2018). Prophylactic antibiotics to reduce pelvic infection in women having miscarriage surgery – The AIMS (Antibiotics in Miscarriage Surgery) trial: Study protocol for a randomized controlled trial. Trials, 19(1). doi:https://doi.org/10.1186/s13063-018-2598-3
Macwilliams, K., Hughes, J., Aston, M., Field, S., & Moffatt, F. W. (2016). Understanding the Experience of Miscarriage in the Emergency Department. Journal of Emergency Nursing, 42(6), 504-512. doi:10.1016/j.jen.2016.05.011
Robinson, J. (2014). Provision of information and support to women who have suffered an early miscarriage. British Journal of Midwifery,22(3), 175-180. doi:10.12968/bjom.2014.22.3.175
Tavoli, Z., Mohammadi, M., Tavoli, A., Moini, A., Effatpanah, M., Khedmat, L., & Montazeri, A. (2018). Quality of life and psychological distress in women with recurrent miscarriage: A comparative study. Health and Quality of Life Outcomes, 16(1). doi:10.1186/s12955-018-0982-z

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