Getting the Care You Need during Pregnancy after Loss


In June 2015, I wrote an article about how to navigate your preconception visit with your healthcare provider, which included questions to ask and considerations to make on your part when trying to select a provider for a prospective Pregnancy After Loss. Now that you’ve picked a provider, this writing will focus on making sure that you are heard and your needs are getting met. This can feel daunting as a PAL is filled with uncertainty, so who might you be to question your healthcare professional? You are the perfect person to do so, as a patient, your child’s advocate and your own advocate.

Not every PAL will need a warrior mama at its helm. There are the healthcare providers who “get it” and will accommodate or actively try to lessen the anxiety that you might be feeling. If this seems to match your experience, the rest of this article might not be relevant. However, if your provider doesn’t intuitively understand what you are going through, read on.

The first thing to do is to assess what your needs are or have been. This can be as simple as writing down a list of your needs: (for example, do I have to restate my history at each visit or do the providers seem to know it?) After you write them down, rank them based upon those that are the most important to you. Once you have a sense of what your needs are and their importance, you can then look through them to see how (or if) they are being met. Providers aren’t perfect, so this is where it is essential to get a sense of your own order. Are there aspects where the provider (or staff) might be falling short that don’t matter as much? Are there gaping holes between the care you are receiving versus the care that you need?

The next step isn’t quite so simple. It involves taking a risk and having a conversation with your provider to see if this will help to fill in whatever gaps might exist. Conversely, if all is going well, take a moment to express appreciation for how your provider is meeting your needs. With this heart to heart, narrow your talking points to the top three things (hopefully, there aren’t more). See how open-minded your provider might be to any suggestions that you have or if he or she is generating ideas on their own. If a provider doesn’t seem willing to listen, this might be a huge red flag for you. Again, if the provider seems open to change, it might be important to see how things go at the next appointment.

Finally, if you have advocated for yourself and your requests seem to fall on deaf ears, it’s most likely time to consider switching care providers. Perhaps this means transferring from obstetric care to midwifery, as built into the midwifery model is a respect for the patient and her desires. However, sometimes, it might mean the opposite: switching from midwifery care to obstetric care, as your concerns weren’t followed up on.

Women become worried about switching practices, especially DURING a pregnancy. Some practices will have cutoffs on when they accept new patients, while others have a more lenient time line. If you are able to interview other practices, this might serve you well so that you can have a preliminary conversation as to why you are switching and identify what your current and future needs might be as well as how they might meet them differently. If you aren’t able to switch practices as perhaps you are too far along, a last minute (and not ideal) solution might be to travel to a hospital where your provider doesn’t have privileges. This will mean accepting care from whomever the on-call OB-GYN might be, which might be better than your current provider. In this case especially, having external support, such as a doula is recommended.

Being pregnant after a loss is scary enough. Having a provider who doesn’t listen, ignores your concerns or in rare instances, who doesn’t seem to be practicing good medicine is a situation that can be remedied. You are your own advocate (and the one speaking on behalf of your child) and you deserve good care.

*Photo Credit: “Sarah & Amy” by Sandor Weisz, santheo @ Flickr, licensed with Creative Commons 2.0.

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About the Author:

Dr. Julie Bindeman
Dr. Julie Bindeman is a reproductive psychologist and co-director of Integrative Therapy of Greater Washington outside of the Nation's Capital. No stranger to loss, Dr. Bindeman is the mother of 6 children--three of which she can cuddle in her arms while three live in her heart. She contributes regularly to Reconceiving Loss, writes professionally, and is an ardent advocate for Women's Rights.

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