On the occasion of the GYNFOCH congress organized by the Gynecology Obstetrics Reproductive Medicine department of Foch hospital, Léa Karpel, clinical psychologist, was able to raise awareness among the audience about the psychological management of miscarriage.
- Since January 1, 2024, women who have suffered a miscarriage can benefit from work leave.
- Some miscarriages are traumatic and can lead to post-traumatic stress if it happened in front of the children or when the child was afraid of dying, for example.
- The importance of psychological help after such an event must be one of the priorities of the care pathway.
Psychologist Léa Karpel begins her speech on the different cultures where miscarriage is not taboo, citing as examples the Japanese rites when a woman suffers a miscarriage (the “Mizuko Kuyo”), Chadian customs or even the Berber traditions of the Moroccan High Atlas.
“There are cultures where we erase and cultures where, on the contrary, we give existence to the baby”, she declares.
“We must dare to tell the parents that the baby no longer has cardiac activity, that the heart is no longer beating”
Her audience being mainly composed of doctors and medical interns, Léa Karpel was therefore able to present her point in the most didactic way possible:
“Before talking specifically about psychological care, there is medical care. Care is first of all a dedicated place, we must avoid welcoming these patients who wait for hours in the emergency room of the maternity ward like a woman who is going to give birth to a live baby.”
“We must also try to train caregivers dedicated to this activity, training them in the psychology and specific care of termination of pregnancy. These are also words that we learn to avoid, we do not talk about embryo or fetus, couples carry a baby. Whether this baby is 10 millimeters or 20 cm does not take away its quality as a baby in the parents’ psyche. We must dare to tell the parents that the baby no longer has cardiac activity, that the heart is no longer beating.”
She also advises healthcare professionals to avoid any terms that refer to objects in a derogatory manner. “Try to avoid the term “expulsion”, it’s terrible! It has a very pejorative connotation. Avoid the word “aspiration” which largely brings to mind a vacuum cleaner. It’s hard to imagine a baby passing through a vacuum cleaner.” The expression “Miscarriage product” should also be avoided by patients and spouses.
Another essential element: do not neglect the importance of the couple, the duo, the two parents in this ordeal. “IL There are men at the ultrasound who stay behind the door, in the waiting room or in the parking lot while waiting. It is not normal that for an ultrasound both members of the couple are not there and that we do not make the same announcement to both members at the same time, in the same way.” she insists.
“Say that you are speaking to a couple who has just lost a baby”
The psychologist is clear on another point, we must not trivialize the loss: “Please tell yourself that you are speaking to a couple who have just lost a baby. That’s all. Everything you do, everything you say, if you have this awareness, will go very well. The parents will understand that you respect the fact that they already have affection for this baby in utero.”
There is often astonishment on the part of parents when the announcement is made. On this subject, the perinatal specialist convinces with her words: “VYou say the final words, then you continue to explain things to the patients except that the patients no longer follow you. You know, they watch your lips move but don’t hear you anymore. It’s a moment of amazement and you don’t have to fill the void with words. You can also let the couple cry for a few minutes, it will not change your life and you will explain the consequences to them later.”
It makes sense, normally, that a doctor “cannot send a woman home with treatment without explaining to her the consequences, the possible hemorrhage, the terrible pain she will experience, without the couple having prepared (getting help, putting the elders in Grand parents…).”
Not all couples will need to see a psychologist after a natural termination of pregnancy, but there are still “30% of women” who experience psychological distress with “anxiety and depression still in the 3 months following termination of pregnancy“, of which “8% with deep distress”.
“This unborn child is idealized because he represents parental success”
And for good reason, the psychologist recalls that “itand unborn child is idealized because it represents parental success. It is proof of the virile power and feminine power recognized in this beginning pregnancy.”
She ends her speech with a text that leaves no one indifferent: “Women tend to no longer invest in the baby during the next pregnancy, and sometimes until childbirth! They wonder if these babies who die are the fruit of love or the fruit of hatred? It is their femininity that we assassinate, it is the most beautiful part of herself that we assassinate in a way. And that sacrifices the mother in her. The miscarriage in these cases is the false mother whose marital diaper is soiled with her deadly blood. It is up to us, caregivers, to take care of them and meditate on their psychological states.”
