Supporting terminated pregnancies to break down taboos

"Approximately 15% of pregnancies end early before 14 weeks of amenorrhea(around 200,000 per year in France, editor’s note.), but this figure is more than trivialized". Based on this observation, Silvia Horsman, medical gynecologist at Foch Hospital, contributed with Prof. Jean-Marc Ayoubi, obstetrician-gynecologist and head of the Women's Health and Fertility Institute at Foch Hospital, to the establishment of a support program for women and couples who experience one or more pregnancy terminations.

We are talking abouttermination of pregnancies, formerly "miscarriages," when a pregnancy does not reach term. Why this sudden change in terminology? We no longer use these terms because in fact there is nothing wrong with them. To say miscarriage is to say that it did not exist, so we prefer to speak either of natural termination of pregnancies, or of spontaneous termination of pregnancies., says Silvia Horsman.

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To meet specific needs, the pathway was created in collaboration with affected patients and couples. Aléna Sorret, head of patient experience at Foch Hospital, was responsible for liaising between the medical team and the patients. For example, doctors proposed a first version of the information booklet, which was then commented on by patients, and members of the Agapa association which supports perinatal bereavement, explains the project managerThis allowed us to move away from medical jargon, with clearer and more reassuring terms, and to add summary diagrams of the process.

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"Neither in dramatization nor in minimization"

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The journey begins upon arrival at the gynecological emergency department. Here, the waiting room dedicated to missed pregnancies is separate from the general obstetric and gynecological emergency room. Patients who arrive with symptoms of missed pregnancies, such as pain or bleeding during the first trimester, therefore do not have to wait with women close to giving birth. “It was really a need identified by many patients, mentions Aléna Sorret. We carried out structural work in the emergency room to create this dedicated, separate waiting room.

In a consultation room, close to the waiting room, doctors welcome these patients.. "The announcement of the termination of pregnancy is reported by patients as a very difficult moment. It is important to adopt the right posture, that is to say neither in dramatization nor in minimization, she continuesEven for caregivers, it's difficult to make these announcements and not always have a solution, we have to manage to maintain this posture despite our emotions."

A new pregnancy often dreaded

The week following their visit to the emergency room, patients are followed by the same midwife, who will check on them by telephone and see them for a consultation on D+7 to perform a uterine emptiness check ultrasound to verify the health of the uterus. Remote monitoring was implemented through questionnaires, to potentially generate alerts and allow caregivers to call patients back earlier if necessary.

The journey doesn't end there. Patients often report a very difficult experience of a new pregnancy, often due to fear of another miscarriage,” continues Silvia Horsman. From the next positive pregnancy test, the so-called "cocooning" follow-up takes over. Midwives from the same program receive patients in consultation to monitor and reassure them through early pelvic ultrasounds. Faced with the anxiety of a second pregnancy loss, but also throughout the process, the patient and her family can receive psychological support.

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“Couples who experience pregnancy loss are not infertile couples.”

Sometimes, pregnancy terminations occur one after another. According to European regulations, we can talk about repeated pregnancy terminations after two or more pregnancy terminations. Couples who wish to do so are offered an appointment with a dedicated gynecologist to possibly carry out additional examinations (parental karyotype examination, pelvic ultrasounds, autoimmunity screening among others)that we will adapt on a case-by-case basis", adds Silvia Horsman.

For couples who experience repeated missed pregnancies, medically assisted procreation (MAP) is not a solution. . "It is important to understand that couples who experience pregnancy terminations are not, by definition, infertile couples, since there is indeed a pregnancy, insists the gynecologist.The outcome of this process is to try to understand the causes of these stops and possibly take action on them."

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Lifting the taboo

One of the objectives of this course is to free up patients to speak out and raise awareness among colleagues of their needs: “ We have the impression that there is a kind of taboo surrounding this question, whereas you only have to ask those around you to realize that it concerns a lot of women,” exclaims Silvia Horsman. This pathway is not unique; in France, several hospitals offer care for women and couples experiencing pregnancy loss. The systematic creation of these pathways is a way, according to the doctor, to recognize this long-invisible suffering experienced by more than one in ten women.