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Finding Solace: Navigating Pregnancy Loss

Dr. Frances Casey explores pregnancy loss and ways to find solace during this hard time.
Finding Solace: Navigating Pregnancy Loss
Frances Casey, MD, MPH
Frances Casey, MD, MPH is the Director of Family Planning Services. 

Learn more about Frances Casey, MD, MPH

Scott Webb: We all process loss and grief differently. And there's no handbook for dealing with pregnancy loss. I'm joined today by Dr. Frances Casey. She's the Director of Family Planning Services at VCU Health, and she has some helpful insight and suggestions for how women and couples can cope with the tragic loss of a pregnancy.

This is Healthy with VCU Health. I'm Scott Webb. Dr. Casey, thanks for joining me. Let's talk about the different types of pregnancy loss and what does it look like in the moment?

Dr. Frances Casey: I think it's really underestimated how frequent pregnancy loss occurs, and this can occur for a variety of reasons. It is more common in the first trimester. It is unfortunately more common in women of color. The rates can be as high as one in five women by the age of 35. And I think it's also really important that we de-stigmatize pregnancy loss because it is so common. In fact, Meghan Markle just recently publicized information about her pregnancy loss. So I think it's even coming up more in social media context and I think that's a really important space because women can find groups where they feel more comfortable.

But when it's discussion of different types of pregnancy loss, even though it is common in the first trimester, pregnancy loss also does occur in the second trimester.

Oftentimes early pregnancy loss, I think it's important to remember in this conversation that early pregnancy loss most often is beyond the patient's control. So I don't want this conversation to come across like I'm intending that pregnancy loss is in some way a person's fault. It's really, really important that a take away from this is that oftentimes there's really nothing different that a patient could have done in relationship to a loss. I never want a person to feel blamed for that. But this conversation is about ways that the whole medical system can improve pregnancy and pregnancy care for women generally speaking. And optimizing health prior to pregnancy, we know is one way to do that.

And sometimes it occurs due to genetic abnormalities or problems with the pregnancy that arise later on. So I just wanted to be all encompassing. Pregnancy loss can also happen very late in pregnancy as well.

And certainly at any point in pregnancy, it can be quite tragic. I think it's really important for providers and patients to understand how extensive that loss can feel for women. And I know we're going to discuss a little bit later, but also just paying attention to that, going into next pregnancies or next outcomes for women related to depression and mental health. It's really imperative that providers pay attention to all of that for their patients.

Scott Webb: You're right, doctor, we are going to cover that. But I want to talk first about the short term and long-term impact on women of pregnancy loss.

Dr. Frances Casey: Right. In the short term, I think oftentimes there can be a variety of emotions that patients experience. Sometimes this is a very desired, very wanted pregnancy. The woman's been trying a long time. Her family has been involved. And so that can be a very devastating loss for a person.

On the other hand, sometimes it really is not the right timing for a pregnancy and sometimes women can even feel a bit of relief that the pregnancy has resolved for them. So it's really imperative that we allow the patients to dictate the conversation, instead of trying to assume that we understand what they're going through or how they feel.

Scott Webb: Yeah, it does seem like it would be really important and almost imperative to really listen to the patients, because as you say, there could be a variety of things going on. Some of this may be a terrible tragedy to some, as you say. Others, because of timing, it may actually be a bit of a relief and kind of everywhere in between, right?

Dr. Frances Casey: That's exactly right. I think it's also very important that we help patients understand they're not alone, that they don't need to feel alone. That no matter when this is taking place for them, that we can help them with further resources. And that we understand that, over time, this can have a long-lasting impact in the sense of sometimes women initially feel grief and go through a grief reaction. Sometimes, eventually there are worse mental health effects. Sometimes even substance use is a problem for people when they're grieving a loss. So we just want to help patients understand that that they don't need to feel alone and that we can help them through their process.

Scott Webb: And I think we can all identify with that, feeling alone, feeling like you're trying to deal with something like this without a support system. And we're going to come back to later and also talk about some of the resources, you know, that are available to people. You mentioned this a little bit ago, that women of color experiencing a higher loss of pregnancy. I wanted to have you talk about that a little bit. Why is that?

Dr. Frances Casey: I think there are a variety of factors there. I think that unfortunately women of color have not received the same kinds of medical care that other women have received. And there are a lot of efforts to change that and to have a greater awareness and recognition. I think some of it is also trust of the medical community and that it's really imperative that we all reach out together to make everyone feel as comfortable as they can.

In preparing for pregnancy, I think preconception counseling and resources is also another area that it’s difficult for people to think in time for that sometimes, but it is really important that if there are medical conditions or other health concerns, that we optimize those prior to pregnancy. And I think that sometimes women of color don't receive the kind of care and attention they deserve for those aspects.

Scott Webb: Yeah. I think you're probably right about that. And you're so right about preconception. So many of us don't go to the doctor until we're sick, right? Many women don't go to see an OB-GYN until they're pregnant, but when you have the time, and this is a sort of a thoughtful planned thing, preconception counseling is really important, right?

Dr. Frances Casey: That's exactly right. And really helping to optimize a person's body to prepare for pregnancy, evaluating any kind of substance use, evaluating a person's health and nutritional status. And if there are ways to improve that at all or provide resources to help with that. And also, most importantly, related to medical conditions, blood pressure is a huge concern in pregnancy and optimizing that. Diabetes is another concern.

Scott Webb: We can't seem to get away from COVID-19. We're still in the midst of this pandemic, despite the great news of vaccines reaching destinations. So I wanted to ask you how is COVID-19 affecting care for those who are experiencing loss?

Dr. Frances Casey: I think COVID-19 is really burdening everyone in so many ways. And I think pregnancy loss is just one additional element of that. Clearly, when a person has a loss or they believe they're experiencing loss, their ability to voice their concerns and be evaluated in a timely fashion, I'm certain that with the fear surrounding being in a hospital setting related to the COVID virus, I'm certain that people are delaying their care sometimes, which of course would contribute to worse mental health outcomes, just having something prolonged like that.

Scott Webb: Yeah. I think you're right. And I'm sure that just even the thought of having a baby right now during COVID-19, people probably have some mixed emotions and mixed thoughts about that. And maybe even the medical community isn't a hundred percent either way. What are your thoughts just in general about people, women having babies right now during the pandemic?

Dr. Frances Casey: There are plenty of people that still feel like it's the right time for them to pursue a pregnancy and they don't feel like they can wait because there's still so many unknowns of whether or not we will actually be completely out of this or will we be coming in and out of social distancing for a prolonged period of time. So I think just supporting people where they are is the most impactful thing that we can do and just trying to be as evidence-based as possible related to the vaccine and pregnancy. We may not have as much information as we would like right now, but we're all trying to make shared decisions with our patients based on the evidence at hand.

Scott Webb: When we talk about loss and grief, we all deal with it differently, of course, but what are some of the resources to help with loss at VCU Health and within the community?

Dr. Frances Casey:  So there are a number of community resources that exist. There's one called Full Circle and there's one called MISS. And there are also a number of psychologists that we have worked with before. So I just want to encourage people to communicate with their providers if they feel like their needs aren't being met.

Often times providers want to be that link for patients. We never want for someone to be suffering in silence. We always want to provide the resources that we can and if they don't feel like they're getting what they need directly from their provider, then it's important that they are linked to community resources. There are even some online groups, there are some Facebook pages. Sometimes there are certain conditions that come in pregnancy or depending on the gestational age where their loss occurs, there may be groups that we can link patients to.

I just really think the main focus should be on de-stigmatizing that this is something that happens more frequently than people realize. And that what we most want is for patients to feel like they and their families can reach out and get the help that they need.

Scott Webb: Yeah, for sure. And you mentioned this earlier, we just don't want people to suffer in silence. It's just not necessary. So there are lots of resources. We want people to speak up and advocate for themselves. And doctor, as we get close to wrapping up here, what does pregnancy following a loss really look like for women and for couples?

Dr. Frances Casey: I think this can be one of the hardest things to navigate because oftentimes, there are specific dates that come up or reminders that come up. And then when you're going into another pregnancy with that experience in mind and those dates and maybe you've had some things that you've tried to do memory making wise or just to work through your grief process, which oftentimes is lifelong. We should never underestimate that.

When you've had a pregnancy loss, that's not always something that people can just work through in a short period of time. Often that related to due dates and anniversaries of things, I mean, that keeps coming back up over and over again. So the first thing I want to mention is that it's just really key for people to honor the memory of their pregnancy loss if that's something they feel like is really important for them and that there should never be any stigma in doing that.

And then going into another pregnancy, I think it's really vital that on the provider side, I would like for providers to recognize how much anxiety there is going into another pregnancy. Sometimes it's the offering of additional ultrasounds or just additional appointments, just to ease patients anxiety so that they can see the progress of the pregnancy over time.

Other patients very much want to distance their appointments because it makes them feel nervous to come in and it brings too many memories for them. So again, this really speaks to honoring the patient where she is and where her family is in the process of things and just making sure that there's open communication.

And I really believe that onus should not be on the patient to do, but I do also want to point out that we also need patients to speak up. And if you really feel like your needs aren't being met or if, you know, the memory of the last pregnancy loss is not being honored in this subsequent pregnancy, it's just important that you communicate that.

Scott Webb: That's a great way to wrap up and I think you're so right. I think we just want to encourage women and couples to speak up to advocate for themselves, to know that they're not alone, that they don't have to suffer in silence. Really great insight today, doctor, and just a great compassionate approach. Thank you so much for your time and you stay well.

Dr. Frances Casey: Thank you.

Scott Webb: Call (804) 828-4409 to learn more. Thanks for checking out this episode of Healthy with VCU Health. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library at for topics of interest to you. Thanks, and we'll talk again next time.