On the Other Side of the Rails
Miscarriage During a Pandemic: Remembering to Pause Amidst the Chaos
Jessica Case, RN, MBA
Photo credit: @gettyimages.com/Chinnapong
I am having a miscarriage. This is the tough truth that I had to accept after I started to have bright red bleeding that soaked through more than a pad an hour. I had been worried for 3 days that I might be having a miscarriage or ectopic pregnancy due to spotting, abnormal vaginal discharge, and one-sided pelvic pain that I didn’t experience with my previous pregnancy. Over several days, I had been in contact with my obstetrician (OB). Since it was an early pregnancy (under 16 weeks), I was told “don’t worry,” “no need to come in,” and finally, “go to the emergency department if you start having bright red bleeding that soaks one pad an hour.”
As an emergency nurse for over 5 years, I am familiar with the emergent instructions we give people with OB issues. I reflected on the many times I told a patient, “Come in for sharp one-sided pain accompanied by heaving bleeding.” This comment was always then defined as bright red blood that soaks through a large sanitary pad every hour. Otherwise, I’d say, “Be in contact with your OB.” From experience, I knew there wasn’t much that could be done in the emergency department for a “normal miscarriage.” Having been in charge of a triage area for many years, I knew what we did with “gyn complication with bleeding” patients – if stable, they waited. Wanting to avoid an unnecessary trip to the emergency department, I contacted my OB; her reply, “Go seek emergency care.” When I arrived to the emergency department, there were more than 60 patients waiting; patients were tripping all over each other in the overcrowded waiting room. I was lightheaded and dizzy, while simultaneously having severe right-sided pelvic pain. Meanwhile, I was bleeding…a lot. Once triaged, the nurse said, “You poor thing, we will do our best,” as she sent me out to wait with the crowd. After 3 hours of discomfort and growing weary of waiting, I asked the triage nurse the dreaded question, “How long do you think my wait will be?” She responded, “Our level 2 patients have been waiting for 7 hours.” My husband and I decided to go home despite still being worried about my symptoms We decided to stop at a smaller emergency department on the way home hoping for a shorter wait time. I was relieved that the waiting room was significantly less crowded. During my triage process the RN asked me what brought me to the emergency department that day. When I started to describe my symptoms, she stopped me midsentence to complain about how her co-worker couldn’t get an EKG without her and she proceeded to walk away for 5-10 minutes. When she returned, she finished up my triage process, taking my vital signs and then sending me to the waiting room. I never truly finished explaining why I was there. On my way to the waiting room the nurse stopped me and stated, “If you have to pee just hold it until we can get you a room.” Two hours later I was still waiting and continuously bleeding; I approached the desk to ask for a sanitary pad and a cup for a urine sample. The front desk receptionist said she had to ask the nurse and that I would have to wait until the nurse had a break from the influx of patients. I was frustrated at the time because there were only 4 patients in the waiting room, and it takes only a minute to hand someone a sanitary pad (which could have been accomplished hours ago). I had finally lost my patience. “Don’t worry about it, the nurse has known for hours that I’m bleeding and doesn’t care,” I retorted. I got the pads and urine cup, went to the waiting room bathroom, and changed out my completely blood-soaked underwear and pad I had been wearing for the last 3 hours.
I was eventually seen and an ultrasound was performed. The results were inconclusive; in essence, the physician couldn’t tell if it was an ectopic pregnancy or a bleeding cyst. They discharged me with instructions to follow up with the high-risk pregnancy clinic. I continued to miscarry over the next week, but I had a much better experience at home than in the hospitals. In the end, I had a normal uterine miscarriage. I was devastated as we had hoped and wished for this baby. Over the Christmas break we had shared the news with our parents and now we had to tell them we had lost the baby. Having to repeat your story over and over is very difficult in and of itself. It was very disappointing and, honestly, I reflected that I should have been more understanding as an emergency nurse for those miscarriage patients I had cared for in my career. When working as a bedside emergency nurse, I always felt the OB office was a more appropriate place for a miscarrying woman than in the emergency department. I still believe that the emergency department isn’t the place for early miscarriage for a variety of reasons, but now I understand that there is often nowhere else for these patients to go. I think it is very realistic to lose sight of how many emotions someone may be experiencing.
I appreciate all of the celebrities who have shared their version of having a miscarriage, but their experiences typically don’t depict the care received by most women in the United States. Many women are left to miscarry on their own. They are not placed in an emergency department treatment room. They are not admitted to the hospital. I felt fortunate to be a nurse knowing what was likely happening to my body while I waited for care; unfortunately, many do not. According to Dr. Christopher Evans, MD, MPH, “Approximately one quarter of all pregnancies result in first-trimester vaginal bleeding, accounting for an estimated 500,000 ED visits annually, and commonly before the first prenatal visit. Overall, 1 in 5 pregnancies results in early pregnancy loss.”1 I believe there is a huge hole in OB care across United States health care as there isn’t a clear place or system to take care of early miscarriages. The health care system needs to do better. Our patients deserve more. Unfortunately, unless processes change, many patients who are miscarrying will likely continue to wait in emergency department waiting rooms. ED nurses need to remember that showing a little sympathy and compassion, along with addressing what comforts they can, will make a difference to those suffering from this devastating loss. Sometimes just a little acknowledgment of what a woman may be going through can go a long way as this could very likely be one of the worst days of her life.
Note from the Editors: In the next published blog post, Rachel Campbell, Perinatal Bereavement Liaison, will address this highly sensitive topic and what can be done to ensure emergency department patients are receiving empathetic and patient-focused care that can ease the trauma and burden felt by those who miscarry.
1. Evans CS. Early pregnancy loss in the emergency department: lessons learned as a spouse, new father, and emergency medicine resident. Ann Emerg Med. 2021;77(2):233-236. doi:10.1016/j.annemergmed.2020.08.035
Jessica Case, RN, MBA
Jessica Case, RN, MBA is currently the Director of Cardiology for HCA at Lees Summit Medical Center in Lees Summit Missouri. She currently oversees the STEMI program, cath lab, echo, stress, IR, vascular clinic, and cardiac rehab. Over the last 10 years she has worked in multiple nursing roles, and slowly taken on more leadership roles. She worked mainly in Emergency Medicine at Barnes Jewish Hospital but has also worked in med-surg, rehab, LTAC, and ICU. She is passionate about emergency care and providing the best care possible for the community she serves in. She has a husband who she met during her tenure at Barnes Jewish and a 2-year-old son.
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We encourage submissions from any reader who has been touched by the healthcare system. Some contributors may be involved directly in patient care and might want to share the impact a patient, family, or colleague had on them. Others may want to write about life “on the other side of the rails” …those moments when the caregiver becomes the patient…or maybe sees healthcare from the vantage point of a family member. Inquiries can be sent to [email protected]
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