Preparing for your first visit with a provider to discuss miscarriage and recurrent pregnancy loss (RPL) can be stressful. You are meeting someone new who may or may not be compassionate, you’re going to have to talk about the miscarriages, you’re scared they are going to tell you something scary, and so on. Being prepared for what to expect and taking a list of questions with you can decrease your anxiety and make the visit more productive. Here’s how to prepare:
Before the Visit
1. Make sure the office has your relevant medical records. Do not assume that because the office requested them or you faxed in a medical release form that the records got to the office on time. Call ahead and double check, and even better, keep a copy of your own medical records that you can bring with you. It’s incredible that in this day and age of technology and electronic medical records that medical offices are still printing and faxing records, and you’d be surprised at how often key records are absent from a stack of papers. Keeping track of your own records is a great way to be your own advocate.
2. Write down your history before you go. The provider will ask about dates of pregnancies and review what happened with each loss. Consider typing it up and handing the provider this information. Keep a copy for your own records. It’s easy to get confused on dates when relying on memory at a consult (especially when you’re nervous). If things are written down beforehand, it will be less stressful, and you can spend more time talking about testing and moving forward rather than dwelling on the past (which is important, but can also be tough to re-live). Think of your history like a story and write down keys dates: when you started trying to conceive, when you conceived, when the miscarriage was diagnosed (how far a long you were in the pregnancy), any fertility treatment used to conceive, how the miscarriage was completed (naturally or with a procedure like a dilation an curettage), was genetic testing done to determine a chromosomal issues as a cause of the miscarriage, any supplemental treatments you did in the pregnancy like aspirin or progesterone. It’s tough to remember these details from the past on the spot so do it ahead of time.
3. Bring a list of your current medications, vitamins, and supplements to review with the provider since it’s easy to forget what you’re taking when asked.
4. If you have a partner, bring them to the visit. This is helpful in so many ways. First, your partner is having losses too and needs to be a part of the conversation. Second, a lot of information will be covered, and two people listening means a better chance that more will be heard and understood. Third, if you go alone and try to review the visit and what happened with your partner, they will most likely have multiple questions that could have been answered at the visit.
5. Prepare a list of questions and bring them with you. If you take some time to write down the questions you want to ask beforehand, you won’t get flustered and forget to ask them at your appointment. I’ve provided a few examples of questions that you may want to ask below. Make sure you bring something to write with to the visit so you can take notes!
At the Visit
Be prepared to review your medical history and obstetric history at the visit. You will likely have blood pressure and other vital signs taken. You may or may not do other testing such as blood work and an ultrasound at that first visit as well.
Prepare a list of questions beforehand to take with you to the visit. Here are some that I would recommend adding to that list:
1. What tests do you recommend?
2. How will I get the test results – when and where?
3. What treatment will you recommend if the tests do not find a reason for the miscarriages?
4. How can I get my questions answered between visits?
5. What happens if I have another miscarriage? Will you continue to provide care for me? Will you recommend genetic testing/chromosomal testing on the pregnancy to see if that caused the loss?
6. If you do provide care for me in the first trimester, how long will you follow me into pregnancy? Do you deliver babies too?
7. What kind of support and wellness resources do you have or recommend? Counselors? Mind/body programs? Support groups?
Bring a list of worries with you to the visit as well, and do not be afraid to ask about anything. One of the first questions I ask patients at a visit is, “What are you worried about?” Patients sometimes seem a little embarrassed when they ask me about some of the concerns listed below, but no worry or concern is silly, and you should just ask!
1. “I’m worried that stress caused the miscarriage.”
2. “I started bleeding and had a miscarriage after intercourse with my partner, and I’m worried that sex caused the loss.”
3. “I had wine before I knew I was pregnant, and I’m worried I caused the miscarriage.”
4. “I didn’t stop exercising after the positive pregnancy test, and I’m worried that made me lose the baby.”
Remember, no worry or concern is silly – just ask!
After the Visit
Reflect by yourself and with your partner after the visit. If possible, reflect immediately after the visit in your car or at a café near the office. Review your notes and write down what you remember from the visit. Do not rely on memory – write things down!
That evening, give yourself a break. It takes a lot of courage and energy to have a consult with a provider about the physical and emotional toll of RPL. Have a quiet evening at home or treat yourself to dinner out. Consider a distraction like a funny movie or dinner with friends. Do something for yourself to celebrate moving forward in your path towards your family! Learn more about how to be an advocate for your own care for miscarriage from my book: Not Broken: An Approachable Guide to Miscarriage and Recurrent Pregnancy Loss.