9 Ways to Advocate for Yourself at the OB-GYN When You’re Pregnant After Loss

Are you pregnant after a loss?  Nothing can be more daunting than going back to the OB-GYN office for routine check ups and testing when your last pregnancy was not routine for you and your family. It can be difficult and even traumatic to be back at the doctor’s office when you’re as anxious as you are. You may be worried about getting to the same week of when your loss happened during your previous pregnancy, or you may be extra worried about genetic testing, the nuchal test, or your 20 week anatomy scan. You may feel nervous to speak up when your doctor is in the room. You might find yourself having trouble concentrating on anything the doctor is even saying until they check for a heartbeat. By learning how to advocate at your doctor’s appointments, you can help reduce some of your anxiety. Having strategies ready ahead of time to cope with anxiety around pregnancy after loss can increase your sense of empowerment around your health and wellbeing for yourself and your pregnancy. Keep reading to learn more.

Anxiety during pregnancy after miscarriage or loss 

Though some people do not struggle significantly during a pregnancy after loss, others can experience significant anxiety, depression, and post-traumatic stress. The Center for Women’s Mental Health at Massachusetts General Hospital cited a study by Farren et al of prenatal women who had experienced a loss previously - 29% reported post-traumatic stress symptoms (PTSD), 24% experienced moderate to severe anxiety, and 11% met the criteria for moderate to severe depression. Particularly in the first few months of a pregnancy, pregnant people are more likely to experience PTSD, anxiety and depression symptoms. However, your medical team may not always be looking out for these symptoms, and may not always be aware of how anxious you are feeling. Getting help for anxiety during a pregnancy after a miscarriage or loss is one step. In addition, by advocating for yourself at doctor’s appointments, you might be able to bolster your mental health by working with your anxiety rather than avoiding your anxiety. You deserve to get your needs met with your medical team. 

Patients from marginalized communities, such as BIPOC and LGBTQIA+, may experience additional barriers in advocating to their medical team. For instance, black mothers experience higher rates of pregnancy-related mortality and are more likely to report racial bias in OB-GYN settings. Finding a doctor who hears you and takes your concerns seriously is especially important for people from marginalized communities.

9 Ways to Advocate for Yourself at OB-GYN

1. Discuss with your medical team if seeing a specialist makes sense for you. Depending on your reproductive history and circumstances around your previous loss or losses, you might benefit from working with a maternal fetal medicine specialist (MFM), a genetics specialist, or a reproductive endocrinologist, in addition to your regular OB-GYN, depending on your situation. 

2. Ask to be seen first thing in the morning or at the end of the day for appointments. If you are feeling particularly affected by your grief about your loss, you might prefer to be in the office earlier or later to avoid the midday rush of pregnant parents. This may be particularly true for you in the early months when you aren’t showing and might be feeling more heightened anxiety or insecurity. If you’re really overwhelmed, you can ask a partner, family member, or friend to handle calling the office to make this request, as an option.

3. Find out ahead of time if you’ll be seeing your actual doctor. Sometimes OB-GYN practices get busy, and they may have you see another doctor, a nurse or physician’s assistant (PA), depending on the type of appointment. It might be helpful depending on how your anxiety shows up for you to know that information ahead of time. You can always request that you would prefer to see your actual doctor. It may not be able to be accommodated depending on a variety of factors, but it’s always worth asking! 

4. Write down your questions and refer to them during your appointment. Especially early on, no question is too small! Avoid Googling your worries later and get the most accurate information you have at the time, which is from your doctor. If you are partnered, compile both of your questions beforehand. Sometimes remembering that your partner has questions (and their own anxieties) can make you feel less alone or isolated in your fears. And don't forget to write them down on a piece of paper or on your phone. You may feel stressed during the appointment and forget to ask. 

5. Let your doctor know if you are anxious. Information is power, and most OB-GYNs will be quite compassionate and sensitive to your anxiety as long as they know that you are experiencing it. They can even explain more about what they’re doing to help alleviate fears – or explain less, if that is what you prefer! Share with them that you are generally feeling anxious about the pregnancy or ahead of a certain appointment, or if a particular test, tool, or situation is triggering your anxiety at that exact moment. Nurses, physician’s assistants, ultrasound technicians—and even the front desk staff—may benefit from understanding that you had a loss and are particularly anxious, if you feel comfortable sharing that information. Ask for what you need – and even what you want! You may not always get it, but if you do, that can be hugely helpful for reducing your stress. 

6. Bring supportive people with you to the appointments. The tricky part here is to think about who actually is supportive in this type of situation. This may be your partner, a friend, or a family member. Ask someone who can help reduce your stress and who understands the complexity of the emotions you might be feeling. Explain to them ahead of time what you might be worried about and what you might need an assist for in advocating for yourself. You could ask a few people in your life to rotate through joining you if that is helpful. Call your doctor’s office ahead of time to see if your person will be able to join you in the exam room. 

7. Ask for a heartbeat check if it will reduce your anxiety. They may not be able to accommodate your request every appointment, but usually they can. Always feel free to ask to check. 

8. Let your medical team know you may have trouble actually hearing and absorbing other information until they check the heartbeat. It can be hard to focus on all of the other medical information or questions if you’re feeling significant anxiety about checking the heartbeat. If you feel that this is true for you, letting your medical team know can help them structure the appointment accordingly. 

9. Ask your questions! Remember those questions you wrote down ahead of the appointment? Share them with your support person and make sure to ask anything that you are unsure about during your appointment. Even if it seems unrelated to what is being assessed during the actual appointment, you’ll be glad that you took advantage of the time to ask all your questions. That way, you can get the most accurate information the doctor knows at the time, and you can avoid late-night Googling when you’re feeling stressed later on.

Therapy for pregnancy after loss

With the right support system, you can move through a pregnancy after loss with more ease and calm. Working with a therapist who specializes in perinatal mental health can help you to build your self-advocacy skills and process the various emotions you’re experiencing during your pregnancy. 

The best way to find a perinatal mental health therapist is to go to the provider directory for Postpartum Support International (PSI). PSI also holds free virtual support groups for people who are pregnant after loss.

Amanda Borson is a therapist who specializes in perinatal mental health, anxiety, and intercultural relationships. If you are a resident of New York or Pennsylvania and are looking for online therapy for a pregnancy after loss, get in touch to book a free consultation. 

Disclaimer: This blog post is not a substitute for therapy or other mental health treatment, and is intended for educational purposes only. Advice or recommendations outlined in this blog post may not be suitable for all.