Subsequent Pregnancy Concerns - An Interview with an OB

Dr. Lewis D. Lipscomb, MD

Dr. Lewis D. Lipscomb, MD

Heartstrings is pleased that one of our former participants, Nora Kowalcheck, has signed on to facilitate the Subsequent Pregnancy Support Group.  Nora has graciously redesigned the group curriculum to give the best support to our expectant mothers in need.  One of the many exciting parts of the group is a visit by a medical professional who will answer the questions a mother may not feel comfortable addressing with her practitioner on her own.  In that spirit, Heartstrings has reached out to Walk for Remembrance & Hope supporter Dr. Lewis Lipscomb from Triad Obstetrics & Gynecology in Winston-Salem.  Nora interviewed Dr. Lipscomb on some of the most common questions and concerns she hears from our rainbow mothers.  Below is the transcript from that interview.  We thank Dr. Lipscomb and his staff for their time and generosity in sharing this information for our families.  For more information about signing up for Heartstrings' Subsequent Pregnancy Support group, click here.

Nora:  Most mothers that have experienced a pregnancy loss know the statistic that 1 in 4 pregnancies end in miscarriage and 1 in 160 end in stillbirth, ⅓ of those stillbirths unexplained. Given these statistics, I would assume that you see quite a few patients who are navigating a subsequent pregnancy.  If you could give them one piece of advice at the start of their subsequent pregnancies what would it be?  

Dr. Lipscomb:  I would first help them to acknowledge that their loss is real, and not to be simply forgotten.  Grieving appropriately is essential to gaining peace and moving forward.  Once the subsequent pregnancy occurs, I would recommend contacting their physician as soon as possible, mainly to address any medical factors that may threaten pregnancy, and to gain reassurance as things progress.

Nora:  Do most of the mothers you see discuss anxiety issues with you in relation to their subsequent pregnancy?  If so, what types of things do you recommend to help alleviate some of their anxiety and fear in between prenatal appointments?   

Dr. Lipscomb:  Couples who have experienced pregnancy loss before usually express [anxiety].  I make every effort to provide objective reassurance.  Some examples of this may include: following the HCG levels early in pregnancy to assure that they are rising normally; performing ultrasound to evaluate fetal growth and viability; performing Doppler auscultation to evaluate fetal heart tones; and antenatal fetal testing in the third trimester.

Nora:  Is it okay for mothers to ask for additional ultrasounds during their pregnancy? 

Dr. Lipscomb:  It is okay for mothers to ask for additional ultrasounds.  If they are clinically indicated, then this is not a problem.  If they are not clinically indicated, we can typically find other ways to provide reassurance.

Nora:  Are there any particular ways that you and your staff have chosen to help mothers who are going through a subsequent pregnancy? 

Dr. Lipscomb:  Our main focus is simply to love those who seek our care.  This means that we actively and selflessly do whatever we need to do to benefit that person and their family.

Nora:  Many mothers express a desire to change care providers after experiencing a loss.  Why do you think this is?  

Dr. Lipscomb:  I think there are a number of reasons for this.  They may not want to visit places that are associated with emotional distress.  They may feel that a particular provider or staff said or did something that was not helpful.  I would encourage women to forgive if at all possible.  The situation of pregnancy loss is difficult for us providers and staff too.

Nora:  What do you think mothers should look for in choosing a care provider after experiencing a loss?  

Nora and her rainbow baby, Elena.

Nora and her rainbow baby, Elena.

Dr. Lipscomb:  They should seek out a provider who they trust.  I would recommend that they visit their provider prior to conceiving to establish a “game plan”, so that they know what to expect next time.

Nora:  Do you think there is a need for more compassionate care of mothers through subsequent pregnancies?  

Dr. Lipscomb:  I suppose more compassion never hurts.  I certainly think that we as providers should always be attentive and compassionate to patients, regardless of their history.  One never knows what someone might be going through.  Even things that are not “on the chart” may be relevant.   [At Triad OB/GYN] we really try to “meet people where they are at” for lack of a better term.  This means making sure that we know our patients, their families, and their situations.

Nora:  Many mothers who have experienced a loss, myself included, find themselves having to remind/tell a nurse at each visit that they lost their last baby.  This is very difficult for mothers to have to constantly retell the death of their last baby while pregnant with their new baby.  Do you think there is anything that can be done to help eliminate this painful and uncomfortable situation?

Dr. Lipscomb:  It is unfortunate that you should feel as though you have to rehash this at every visit.  Perhaps affirming those providers who don’t make you feel that way would be a start.  I personally try to review every patient’s chart before I walk into the room, so that I am aware of their history and potential anxieties that they may have.  This however doesn’t mean that I am a mind-reader.  It is always important to find a provider with whom you feel comfortable discussing whatever is on your mind.

Nora:  As mothers get closer to the end of their pregnancy, what options do you discuss in terms of labor and giving birth specifically with mothers who have experienced a stillbirth?  

Dr. Lipscomb:  This is definitely a very anxiety provoking time.  As necessary, we typical have more frequent visits.  We also have informative discussions about when and how to delivery the baby, and if interventions will be necessary.

Nora:  Do you notice any similarities in the mothers you see that have experienced the loss of a baby and who are pregnant again?  

Dr. Lipscomb:  I think the one thing that I notice most is a stronger faith component to their journey. 

Nora:  What do you think more practitioners should/can do to help mothers in a more comprehensive way through a nerve wracking pregnancy?

Dr. Lipscomb:  Be available as much as possible.  Be patient as much as possible.  Be flexible as much as possible.  Empathize, as painful as that might be.

Nora:  Is there anything that you recommend mothers/parents do to help navigate the labor of their new baby in terms of a support person during labor like a doula or close friend, photographer, etc?

Dr. Lipscomb:  Every woman is different, every couple is different, and every situation is different.  I would encourage couples to make every effort to discuss these things well in advance of that important day.

Nora:  The mothers you have helped through this difficult journey, is there any one thing that you have noted as having been extremely helpful in easing their anxiety and fear?  Any moms you think have it “right” when going through a new pregnancy after a loss? 

Dr. Lipscomb:  Every woman, every couple, and every situation is different.  I would say that I find it most helpful when people articulate to me their fears and anxieties.  This doesn’t have to happen at the first visit, of course.  But when I am invited to walk the journey with them, I feel like I can address their needs more effectively.  I also think that faith and prayer are extremely important.  The couples who allow their faith to guide them seem to have the most peace.

Nora:  Is there anything you want to add or share from your own experience in serving these strong and brave mothers?

Dr. Lipscomb:  It is a real privilege to serve these courageous women and their families.