I am so excited to have Dr. Kate White joining me on The Egg Whisperer Show! The title of today’s show is Hope and Healing After Pregnancy Loss. Dr. Kate is a practicing gynecologist, and the vice-chair of academics and the director of fellowship and complex family planning at Boston Medical Center, and associate professor of OBGYN at the Boston University School of Medicine. We’re here to talk about her book, Your Guide to Miscarriage and Pregnancy Loss: Hope and Healing When You’re No Longer Expecting. She teaches women how to better understand their bodies, and helps women be unafraid of seeing the doctor, and you arm them with the right questions to ask. Dr. Kate gives people the information they need to make the best choices for themselves and their lives.
Dr. Aimee: I’m just so honored and feel so lucky that you gave us the time today to talk to us about your passion. Welcome to the show, Dr. Kate!
Dr. Kate White: This book was just a labor of love. I could talk about it all day long to anyone who wants to listen, so I’m happy to be here.
Dr. Aimee: I love hearing about doctors, and obviously a particular thing I like to hear about is how you made your way into this specialty. What drew you into this field?
Dr. Kate White: I think I was like a lot of medical students in that I really liked everything that I rotated through in the year where you’re trying to decide what to do. But I think it came down to two things.
The first was that in OBGYN you get to have these long term relationships with patients and you get to fix problems. I think by nature I’m a problem solver, I like to fix things, in addition to having time with a person over the course of their lives.
The second was how much I enjoy teaching patients. I found that in a lot of the primary care specialties you’re telling patients things they don’t want to hear,: “stop smoking, lose weight, exercise, watch your cholesterol, watch your blood pressure.” But in OBGYN, it’s “here’s why your discharge is normal, here’s why your body is actually normal, here’s what all of the changes mean during pregnancy.” That relationship with patients where they really wanted to hear all of the things I had to teach made it feel more like a partnership than this hierarchical relationship, so that’s what sealed the deal in the end for me.
Dr. Aimee: There’s so much about what you do that holds a special place in my heart, but my father actually was an OBGYN and he did his residency at BU, and that’s where I was born, and my sister as well. Then I went into this field because of the miscarriages that my mom had. So, thank you for writing this book for all of those women who have suffered the way that she suffered. Hopefully, your book will help them suffer even less.
after having experienced one. Its medical approach to miscarriage care with a compassionate exploration of the physical and emotional aftermath of pregnancy loss.
What drew you to write this book?
Dr. Kate White: It was a combination of two things. The first oneI was that I wrote the book that I wanted to have when I went through my pregnancy losses. I had a really traumatic stillbirth at 29 weeks and a more typical first trimester loss around 6 weeks. Even though you think, “I’m a doctor, I should know everything,” I certainly knew the medicine, but I was not prepared though for the journey of recovery that followed miscarriage. It felt pathless and directionless. For a person who is a Type A personality who is always in control of everything, it was a really scary time. So, I liked the idea of giving people a roadmap to what was going to happen before, during, and after their losses.
The second thing is that I wrote the book that I want my patients to have. I think we never get enough time with people in the office, especially when we’re talking about big important things. Visits always have to end too quickly. This book continues the conversation that I have a chance to start in the office, and I want patients to take a piece of me home with them. By writing a book, then it’s not just a pamphlet. In my bookoffice, all patients get to hear how I talk to my patients about loss.
Dr. Aimee: I feel like there should be a miscarriage help desk, and your book will be just handed out at that help desk. There are millions of miscarriages every single year, I think even in this country alone.
Dr. Kate White: There’s a Butterball Turkey hotline for people at Thanksgiving when they’re cooking their dinner. How do we not have on-demand access from experts for miscarriage care?
Dr. Aimee: Literally, I dream of things like that, like how we can do things. We should talk and make that happen. I’m going to add that quote and make sure that people tune into this show, because you’re right, this could be our version of the Butterball help line.
You divided your book into three different sections, and I think the organization is perfect, preparing, experiencing, and healing. Obviously, I don’t want to give away everything that’s in the book, I want people to actually get a copy and have it for when they really need it. But can you just walk us through the preparing part?
Dr. Kate White: The first is around getting a diagnosis, which you might think would be really clear. You’re pregnant or you’re not. You have a healthy pregnancy or you don’t. But as all OBGYNs and OB care providers know, it is not always that simple. You can actually have doubt for weeks based on how your ultrasound looks, based on the results of your blood tests, so it’s also a lot of waiting. I talk about why you can’t get the diagnosis right away and what it means for it to take this long.
Then there’s also understanding what it means when someone says that you have a loss. Is it a regular first trimester loss where it was a pregnancy in the uterus that stopped growing? Do you have one of the odder losses that I talk about that aren’t as common and get no air time, like a pregnancy in your tube or a molar pregnancy? Because there are other kinds of losses in addition to the standard first trimester miscarriage.
Then I talk about what to do while you’re waiting, because even though a lot of people really wish that a provider could snap their fingers and the pregnancy is over, it is never that simple. You can do a lot of things to prepare yourself before the miscarriage eventually happens.
Dr. Aimee: That’s true. That goes into experiencing the loss. How should someone think about that part?
Dr. Kate White: If you are like most people undergoing a first trimester loss, once you have certainty about the diagnosis, very often you have a choice, which does surprise some people. At a time that you are feeling totally powerless, you actually have a little bit of choice about how to manage your miscarriage.
As you choose which way to go, whether it’s waiting it out for your body to pass the pregnancy on its own, choosing a surgical procedure, (a D&C,) or something in the middle, which is medication management, living through it feels really different. I talk in really great detail, much more than you can get from an internet search, about what it is like to experience these three things.
I do talk about all these other kinds of special circumstances. If you don’t have a typical loss and no one knows what to say to you, and your friends have no idea what you’re going through, I take you through all of those processes, too.
Dr. Aimee: When does a loss get labeled as recurrent, what does that mean?
Dr. Kate White: The textbook definition from when you and I were both in medical school is when a person has had three or more first trimester losses. That is the classic definition. A lot of us would now recommend that people begin a workup if they want to try to know what’s happening and what might be causing it even after two losses, especially if you’re in your mid-30s or beyond. I would never make a patient wait for a third loss before I would start doing some testing.
Dr. Aimee: Right. Healing is your last section. I’m sure there are a lot of people out there that can relate to some of the…, I’ll call them snarky comments that well-intentioned people try to make to help you heal. From your perspective, what is the best way for someone to actually go through that healing process?
Dr. Kate White: The first thing I tell my patients, whether it’s in my office or in this book, is I want to validate this grief. It doesn’t matter if you were six days, six weeks, or six months pregnant. When you lose a pregnancy, you are losing all of the hopes and dreams that went with that pregnancy. You were picturing giving birth to a baby, about what your family is going to look like, what your Christmas card picture may look like. You’re probably picturing first steps, first smiles, and possibly even graduationng from high school.!
You lose all of that in one fell swoop. So, the first thing is don’t let anyone tell you, “You were early,” or, “You could just try again.” It doesn’t matter. You wanted to be pregnant now, at this point in time, with this pregnancy. The grief is real, so the first thing to do is just give yourself space for that.
Next, it is to take care of yourself in those first days and weeks after the loss, whatever that looks like. Hopefully you work for an employer who will give you some leave. Miscarriage leave absolutely should be universal, but right now it’s dependent on who your employer is. If it’s time away, if it’s turning down other obligations, if it’s not decorating for the holidays this time of year, or, heaven knows, not going to someone else’s baby shower because you don’t want to, do whatever it takes for you to just be able to breathe in those first days and weeks.
After that, it’s looking for ways to remember the pregnancy if you want to. That looks different for everyone. My husband and I have planted a tree at every house we’ve lived in since we lost our daughter at 29 weeks of pregnancy, so it’s Samantha’s tree. It’s always one that grows the best in our backyards, I have no idea why. Maybe we give it a little bit more TLC. I don’t know. But other people do other kinds of rituals or ceremonies. Whatever feels right to you about recognizing that pregnancy, which will always be a part of you even as time goes on.
Dr. Aimee: You brought up having a partner. For you, it was your husband, and it sounds like you guys were on the same page. But not everyone has that supportive partner. Do you have advice as to how someone can communicate with that person if they’re not necessarily understanding why you’re hurting and grieving so much?
Dr. Kate White: I love my partner. I got really lucky. I feel like I married a good one. Hopefully, it will be my only marriage for life. WBut we were NOT always not on the same page. It came down to the fact that because with my first loss I almost lost my life, and he was really grateful just to keep me. I felt no such gratitude. I was not that happy. I could not believe that I woke up from this trauma without my baby. So, we were in very different places from the beginning. As time went on, he wanted to try to move on – I hate that expression – and I wanted to talk about it and think about it and ruminate a bit more. We were very much not in the same place.
Years later, we got some couple’s therapy, which I think would have helped us if we had gotten that four or six months after the loss. So, I cannot say enough positive things about that for people who are really in different places. If you can’t afford it, don’t want to at the time, or can’t drag your partner there, I think what you need to do is both talk about where you are and figure out how to meet in the middle. Which sometimes is putting a time limit on a conversation, meaning we’re going to talk for 10 minutes, I’m going to tell you everything that I’m feeling, and then we’re going to stop, which gets across my need to purge to you all the things that I’m feeling right now, and he knows it’s not going to last forever.
So, trying to find a way forward for both of you. For us, a little bit of professional help was helpful, but otherwise just good open communication and meeting in the middle.
Dr. Aimee: I think you’re right, professional help as soon as possible and taking care of yourself. I feel like one of the first things when I share with someone that the pregnancy has stopped growing, they say, “Now I’m going to go eat a whole bunch of stuff that I shouldn’t be eating and drink way more alcohol than I should be.” That might make us feel good in that moment, but I think I want people to nourish themselves with healthy food and continue to be active and get the help that they need at the time of diagnosis.
Then there’s also this whole messaging and mixed messaging about when you can try to get pregnant again. I get frustrated because sometimes I have patients that have come to me and their doctor told them, “You need to wait a year to let your uterus heal.” That just drives me bonkers, and I can see it drives you bonkers too. How does someone know they are ready to try to get pregnant again?
Dr. Kate White: I will start with a caveat that there are some kinds of rare pregnancy loss where you do need to wait. If you had a third trimester stillbirth, or that required a C-section to deliver your baby, for instance, it is likely that you need a chance for your uterus to heal before you want to get pregnant again. If you had an ectopic pregnancy, a tubal pregnancy, and you had to take methotrexate, which is a really powerful medication to dissolve that pregnancy, we don’t know what the effects of methotrexate are if they’re lingering when you get pregnant again, so often the advice is to wait three to six months. So, there are these really specific situations in which you should wait.
For everybody else, you do not need to wait at all. Your body, though, might be ready faster than your heart is. I tell people from a medical perspective you often can start trying as soon as you want to. Your body after a pregnancy is over is really ready, your ovulation returns quickly and you are ready to get pregnant again, but your heart may not be, and that’s okay. If you want to wait for healing, for the time to be right, that’s perfectly okay. But don’t let any doctor tell you that you have to wait three, six, twelve months, because it just isn’t true.
Dr. Aimee: I agree. Thank you, Dr. Kate, for all of the hard work you put into this phenomenal book. I’m going to make sure to let all of my patients know about it from the time of a diagnosis so that they can feel less alone. Is there anything else that you want to share with our listeners today?
Dr. Kate White: I would say that because miscarriage is more common than most people realize, everyone knows someone who has gone through pregnancy loss. You usually don’t know that until you start sharing your story.
I would never want someone to go past their comfort zone to talk about something really personal and painful, but the more people talk about it and the more you can tap into that community of people around you, you realize that a lot of people have walked this road before you, and you can find support and strength in places you never knew if you can be open enough to talk about it. The community of people is out there who have experienced loss. Even though you never wanted to join that community, it welcomes you with open arms.
Dr. Aimee: That’s so true. Can you tell us again where people can find you to learn from you and to buy your book?
Dr. Kate White: You can visit me on my website, DrKateWhite.com. My book is available everywhere. For the fastest online experience, it could be up to your house in two days from all of the major retailers online, but you can also get it at independent bookstores or bookstore chains near you.
Dr. Aimee: Wonderful. Thank you again for everything that you’re doing. Say hi to all of my friends at BU. My residency director Dr. Jodi Abbott, I think she’s still there, so please give her my love. I’m a huge fan of you and her and all of the work that you guys do there. Thank you again for continuing to do things to make our lives better as women, especially when it comes to the support we get when we miscarry. Thank you, Dr. Kate.
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