Robert Wood Johnson Foundation (RWJF) Clinical Scholar (2005-2007) Katherine Gold, M.D., M.S.W., M.S., turned one of life’s most heartbreaking experiences—losing an infant— into a commitment to help other parents understand and overcome such a tragedy. “A few weeks after I graduated from medical school,” Gold recalls, “I lost my second child unexpectedly just days before my due date.” In an effort to heal, Gold joined a bereavement group. That experience would not only help her cope, it would shape her research for years to come.
“Once I joined this small club of people who were sharing these awful experiences, I was surprised to hear their complaints about how hospitals cared for people who had faced a terrible event like this,” Gold said. “In some cases, people were even complaining about physicians I knew.”
Concerned about the lack of advice and support for men and women who had suffered miscarriage or stillbirth (loss after 20 weeks gestation), Gold began to look for studies on how couples fared. “There was very little research on how people dealt with this type of loss or what types of clinical care were most helpful,” she said. “Because of the lack of research and my passion about the issue, my Clinical Scholars program mentors encouraged me to pursue the topic,” said Gold, who is an assistant professor in the Department of Family Medicine and the Department of Obstetrics and Gynecology at the University of Michigan.
“There was a good deal of research on what happened to people after the death of a child, but no one had looked at how cohabitating couples [40 percent of moms are unmarried and about half of them are cohabitating] or married spouses did after fetal loss,” Gold explained. Using data from the National Survey of Family Growth, Gold and her team analyzed 7,643 women who reported 13,593 pregnancies to conduct the first national study to establish that parents have an increased risk of breaking up after a miscarriage or stillbirth. “We found that couples who had experienced a miscarriage had a 22 percent greater risk of divorcing or ending their relationship than couples who had not lost a baby. For couples who had suffered a stillbirth, the risk was 40 percent higher,” Gold said.
Further analysis of the study, “Marriage and Cohabitation Outcomes After Pregnancy Loss,” published in the May 2010 issue of Pediatrics, found that while the risk of a breakup remained higher for only two or three years for couples who had experienced a miscarriage, it remained higher for up to 10 years after a stillbirth.
Family and Caregivers Often Misunderstand
As Gold searched the study results for answers, she discovered that there were key characteristics of couples themselves, as well as their support networks, that potentially put them at risk. “As we reviewed the possible reasons why this is such a difficult event for couples to survive, we asked: Were these couples who were already struggling or were there other factors that we could not measure? We did find the risk was most pronounced in couples who were younger or cohabitating,” Gold said.
But another significant issue, Gold added, “is that the loss of a baby—unlike the loss of an older child—is not acknowledged by society or even sometimes people close to the couple. People are uncomfortable talking about it or may say unhelpful things like, ‘at least it wasn’t a real baby or at least you weren’t attached to the baby,’ to the couple,” explains Gold, who now teaches residents how to address perinatal loss. “Couples often find that after a few weeks, no one wants to acknowledge the loss or talk about the baby anymore which makes them feel more alone in their grief and coping.”
To help couples, “it’s very important for families to support them at this time. Physicians and hospitals should also offer bereavement counseling,” said Gold, acknowledging that most hospitals have some method of dealing with fetal loss, but vary widely in the level of support they offer. “Couples should also consider seeking counseling to work through their feelings if they find they are struggling to safeguard their relationship.”
A Focus on Helping Women
“This study is one small piece of my work on what happens to women after perinatal loss,” Gold said. “I am now working on a survey of a group of women in Michigan who have experienced a stillbirth or infant death. I will be following them for two years and looking at their mental and physical health and subsequent pregnancy choices, with the support of a K23 Award from the National Institutes of Health. But I credit the Clinical Scholars program for my ability to conduct these studies because it focused on mentoring, encouraging us to follow our passions and taught us multiple research methods. I couldn’t have done any of this work without the Clinical Scholars program. It really changed my entire career and I feel really grateful for that,” Gold said.
While the loss of a baby is a life-changing event and it often causes couples to fear that they may never become parents, Gold advises, “I do not want couples to read my research and feel doomed. Anecdotally, I’ve found that while grief is a huge stress, it also sometimes brings couples much closer together as they work their way through it,” says Gold, who is now the mother of three healthy children.
The Robert Wood Johnson Foundation Clinical Scholars program advances the development of physicians who are leaders in transforming health care through positions in academic medicine, public health and other roles. The program trains clinicians in the program development and research methods that will enable them to find solutions to the many challenges posed by the health care system, community health and health services research.
While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
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