The ultrasound is a situation that many women fear if they’ve received bad news in a prior pregnancy during an appointment of this type.

Even when a pregnancy is uneventful, women’s experiences of the ultrasound can vary widely. A warm, chatty technician is reassuring for some while for others, someone who appears confident and competent is all that matters. When all goes well, most women would agree that the personality and demeanor of the technician is much less important than the information they are receiving. However, when bad news must be delivered, it is common for my clients to share that sensitive and compassionate care has made a big difference for them in how they experience what for many is a traumatic situation.

Many clients are anxious, regardless of whether it is the first pregnancy or the third. Men and women go into the ultrasound appointment with fears, concerns, and questions they hope to be answered such as how far along they are, whether or not there is a heartbeat, the sex of the baby, and any problems that might be apparent.

Should a fetal demise have occurred or should a problem be detected, the ultrasound technician has the very difficult job of maintaining a demeanor of professionalism and neutrality while herself experiencing any number of emotions. In most settings, the technician cannot make a medical diagnosis, but she can share with you the sex of the baby and how many weeks the baby is measuring. For anything medical, in most settings, the technician must have the obstetrician, midwife, or maternal fetal medicine specialist review her findings.

However, there is a wide variation in practices and some technicians are more silent while some may be more inclined to make small talk throughout an ultrasound. I believe it requires a certain type of personality and skill set to be able to put a mom at ease while also adhering to the restrictions on not disclosing certain types of medical information.

When there is no heartbeat, often a technician will get the physician to verify. There is a wide variety of responses and styles that a technician might use to communicate this information. For some of my clients, subtle changes in the technician’s demeanor signaled that something was wrong even before left to bring in the doctor.

This is a very difficult situation for everyone involved. Receiving bad news in this situation is hard enough. Receiving it in a way that is not compassionate can be traumatic for some women. Fortunately, it seems to be more likely (at least anecdotally) that people experience the technicians as compassionate in most situations even when the technicians are not very expressive.

In a pregnancy after loss, what can a woman do to avoid a repeat of a bad ultrasound experience? Sometimes it helps to have one’s chart flagged as having had a prior loss which would suggest to the technician that there might be increased anxiety or more emotions expressed by the patient. It is not uncommon for women with prior losses to cry during the ultrasound. Some women I know have barely been able to look at the baby on the screen for fear of seeing something wrong or fear of getting too attached to a baby even when all is going well.

Although I can and do suggest specific strategies to women in a PAL such as breathing exercises or ways to challenge anxious thoughts, what I do most often if to validate their fears that are based in their prior experience of loss. I also state the reality that they can’t control every outcome. It is a possibility that a patient might receive bad news in a new pregnancy. This is one of the risks of being pregnant and the biggest fear for many of my clients. It is a brave decision when a couple chooses to become pregnant again after a loss. That bravery involves the risk of losing again.

Reminding them of this, in my experience, seems to help couples feel stronger going into the ultrasound. I also remind them to mobilize their support resources—tell supportive family members or friends that they are going to an ultrasound and ask them to check in with them later that day. Sometimes, the mother has to push through fear even to make it to the appointment. Encourage the PAL mom you know to take care of herself before and after the appointment by talking to supportive others or engaging in some activity that feels comforting.

If physicians attended every ultrasound, women might not have to deal with the uncertainty of knowing that something’s wrong and having to wait for the doctor’s confirmation.   However, given the real constraints that already exist in medicine, it is unlikely that the current practice will change drastically.

How have you dealt with the anxiety of an ultrasound in a PAL? Did the technician’s demeanor and level of conversation make a difference? Are there practices, like flagging a chart, that can make this situation more bearable for a PAL mom?

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