Pathology

Please note, in this article the term “fetus” or “fetal remains” is used for consistency only and is not meant to take a political stance. You may have called your fetus a baby, or even given them a name, and this is all normal and healthy. The name you use for the pregnancy you lost is the right one.

If you have ended a wanted pregnancy or experienced a loss in which your fetus’ remains were not returned to you immediately in the hospital, it’s likely that you consented to sending them to the pathology department. Pathology is the process of searching for the cause of your fetus’ anomaly or exploring it further if you received a prenatal diagnosis. This involves analyzing fetal remains, taking samples of them under the microscope, and testing them. You may have made plans for your fetus’ remains that include cremation or burial. If experienced an L&D, you may have also consented to an autopsy in which your fetus’ body is examined for pathology but is still intact, so that you have the option of a burial or viewing once this is complete.

Pathology is an extremely valuable and important process that can give you more detailed information about your fetus’ condition, including the likelihood of a chromosomal or fetal anomaly happening in a subsequent pregnancy. Your healthcare team will explain to you the different options available, but you should know that some of the more recent tools to explore genetics don’t always provide concrete answers. They might give you an estimate or idea of future risk, but they are not a perfect science. Still, you need to decide how much information you need to know, and what that information will do. Ask yourself:

Will knowing whether there is a likelihood of this happening again stop me from having more children?
If this happens in a future pregnancy, what care can I have in advance to help me know sooner?
Does knowing this information make me more likely to engage in a process like IVF, in which future pregnancies can be screened? Do I have the financial resources for IVF? Alternately, would I consider adoption, donor egg/sperm, or other routes of having a family that will not result in an affected fetus?

It is also very important to understand that many hospital systems have options for clients to view their medical charts and any information associated with them. Please prepare for your pathology report to be made available to you before your provider gets in touch to help you read it. It can be extremely surprising or upsetting to read a pathology report that is written in precise, scientific language as it can feel dehumanizing to your fetus and invalidating of your grief. Many grieving parents have unexpectedly clicked on a pathology report to read specific details of their fetus’ anatomy, and this can also be triggering. It can be very helpful to ask a trusted loved one who is not as close to the loss as you are to login to your medical chart before you do, to screen it for the pathology report and any potentially triggering language. You may want to ask your physician if there is a way to block the pathology report from your view so that they can look at it first and call you to discuss the findings. Often, this is as easy as not clicking a button “releasing report to patient”, but physicians may need to be reminded not to do this, as it can be habit to make all records immediately available, and there may need to be a written record of an explicit request not to do so.

Remember that pathologists use a language that may not always feel patient-centered or mindful of your tender emotions after a babyloss. The goal is to analyze, describe, diagnose, and potentially make predictions. The intent is not to harm you, but to create useful information that your doctors can help you understand when you are ready. Still, it can feel hurtful to read about your fetus in such a detached way, and it’s truly best to prepare for it. Remind yourself that you might have to resist clicking immediately on the file if it pops up unexpectedly. Take a breath and find support or call your provider’s office to ask them to read it and summarize it for you first. As time goes on, you may feel more enabled to look at this document directly, but don’t force yourself. As a part of your medical chart, it will always be available, ready when you are, to read and understand what it means.

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Posts by E. Goldblatt Hyatt

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