A fertility practitioner may see one piece.

A sonographer another.

A psychologist another.

A midwife another.

A grief practitioner another.

Each may provide excellent care within their scope.

But when a woman has experienced recurrent pregnancy loss, I keep coming back to one question:

Who gets to see what has accumulated between all of those pieces?

Because recurrent pregnancy loss is not simply the same experience happening again.

And she doesn’t necessarily return to zero between losses.

She may enter the next pregnancy, appointment, scan, treatment cycle or loss carrying what came before it.

The grief.

The fear.

The medical experiences.

The loss of trust in her body.

The memories of previous scans or appointments.

The changes within her relationships.

The questions that were never answered.

The ways she has learned to protect herself.

The possibility that hope itself no longer feels safe.

Yet our systems of care can mean that each practitioner encounters only one part of that reproductive story.

And that creates a distinction I think is incredibly important.

Good practitioners can exist inside a fragmented system

When we talk about gaps in pregnancy loss care, it can be easy for the conversation to sound like an accusation.

Someone should have done more.

Someone should have noticed.

Someone failed her.

Sometimes, of course, care does fail women.

But fragmentation can happen even when every individual practitioner is providing excellent care within their scope.

The fertility practitioner may be investigating why the losses are occurring.

The sonographer may be providing compassionate care during an incredibly anxiety-provoking scan.

The psychologist may be supporting trauma, anxiety or grief.

The midwife may be caring for her during a subsequent pregnancy.

The grief practitioner may be helping her process what she has lost.

Each piece can matter enormously.

The gap may exist between those otherwise excellent pieces of care.

Because who is holding the cumulative picture?

What happens between the losses matters too

After recurrent pregnancy loss, we understandably ask questions about what is happening medically.

What caused this loss?

What investigations are needed?

Is there something that can be treated?

What should happen before trying again?

These questions matter.

But there is another question I want us to become more comfortable asking:

What is she carrying into this experience from everything that came before it?

Because the current loss might be why she entered your care.

It isn’t necessarily where her story begins.

Perhaps this is her third pregnancy loss, but her first time seeing you.

You are meeting her today.

Her nervous system isn't.

Her body has a history.

Her relationships have a history.

Her experience of healthcare has a history.

Her expectations of pregnancy have a history.

The meaning she makes of what is happening now may be influenced by everything that happened before she walked through your door.

That doesn't mean every practitioner needs to assess or treat every dimension of her experience.

It means the cumulative story matters.

The answer isn't to become everything to everyone

This is where I think multidisciplinary reproductive loss care becomes incredibly important.

Because when we begin talking about the biological, psychological, neurobiological, relational, reproductive, identity and grief experiences surrounding pregnancy loss, it would be easy for practitioners to think:

How am I supposed to hold all of that?

You're not.

A psychologist doesn't need to become a fertility practitioner.

A fertility practitioner doesn't need to become a grief specialist.

A midwife doesn't need to become a trauma therapist.

And a grief practitioner doesn't need to understand reproductive medicine at the depth of a clinician working within it.

Scope still matters.

But perhaps reproductive loss literacy means understanding enough of the whole to be able to say:

This is my piece.

This isn't my piece.

And I know enough to recognise when she may need something beyond what I provide.

That's very different from asking every practitioner to become an expert in everything.

It's asking us to understand that the woman sitting in front of us doesn't experience herself in professional silos.

She is the person moving between the pieces

She doesn't leave her grief with the grief practitioner before entering the fertility clinic.

She doesn't leave her previous medical trauma outside the ultrasound room.

She doesn't leave the fear created by previous losses behind when she becomes pregnant again.

She doesn't necessarily stop experiencing the physical consequences of loss because she has been medically discharged.

And she doesn't divide herself into:

This is the fertility part of me.

This is the mental health part.

This is the grief part.

This is the trauma part.

We may organise care that way.

She doesn't necessarily experience it that way.

That's why I think advancing reproductive loss care requires more than simply adding another service.

We need to become more curious about the spaces between services too.

What information isn't travelling with her?

What questions aren't being asked because they technically belong somewhere else?

What does one practitioner notice that another may never have the opportunity to see?

And when everybody is appropriately holding their individual piece...

who is seeing the whole?

Perhaps this is the next conversation in reproductive loss care

I don't think the answer is one practitioner taking responsibility for every part of a woman's reproductive experience.

I think the opportunity is much bigger than that.

It's practitioners across disciplines becoming more aware of the cumulative nature of reproductive loss.

Understanding where their expertise fits within the wider picture.

Recognising where another professional may need to enter.

Communicating across disciplines where possible.

And becoming curious about the reproductive story that existed before this particular moment of care.

Because recurrent pregnancy loss isn't simply a collection of separate clinical events.

There is a woman moving through all of them.

And if we want to advance reproductive loss care, perhaps one of the most important questions we can begin asking isn't only:

“What does she need from me right now?”

But also:

“What might she be carrying into this experience from everything that came before it?”

Different disciplines.

Different expertise.

One woman moving between them.

And someone needs to remain curious about the whole story.