What to Expect: Termination for Medical Reasons (TFMR)

When faced with the difficult decision to terminate a pregnancy for medical reasons (TFMR), you may feel overwhelmed, anxious, and alone. We can relate to the big emotions and feelings that accompany this experience. Below you will find some information on next steps as you move through this process and work towards healing. 

Know that you are not alone, we are ready and willing to journey alongside you.

Common Emotions & Feelings

These emotions and feelings, and any others that you experience are completely normal and expected under the circumstances. No emotion is “bad” or “wrong”.  Many of these emotions will come and go. Some may be present at the same time. No matter what or how you feel them, our goal is to help you navigate your way as you move towards healing. 

  • Grief
  • Anger
  • Cheated
  • Fear
  • Self-Doubt
  • Heartbroken
  • Sadness
  • Self-Judgement
  • Loneliness
  • Isolation
  • Jealousy
  • Longing
  • Guilt
  • Shame
  • Confused

Fear: It's Complicated!

The fear you feel will be complicated. The fear you feel will be complicated. There may be fear around the procedure, or labour, itself, what the baby will look like, and how you will feel during and after. See the below section on “Preparing for your TFMR” to help you make plans for support and coping with this fear.

There may also be fear of living with the pain that you feel both physically and emotionally after your loss. On the other hand, you may fear living without the pain because it somehow feels like you have forgotten your child. When you consider future pregnancies, you may have fear around whether you can carry a baby to term, but you may also fear that next positive pregnancy test.

Remember, we are here to help you move through even the most complicated emotions.

Postnatal Physical Effects: What to Expect

Depending on how far your pregnancy has progressed, there are some postpartum physical symptoms you may experience in addition to the emotional ones. Some of the potential effects are listed here:

  • Vaginal bleeding
  • Misaligned hips
  • Lactation*
  • Slack skin around the belly
  • Hair loss
  • Drop in Estrogen & Progesterone (which may impact mood)

* There are steps that you can take to help stop milk production however, there is no way to stop the milk before it comes in. There are some homeopathic methods to ease the discomfort when milk comes in, such as putting cold cabbage leaves against your breasts, taking antihistamines and drinking sage tea. Talk to your doctor to find out more before you try using any supplements or medications in case these are contraindicated for you.

The physical symptoms you experience should stop within a few days to weeks. Please talk to your doctor if you experience any severe symptoms, such as fever, heavy bleeding or very painful abdominal cramping. The emotions that you are going through may be affected by the physical symptoms as well. It is important at this time to rest and take care of yourself. Remember that you are experiencing postpartum symptoms. This is very difficult to come to terms with because unlike other postpartum bodies, you are also grieving your baby. This is even more reason to allow yourself permission to rest and recover. Engage others who can help take care of you and other responsibilities you may have (i.e. other children, household chores, work) while you recover and heal.

What Happens Before TFMR?

(Alberta Health Services, 2017)

  • Counselling may be offered prior to making the decision to terminate, or release, your pregnancy,, which can be for the birthing parent only or if you should choose for your partner and/or other family members.
  • In the case of fetal anomaly, reproductive counselling should be made available to you both before and after termination.
  • Your consent must be obtained before the termination is carried out.
  • You are entitled to obtain any information you reasonably need or request about the prognosis or the procedure and this must be given in a way that you can easily understand. If you feel you do not understand or need more information, do not hesitate to ask your health care providers. This may be difficult to do when you are feeling overwhelmed with emotions, so it can be helpful to engage your partner or a supportive friend or family member to help you advocate for yourself and your baby.
  • This includes but is not limited to:
    • All available options for the birthing parent and the baby.
    • Being advised of the option to document a “do not resuscitate” order.
    • Neonatal palliative care options – that is, in the case of a live birth, measures to reduce suffering for the baby.
    • Any non-medical information that may be applicable.
    • Information to help decide whether to stop the baby’s heart before induction.
    • Information about getting an autopsy done.
  • They may send you home after receiving your induction medication until contractions start.

Questions That May Arise Before/During/After

1. What does the prognosis mean for the quality of life?
You may be ready and willing to face both the challenges and joys that come with raising a child with special needs, yet you have questions about the quality of life they will have if you continue with the pregnancy.

2. How do we give our child a different story?
The research on your child’s/the birthing parent’s prognosis may or may not be readily available but this question comes up for a lot of families facing a hard prognosis and seeking to change the outcome.

3. What is the right decision? How do I make the right decision? Did I make the right decision?
There will always be a part of you that asks these questions, and the honest answer is that you will never know for sure, but we know that you made the best parenting decision you could make with the information and prognosis that you were given. According to Dannielson and Levine (2020), errors in a diagnosis that would lead to the recommendation of medical termination are extremely rare.

4. Did I move too fast? Did I do my due diligence?
Know that all the time and research in the world would not have made this decision any easier. Additionally, time is often something that is not on your side which can make it feel like the decision was rushed. Each case is highly individual, and this recommendation is not made lightly without all options and facts available to you being considered.

5. How will I forgive myself?
Finding and accepting forgiveness will be part of your healing journey. Being able to accept that you made a good and right parenting choice will be challenging and may start with joining our difficult decisions peer support group. A peer support group is a great place to share stories, ideas, and emotions that others may not be able to understand. Forgiveness of yourself will be a process and will not happen in a day. Journeying with others who can understand a little of what you have been through can help start that process in a gentle way.

Preparing for your TFMR:

It can be helpful during this difficult time to complete a perinatal loss plan, if time allows. This plan represents your wishes for the procedure/labour/delivery process, postpartum care and/or neonatal care for your baby. It is important to note that there may be some circumstances outside of everyone’s control but having a loss plan can help to serve as a guide for health care providers to understand and follow your wishes.

Some of the things you can include in your loss plan could be (Sue Steen / Sherokee Ilse, 2010):

  • Your overall goals and hopes for the process (i.e. being alert and present, doing as many parenting responsibilities as possible, involving support people, loss doula and/or living children, etc.)
    Some background information about your pregnancy experience; i.e. infertility issues, previous losses, living children, your pregnancy experience, etc.
  • Your plan for child care / involvement of your living children during this time.
  • Information about your spiritual/cultural support needs and whether you would like a rabbi/priest/pastor/imam/elder to attend, whether to have a baptism/blessing, smudge or naming ceremony.
  • Your wishes about the procedure/labour i.e. who you would like to be with you (in the room or close by), medication, pain management, as well as any concerns or fears you and your partner have about the procedure/labour/delivery, and what you are looking forward to or hope will happen.
  • Your wishes for birth classes/education, what things may be important to have with you in the room (music, clothing, type of birth, IV or not, who is present, cutting the umbilical cord, etc.)
  • How much uninterrupted time you want to spend with your baby and if you want staff support with anything during this time.
  • It can be important to also think about creating memories with your baby, collecting mementos and having rituals i.e. if you are able to see, hold, touch the baby, take a lock of hair, handprints/footprints, take pictures, video tape the birth or baby, bathe or help bathe, diaper/dress baby, wrap baby in a blanket, play music, read to baby, take baby outside or home).
  • Your wishes for an autopsy and/or genetic testing, information about these options and your rights in this regard.
  • Your wishes for your baby’s remains; cremation, burial, funeral arrangements, viewing of the body prior to cremation, a memorial service, etc.
  • Your wishes if baby is born alive (use of medical intervention to prolong life, no heroic measures or some combination of the two, if baby should be held the entire time until death, who is allowed to hold baby, if you want pictures without tubes and other medical devices, specific mementos you wish to keep).
  • Any referrals to resources you may need (counselling, postpartum support, funeral services, government sick leave benefits).
  • Any other ideas you have or questions you may need answers.

What Happens After TFMR?

  • Follow-up care will be provided by your primary care provider
  • Bereavement support and follow-up will be offered to the birthing parent and partner/family.
  • If you have chosen to have an autopsy done, your child will stay at the hospital and arrangements can be made to have your baby transferred to the funeral home of your choice.
  • You may be offered a hospital burial or cremation at no cost
  • Emotions that you may not even understand may come up for you.
  • You may need/want to take some time off from work while you recover both physically and emotionally. It is ok to feel like you cannot return to normal activities right after your loss; it is also ok to feel like you want to return to normal activities. There is no one right way to grieve.
  • If you feel you need some time off, you may want to request a letter from your doctor for your employer recommending that you be allowed to take time off. There are financial supports available to you while you take some time off:
    • Benefits that may be available to you through your employer include sick leave and/or short/long term disability. Your manager/supervisor or Human Resources advisor should be able to provide you with this information.
    • If you do not have these benefits available to you through your employer, there are benefits available through the federal Government of Canada, namely, Employment Insurance benefits, which is 15 weeks of benefits at 55% of your regular pay (or at least $500 before taxes per week if Covid benefits are still available). If your pregnancy ends before week 20, you could receive sickness benefits. If your pregnancy ends in week 20 or later, you could receive maternity benefits. You can contact EI online or by phone at 1-800-206-7218.
    • If you are not eligible for EI benefits, there may also be social assistance benefits available to you through your provincial government. Please contact your provincial social assistance branch for more information.
  • You may also need/want some help with child care of your living children. If you can, take some time to think about who may be able to support you with this and ask them for help during this time so that you can have breaks to take care of yourself and your needs.

We are here to support you as you navigate through this complex time. Please visit www.pilsc.org for more information. You are not alone.

NOTE: This document is part of our FREE Resources collection. To see our other FREE Resources, visit this page.

(If you see an error on this document or have additional info that we could include, please contact us and let us know.)

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