Narrative Inquiry in Bioethics

"The sonographer placed the ultrasound gel on my abdomen, and I asked [my husband] to get ready to record the visit so that we could share the ultrasound with our families. No one in my family, except for my sister, knew about the pregnancy yet. When the sonographer said, 'let's just wait a minute to make sure everything is okay,' I knew at that moment it wasn't. She confirmed one of my worst fears—there was no heartbeat."

This excerpt from Christina Mulé's story—one of twelve in this issue of Narrative Inquiry in Bioethics—describes the moment an expectant mother's dreams were dashed. Though some people who experience pregnancy loss may feel relieved or conflicted, all of the stories we received for this symposium, simply titled, "Pregnancy Loss" were from mothers who experienced the loss of a wanted baby—all were distraught by the loss—most were shocked.

Different terms are often used to describe pregnancy loss, including, miscarriage, stillbirth, or an intrauterine fetal death (IUFD). Pregnancy loss may occur in as many as one in four pregnancies. Despite it being a fairly common experience, pregnancy loss can be isolating. Parents must navigate their grief, anger, confusion, guilt, shame or other feelings alone. They may be left wondering, "Did I do something wrong?", "Will this happen again?" or "How do I grieve this loss?" Family members, friends, and healthcare professionals may be unsure how to respond or support people who have experienced pregnancy loss.

The symposium editor, Elena Kraus is a practicing OB/GYN at Creighton University Medical Center's CHI Health Clinic. In addition to serving as the symposium editor, Dr. Kraus contributed one of four commentary articles. Reflecting on the authors' stories, she writes, "Statements often meant to provide hope or move a family beyond grief can [be] received as indifference or as evidence of a lack of acknowledgment for what was lost. Words are important, and missteps were not lost on this issue's authors. At times, I cringed imagining these interactions, hoping I never caused such injury."

Three additional commentary articles, written by Kathryn R. Grauerholz, Raymond G. De Vries, and Tammara Ruiz Ziegler offer important insights into the authors' stories. Grauerholz, an Adult Nurse Practitioner and Advanced Certified Hospice and Palliative Care Nurse, is the Director of Healthcare Programs at the Institute of Reproductive Grief Care. She observes that nearly half of the story authors in this symposium are healthcare professionals, "which did not buffer the shock and emotional trauma" of the loss they experienced. She goes on to write, "for this subset of authors, reflections on the assets and perils of this juxtaposition in the caregiving dyad revealed unique professional and systematic practice gaps and presented opportunities for improvement."

De Vries, a sociologist who studies the organization and delivery of maternity care, eloquently relays why the loss of a pregnancy, no matter the stage, is deserving of our sympathy and a caring response, "A miscarriage is the loss of a pregnancy [End Page vii] and a child, yes, but it is also the loss of confidence in one's ability to parent, of an imagined future, of things hoped for." De Vries notes that "the bureaucracy and hierarchy of medical settings prevent what should be ordinary and important caring reactions to the tragedy of miscarriage." He notes the role of religion and ritual in helping the authors find meaning in and peace after their tragedy.

Ruiz Ziegler, a Perinatal Bereavement Coordinator and Ethics Consultant concludes, "So much of the failure or success in caring for the women and families in the stories hinged on good communication. [T]hese are learnable skills and those we care for desperately need us to be the ones to build a bridge of communication with them when they are in crisis."

The research article in this issue, "Beware the Unknown: View on Genetic Technology in Conservation," was written by Henry Dixson et al. Using artificial gene drive (GD), scientists have the potential to edit and affect specific genetic traits, including those that determine sex, which could drive a species to extinction if...