Practicum Highlight: Eri Shindo, MPH'24

Enhancing Care for Lactation after a Second Trimester Abortion or Fetal Loss

As an undergraduate at Keio University in Fujisawa, Japan, Eri Shindo wrote her senior thesis on the challenges faced by people with eczema navigating the world of medical therapies and alternative treatments. As an early-career professional, she worked in customer development for Proctor & Gamble in Kobe and later as a senior researcher in marketing for a Tokyo-based healthcare marketing research company. She made her way to Dartmouth’s Master of Public Health program through a decidedly more personal experience—a medically difficult pregnancy and second-trimester loss.“I received very good care, but I knew that was a privilege, and not many people receive that level of care,” she says. “Public health is focused on accessibility, quality, and holistic care.”

For her practicum, Shindo delved deeper into the unique needs of people who experience second-trimester loss. “My personal experience was my way in,” she says, “but researching more about the second-trimester population, I found that they’re often understudied.” In particular, she notes, the population is highly variable, including people who experience induced abortions for socioeconomic reasons or emergency termination due to fetal anomalies or maternal complications, as well as spontaneous fetal loss. “There’s often a sense of shame or failure,” says Shindo, “and there can be a lot of stigma around termination, even if it was a heartbreaking decision in a very desired pregnancy.”

Adding to the emotional and physical challenges of second-trimester pregnancy loss, milk production begins at gestational week 16, and lactation commences with delivery of the placenta, regardless of pregnancy outcome. Yet, in her literature search and interviews with providers, Shindo found that discussion about lactation with second-trimester patients is minimal. To facilitate conversation, she developed a rigorously researched patient brochure that introduces the support options available—from medications that suppress lactation to expressing and donating to a milk bank. In anticipation of a second phase of the study, Shindo completed the Institutional Review Board approval process that allows her to recruit and interview people who have experienced second-trimester abortion and fetal loss to explore their needs and preferences for enhanced lactation support.“This project really immersed me in the clinical environment, talking to different professionals in the hospital and getting a feel for how departments interact,” says Shindo, who plans a career in maternal and child health research. “That was a very powerful experience.”

Written by: Sharon Tregaskis

POSTED 3/25/2024 AT 02:52 PM IN #practicum