Early Pregnancy Assessment Services in Australia: What psychosocial support is available? A qualitative study

Abstract

ProblemWomen commonly experience emotional distress following miscarriage but do not receive the support they need from healthcare providers. BackgroundMiscarriage can result in psychological morbidity; however, appropriate support at the time of a miscarriage can lead to better psychological outcomes. Early Pregnancy Assessment Services (EPASs) are dedicated outpatient services considered the “gold standard” for miscarriage care. Little is known about the psychosocial support EPASs provide in Australia. AimsThe aim of this study was to explore the provision of psychosocial support in Australian EPASs. MethodsSemi-structured interviews were conducted with 29 purposively sampled key-informants from 13 EPASs. Interviews were audio-recorded, transcribed, and thematically analysed. FindingsConsiderable variation was found in how EPASs functioned and their provision of psychosocial support. Many services were co-located with antenatal services, run by doctors with limited experience and most did not offer any psychosocial training to staff specific to EPAS. Referrals for additional support were generally not offered for first trimester miscarriages, and follow-up typically focused on physical management rather than emotional wellbeing. All EPAS staff demonstrated a strong commitment to providing best possible care to women within their own clinical setting and acknowledged the need for improved psychosocial support. ConclusionThis study provides the first exploration of Australian EPASs’ provision of psychosocial support. It has shown that while health care professionals working in EPASs are dedicated to providing the best possible care to women within their clinical setting, psychosocial support is very limited and could be improved.