OP61 Women’s experience of miscarriage; a qualitative study

Abstract

Background Miscarriage is the most common adverse outcome in pregnancy. Half of women experience high levels of psychological morbidity after miscarriage, particularly elevated levels of anxiety and depressive symptoms. Such psychological morbidity may endure for up to a year after miscarriage. This study explores the experiences of women who have had two or more miscarriages. From this exploration, we also aim to gain insight into how women were managed following miscarriage in order to identify ways to improve their care. Methods In-depth qualitative interviews were undertaken with women who had experienced two or more miscarriages. A purposive sample of 10 women was recruited from a large tertiary level maternity hospital in the Republic of Ireland. The following criteria of; maternal age, parity and area of residence (urban/rural) were utilised for sampling purposes. In this study an interpretative phenomenological analysis was undertaken in order to identify superordinate themes through the close examination of women’s experiences of miscarriage. Results When women were miscarrying they felt that there should have been better communication with clinical staff both in the hospital and over the telephone. Women who miscarried later in pregnancy spoke about being unprepared for the physical trauma of the miscarriage. Women were uncertain as to whether they should stay at home to continue miscarrying or attend hospital, if they had attended hospital there was still uncertainty as to when they should re-attend. Following miscarriage women expressed frustration that medical examinations, such as karyotyping, would not be undertaken unless they experienced recurrent miscarriage (three consecutive miscarriages). This frustration was heightened in women who felt that other risk factors should be taken into consideration, such as advancing maternal age. All women were keen to determine if there was an underlying cause for miscarrying and expressed difficulty in coping with the uncertainty of the outcome of a future pregnancy. In subsequent pregnancies women highlighted the value of reassurance scans early in pregnancy to alleviate feelings of anxiety. Many of the women went on to attend obstetricians privately for their subsequent pregnancies, further emphasising the potential importance of continuity of care. Conclusion This study highlights that thorough investigation of the underlying causes of miscarriage and continuity of care in subsequent pregnancies are priorities for women who experience miscarriage. Consideration should be given to how these priorities can be addressed in clinical practice.