“The loss was traumatic… some healthcare providers added to that”: Women’s experiences of miscarriage

Abstract

Background

Miscarriage is a common event in Australia and is estimated to occur in up to one in four confirmed pregnancies. Prior research has demonstrated that miscarriage is associated with significant distress, grief and loss, and in some cases clinically significant levels of depression, anxiety, and Post Traumatic Stress Disorder. Despite these consequences for women’s emotional and mental health, studies have commonly found that women feel that healthcare providers often lack empathy, support, and acknowledgement of their loss.

Aim

The aim of this study is to explore the psychological distress experienced by women as a result of miscarriage, as well as the perceived support provided by healthcare professionals.

Methods

Fifteen women were recruited in Australia and participated in semi-structured interviews either in person or over the telephone.

Findings

It was found that for most women, the levels of distress, grief, and loss associated with their miscarriages were significant. While women experienced both positive and negative interactions with healthcare providers throughout their miscarriage journeys, all women interviewed expressed their increased distress following negative experiences.

Conclusion

A number of recommendations have been provided by women to improve the service of healthcare providers in the event of a miscarriage, including referral to a psychologist, and ongoing follow-up after their miscarriage, which women felt would assist them with managing their distress.

Introduction

In Australia, miscarriage is defined as the loss of a pregnancy before 20 weeks gestation.1, 2 Miscarriage is a common event and is estimated to occur in approximately one in four confirmed pregnancies.1, 3 It is difficult to measure exactly how often miscarriage occurs, as many losses are experienced before women are aware they are pregnant, and it is commonly assumed to be a late or heavy period.1, 4 The high frequency with which miscarriage occurs, combined with the relative ease with which it can be managed medically, has meant that it is generally considered a routine pregnancy complication.⁵ Yet this medicalised view does not take into account the significant psychological distress, trauma, and grief frequently experienced by women following a miscarriage.1, 6

Previous research has shown that, similar to other types of loss, women commonly experience grief and psychological morbidity following miscarriage; feelings of grief, distress, guilt, isolation, sadness, and anger are often reported.6, 7, 8, 9, 10, 11, 12, 13 In some cases, the levels of depression, anxiety, and posttraumatic stress disorder (PTSD) cause clinical concern.6, 8, 14, 15, 16, 17, 18, 19

For many women the distress associated with miscarriage stems not only from the physical loss of their baby, but also the hopes, dreams, and future aspirations associated with having a child. While it is frequently assumed women have not yet formed strong attachments in the early stages of pregnancy, previous research has shown gestational age, as well as other obstetric factors, have no association with the level of psychological distress experienced as a result of pregnancy loss.1, 6, 16, 20, 21

While in Australia there is an abundance of information and clinical guidelines for healthcare professionals on the medical management of miscarriage, the psychological morbidity is often overlooked.⁵ There are few, if any, resources or care guidelines regarding the support of grieving parents as part of routine care, and women are rarely followed-up by healthcare practitioners.12, 20

Healthcare professionals can play an important role in shaping the miscarriage experience for many women, and in the associated psychological impact. Numerous studies have found women commonly report a lack of acknowledgement, compassion, and support from healthcare providers.2, 6, 7, 22, 23, 24 Clinical care issues commonly raised include a lack of sensitivity and empathy, a lack of information provided, a lack of follow-up care including referral to support services, and a lack of causative information.2, 7, 25

In Australia, women can choose between prenatal care in the private or public healthcare systems. If women choose to have their babies in the public system, they are usually cared for by a combination of general practitioners (GP’s), midwives and public obstetricians, and will commonly see different midwives and/or obstetricians at each prenatal visit. They will then give birth in a public hospital, cared for by midwives and/or obstetricians who are working in the hospital at that time. In the private system, women choose their own obstetrician who they see throughout the pregnancy and birth, and they will usually give birth in a private hospital.

Given the significant psychological impact of miscarriage on women, as well as the frequency with which it occurs, it is important to understand women’s perceptions of their experience, emotional management by healthcare professionals, and most importantly how this may be improved in the future. While women’s experiences have been investigated in prior research, recommendations for future healthcare practice in Australia from women’s perspectives have not been widely explored. The aim of this study is to explore women’s healthcare support experiences and how these impacted women’s psychological distress, as well as recommendations for how support could be improved in the future. The purpose of this study is to gain a better understanding of women’s experiences following miscarriage, particularly in relation to healthcare provider support, with a view to raising awareness among healthcare professionals and the broader community of women’s emotional support needs and providing recommendations for improved care.