Expectations and experiences of women presenting to emergency departments with early pregnancy bleeding

Abstract

Objective To explore women's expectations and experiences when presenting to the ED with early pregnancy bleeding. Methods We conducted a qualitative study where women presenting to the ED with early pregnancy bleeding participated in two semi‐structured interviews. An initial interview explored expectations of care and was conducted prior to ED treatment. A follow‐up interview about experiences with care was conducted after discharge from the ED. Women were recruited from three EDs in suburban Melbourne: one tertiary referral centre and two urban district hospitals. Results Thirty women with early pregnancy bleeding completed the initial interview and 22 completed the follow‐up interview. Eleven participants were primigravid women and 21 participants had never experienced early pregnancy bleeding prior to their ED presentation. Four themes relating to the patient experience were identified: (i) Acknowledgement of patients' concerns by hospital staff, including informing patients of progress and explanation of investigation results; (ii) Early pregnancy bleeding as a distressing experience, with most participants expecting that this would be acknowledged by ED staff, and privacy provided to allow for grieving; (iii) Prolonged waiting time for an urgent medical condition; and (iv) Ongoing care and support, such as providing recommendations of available services to support patients on discharge from the ED. Conclusion Early pregnancy bleeding is a distressing and anxiety‐provoking experience for women attending the ED. Appropriate emotional support is critical to the holistic care for those seeking emergency care.

Toward Optimal Emotional Care During the Experience of Miscarriage: An Integrative Review of the Perspectives of Women, Partners, and Health Care Providers

“…Finally, women expressed limitations in their capacity to process and retain verbal information because of their emotional state, especially for complex medical terminology and processes 33,44,45 . They indicated that it would be helpful to receive supporting written information, including a list of resources or health care services to contact if needed, so they would be able to process the information when ready 33,39,40,46,47 …”

“…Women reported feeling acknowledgment in the hospital when they and their partners were placed in environments that provided privacy to process their situation 12,18,33,36,40,49 . Specifically, women appreciated when HCPs recognized that physical proximity to pregnant women or newborns could amplify their feeling of loss 12,14 .…”

“…Many women reported valuing care that was individualized and sensitive to their choices and needs 12–14,25,30,31,33,40–42 . Some reported desiring support and follow‐up options tailored to the cultural and spiritual needs of their family 25 .…”

“…Women also reported desiring information about their physical recovery and possible complications, 25 , 29 , 33 , 40 as well as the emotional journey ahead, including the grieving process and emotions derived from self‐blame. 12 , 13 , 14 , 18 , 28 , 29 , 30 , 31 , 33 , 34 , 41 They reported seeking additional information through helplines, websites, online forums, support groups, grief counselors, and psychological services.…”

Emergency Medicine Clinician Experiences Addressing Uncertainty in First-Trimester Bleeding

“…Past work has examined shared decision-making related to EPL ( 12 ), provider education about the patient impact of EPL ( 13 ), training for delivering the news of EPL ( 14 , 15 ), and patient perceptions of optimal EPL communication ( 16 , 17 ). Uncertainty is mentioned explicitly by patients as contributing to self-blame in EPL ( 18 ) and is noted to be present during their evaluation ( 19 ) and after discharge ( 20 ). Uncertainty is also mentioned by patients as a driver for return visits for re-evaluation of EPL ( 21 ).…”