Reframing How Early Pregnancy Loss Is Viewed in the Emergency Department

Abstract

Women experiencing early pregnancy loss frequently seek care in emergency departments or early pregnancy clinics. The existing qualitative literature on the experience of miscarriage has yet to address how to connect how these women perceive their care experience and the prevailing structures which may be at the root of why their experience continues to be challenging. This study aimed to look deeper into the sources of negative experiences of early pregnancy loss for insight into how to rethink where to make impactful changes to care. Phenomenologically informed interviews with 59 women revealed several points of tension in the framing of early pregnancy loss, including the view of miscarriage as common, of it as a medical versus emotional experience, and the assumptions around care needs. Our work suggests that these tensions need to be dismantled through more patient-centered approaches to patient–provider relationships, policies, models of care, and medical discourse.

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

“…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 .…”

“…Some women found the information provided about causes, symptoms, and frequency of miscarriage to be inadequate in helping them navigate through the unfamiliar and sudden circumstance of miscarriage. 18 , 25 , 28 , 29 , 30 , 31 Some reported seeking out further information regarding causes, symptoms, and frequency of miscarriage to better understand their situation. 14 , 25 , 32 , 33 , 34 Others reported needing information about what to expect throughout the miscarriage process, and needing to understand treatment and management options and the associated risks.…”

“…Women rated care favorably when they felt that HCPs treated them as individuals experiencing something meaningful and distressing, acknowledging both the emotional and physical components of the loss. 12 , 13 , 15 , 25 , 28 , 30 , 31 , 33 , 36 , 40 , 41 , 45 Women reported they were not looking for specialized counseling skills, but rather that HCPs were just present, actively listening to their experience, and taking the time to identify their feelings and needs. 12 , 30 , 33 , 41 , 44 , 45 This offered a sense of validation for their thoughts and feelings.…”

Midwives’ and registered nurses’ role and scope of practice in acute early pregnancy care services in Australia: a scoping review protocol

“…2,10 This is also reflected in international literature. [11][12][13] Some authors identify the midwife as a key provider of care 14,15 or highlight the potential for midwives to provide the most appropriate and holistic physical and psychosocial care to women and families experiencing early pregnancy complications. 3,4 Warner et al 16 clearly identify themselves as senior midwife researchers in their exploration of women's experiences when accessing care in early pregnancy in an ED, although there is no reference to midwives in their study publication.…”

Emergency Medicine Clinician Experiences Addressing Uncertainty in First-Trimester Bleeding

“…Some research exists on the adequacy of clinician training in managing FTB and communicating a confirmed diagnosis of early pregnancy loss (EPL). 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 ).…”