Satisfaction with pregnancy loss aftercare: are women getting what they want?

Abstract

While there is increasing recognition that early miscarriage represents a significant loss experience that often provokes depression and anxiety, women's dissatisfaction with some aspects of care received from healthcare professionals following a pregnancy loss and the potentially negative consequences of this are often less recognized. This review examines available literature to identify what comprises "treatment as usual," how satisfied women are with the typical services they receive from healthcare personnel, and whether these services are consistent with women's self-identified needs. Results are reviewed according to four major themes-patient satisfaction with: attitudes of healthcare providers, provision of information, interventions provided, and follow-up care. In general, women and families who have experienced a miscarriage report low levels of satisfaction in the presence of perceived negative attitudes from healthcare providers, insufficient provision of information, and inadequate follow-up care that did not focus on emotional well-being. Higher levels of satisfaction are reported among women whose providers were emotionally attuned to the magnitude of the loss, provided information, and involved women in treatment decisions when possible. Limitations of current research are reviewed and directions for future research, training, and practice are briefly discussed.

Primary care considerations of miscarriage management

“…As a result of this it would seem that women who miscarry are experiencing higher levels of depression and anxiety than women without a recent reproductive loss (Geller, Psaros, & Kornfield, 2010).…”

“…Swanson (1999b) found that 39% of women grieved for six months or longer after the loss. Elevated levels of anxiety were found in 32% of women 12 weeks after miscarriage (Geller, Psaros, & Kornfield, 2010) and these rates can be as high as 45% of women, persisting for up to a year (Nikcevic & Nicolaides, 2013;Sejourne, Callahan, Chabrol, 2010b). Compared to their male counterparts, women appear quite vulnerable to developing a depressive episode following a stressful life event (Groh & Hoes, 2003) and as many as 15% of women will experience depression for up to a year after a miscarriage (Nikcevic & Nicolaides, 2013 Research shows that nurse practitioners provide treatment for women with depression that is consistent with national standards (Groh & Hoes, 2003).…”

“…It is estimated that 15-25% of all clinically recognized pregnancies end in miscarriage; most of these occur within the first three months (Geller, Psaros, & Kornfield, 2010). Miscarriages are more frequent in older women, but even in those younger than 35 years of age it is estimated that 10-12% will miscarry.…”

“…Miscarriages are more frequent in older women, but even in those younger than 35 years of age it is estimated that 10-12% will miscarry. Miscarriage is defined as the spontaneous death of a fetus before 20 weeks' gestation (Geller, Psaros, & Kornfield, 2010). This can also be referred to as a fetal demise or spontaneous abortion.…”

“…However, despite the research supporting a change in practice, less than optimal care is often given (Geller, Psaros, & Kornfield, 2010;Lok & Neugebauer, 2007;Rowlands, & Lee, 2010). This is likely due to the lack of practice guidelines addressing the holistic supports needed during and after miscarriage.…”