A qualitative investigation into women's experiences after a miscarriage: implications for the primary healthcare team

Abstract

Background: Approximately 16% of clinically confirmed pregnancies end in miscarriage. However, there is frequently no routine follow-up by the primary healthcare team (PHCT) to identify psychiatric morbidity after miscarriage.

Aim: To explore women's experiences of miscarriage care that may impact on the ability of the PHCT to detect psychiatric morbidity after a miscarriage.

Design of study: Qualitative study using questionnaires, semi-structured interviews of patients, and interviews of healthcare professionals in focus groups.

Setting: Patients who had experienced a miscarriage were recruited from the gynaecology wards of a district general hospital. The healthcare professionals were recruited from 14 local general practices.

Method: Post-miscarriage 'psychiatric cases' were identified using the hospital anxiety and depression (HAD) scale. A theoretical sampling technique was used to identify patients for semi-structured interviews. Interviews with healthcare professionals were conducted in three focus groups.

Results: Seven themes emerged from the interviews and focus groups that characterised the experience of patients and the perception of health professionals after a miscarriage. These were a need and desire for formal follow-up plans, poor recall and understanding of initial events, a need for more information and answers, normalisation of miscarriage by the PHCT, guilt and false assumptions, variable standards of care and skills deficiencies, and suggestions for further improvements.

Conclusion: Themes that emerged from interviews, questionnaires, and focus groups indicate that there are deficiencies and inconsistencies in current care provision that are likely to impact on the ability of the PHCT to identify psychiatric morbidity following a miscarriage.