Dimensions of a Woman's Experience of Inevitable Miscarriage

Objective: To explore a woman’s experience of early pregnancy loss when she is diagnosed with an inevitable miscarriage through understanding her description of symptoms and treatment decisions

Design: This qualitative study consisted of transcribed data from a recorded telephone interview lasting from 30 – 45 minutes. Researchers used a semi-structured interview guide.

Setting: Nurses recruited the participants from an obstetrics/gynecology outpatient clinic at a midwestern medical center.

Sample: A purposive sample of women who experienced a miscarriage at or before 14 weeks of pregnancy, needed to make a treatment decision (medical, surgical, expectant management), were at least 18 years old, and spoke English were recruited.

Methods: Dimensional analysis, a method generic to grounded theory, but appropriate for existing data, was used to analyze transcripts. Women were asked to “Tell me about your miscarriage” with follow-up questions such as “How did you decide what to do next?” or “What went into knowing what to do next?” Using line-by-line analysis, the research team identified dimensions and related conditions.

Results: Participants ranged in age from 23 – 40, with a mean age of 31. All were married. Fifteen women decided on surgical intervention, 1 chose medical, and 7 chose expectant management. The women described two central dimensions: being sure they were miscarrying and being sure they chose the right treatment option. Making decisions about treatment were compelling due to potential for pregnancy viability. Conditions for "being sure" included relationship with their health care provider (physician or nurse midwife), severity or extent of symptoms (bleeding and cramping, absence or change in pregnancy symptoms), medical technology, personal intuition, and input and advice from others (e.g., friend who had miscarried).

Conclusion/Implications for nursing practice: Women wanted to know what to watch for (e.g., how to determine how much bleeding is too much) when they learned their miscarriage was inevitable. They were also traumatized by miscarrying in the toilet and either retrieving or flushing the products of conception. Findings support the critical role of nurses in health care of women with early pregnancy loss. Understanding symptoms, helping women know what to expect, the importance of confirmed nonviability of pregnancy, and the need for support from the woman’s health care team are key to evidence-based and relationship-based nursing care.

Keywords: miscarriage, medical decision making, perinatal loss, ultrasonogram