Whose role is it? Primary care and the provision of emotional support for women experiencing miscarriage: a pilot qualitative Australian study
Vellyna Sumarno
A , Meredith J. Temple-Smith A C and Jade E. Bilardi A B C D
A Department of General Practice, University of Melbourne, 780 Elizabeth Street, Carlton, Vic. 3010, Australia.
B Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia.
C Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia.
D Corresponding author. Email: jade.bilardi@monash.edu
Australian Journal of Primary Health 26(5) 388-395 https://doi.org/10.1071/PY20042
Submitted: 27 February 2020 Accepted: 1 July 2020 Published: 25 September 2020
Abstract
Miscarriage can cause significant psychological morbidity. Women frequently report dissatisfaction with healthcare professionals’ support following miscarriage. This pilot study aimed to explore the views and practices of GPs in providing emotional support to women experiencing miscarriage. Eight GPs participated in semi-structured interviews. GPs considered women’s physical care their top priority at the time of miscarriage; however, acknowledged miscarriage could result in significant emotional sequelae. Most GPs felt it was their role to provide emotional support, including expressing empathy, listening and normalising miscarriage to mitigate guilt and self-blame. GPs preferred an individualised approach to emotional support and mostly offered follow-up appointments if a patient requested it or was considered ‘high risk’ for mental health issues. Some GPs believed miscarriage support was within the scope of primary care practice; however, others felt it was the role of social networks and pregnancy loss support organisations. GPs identified several structural and external barriers that precluded enhanced emotional support. Further tools and resources to enhance support care may be of benefit to some GPs. The feasibility of GPs providing follow-up support remains uncertain. Further research is required to determine whether support is best placed within primary care or better served through external organisations.
Keywords: early pregnancy loss, general practitioner.
References
Bellhouse C, Temple-Smith MJ, Watson S, Bilardi JE (2019) “The loss was traumatic… some healthcare providers added to that”: women’s experiences of miscarriage. Women and Birth; Journal of the Australian College of Midwives 32, 137–146.| “The loss was traumatic… some healthcare providers added to that”: women’s experiences of miscarriage.Crossref | GoogleScholarGoogle Scholar | 30153984PubMed |
Bilardi JE, Sharp G, Payne S, Temple-Smith MJ (2020) The need for improved emotional support: an online survey of Australian women’s access to healthcare services and support at the time of miscarriage. Women and Birth
| The need for improved emotional support: an online survey of Australian women’s access to healthcare services and support at the time of miscarriage.Crossref | GoogleScholarGoogle Scholar | 32758392PubMed |
Boyle F, Chapman R, Hancox J (2000) General practice care following miscarriage. Australian Family Physician 29, 197
Claringbold L, Bilardi J, Temple-Smith M (2019) The provision of psychosocial support in early pregnancy assessment services. 19th Congress of the International Society of Psychosomatic Obstetrics and Gynaecology (ISPOG), 9–12 October 2019, NH Den Haag Hotel, The Hague, The Netherlands.
Evans L, Lloyd D, Considine R, Hancock L (2002) Contrasting views of staff and patients regarding psychosocial care for Australian women who miscarry: a hospital based study. Australian and New Zealand Journal of Obstetrics and Gynaecology 42, 155–160.
| Contrasting views of staff and patients regarding psychosocial care for Australian women who miscarry: a hospital based study.Crossref | GoogleScholarGoogle Scholar | 12069141PubMed |
Farren J, Jalmbrant M, Ameye L, Joash K, Mitchell-Jones N, Tapp S, Timmerman D, Bourne T (2016) Post-traumatic stress, anxiety and depression following miscarriage or ectopic pregnancy: a prospective cohort study. BMJ Open 6, e011864
| Post-traumatic stress, anxiety and depression following miscarriage or ectopic pregnancy: a prospective cohort study.Crossref | GoogleScholarGoogle Scholar | 27807081PubMed |
Friedman T (1989) Women’s experiences of general practitioner management of miscarriage. The Journal of the Royal College of General Practitioners 39, 456–458.
Geller PA, Psaros C, Kornfield SL (2010) Satisfaction with pregnancy loss aftercare: are women getting what they want? Archives of Women’s Mental Health 13, 111–124.
| Satisfaction with pregnancy loss aftercare: are women getting what they want?Crossref | GoogleScholarGoogle Scholar | 20177721PubMed |
Herbert D, Lucke J, Dobson A (2009) Pregnancy losses in young Australian women: findings from the Australian Longitudinal Study on Women’s Health. Women’s Health Issues 19, 21–29.
| Pregnancy losses in young Australian women: findings from the Australian Longitudinal Study on Women’s Health.Crossref | GoogleScholarGoogle Scholar | 19111784PubMed |
Herbitter C, Bennett A, Schubert FD, Bennett IM, Gold M (2013) Management of early pregnancy failure and induced abortion by family medicine educators. Journal of the American Board of Family Medicine 26, 751–758.
| Management of early pregnancy failure and induced abortion by family medicine educators.Crossref | GoogleScholarGoogle Scholar | 24204072PubMed |
Jensen KLB, Temple-Smith MJ, Bilardi JE (2019) Health professionals’ roles and practices in supporting women experiencing miscarriage: a qualitative study. Australian and New Zealand Journal of Obstetrics and Gynaecology 59, 508–513.
Lok IH, Neugebauer R (2007) Psychological morbidity following miscarriage. Best Practice & Research. Clinical Obstetrics & Gynaecology 21, 229–247.
| Psychological morbidity following miscarriage.Crossref | GoogleScholarGoogle Scholar |
Meaney S, Corcoran P, Spillane N, O’Donoghue K (2017) Experience of miscarriage: an interpretative phenomenological analysis. BMJ Open 7, e011382
| Experience of miscarriage: an interpretative phenomenological analysis.Crossref | GoogleScholarGoogle Scholar | 28882928PubMed |
Neergaard MA, Olesen F, Andersen RS, Sondergaard J (2009) Qualitative description – the poor cousin of health research? BMC Medical Research Methodology 9, 52
| Qualitative description – the poor cousin of health research?Crossref | GoogleScholarGoogle Scholar | 19607668PubMed |
NICE Clinical Guidelines (2012) Ectopic pregnancy and miscarriage. (National Institute for Health and Clinical Excellence: Manchester, UK) Available at https://www.ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical%20-%20Gynaecology/NICE-Ectopic-pregnancy-and-miscarriage.pdf?ext=.pdf [Verified 11 April 2019]
Prettyman RJ, Cordle C (1992) Psychological aspects of miscarriage: attitudes of the primary health care team. The British Journal of General Practice 42, 97–99.
Queensland Clinical Guidelines (2018) Early pregnancy loss: maternal and neonatal clinical guideline. (Queensland Clinical Guidelines: Brisbane, Qld, Australia) Available at https://www.health.qld.gov.au/__data/assets/pdf_file/0033/139947/g-epl.pdf [Verified 7 June 2019]
Roberts H (1991) Managing miscarriage: the management of the emotional sequelae of miscarriage in training practices in the West of Scotland. Family Practice 8, 117–120.
| Managing miscarriage: the management of the emotional sequelae of miscarriage in training practices in the West of Scotland.Crossref | GoogleScholarGoogle Scholar | 1874354PubMed |
Rowlands IJ, Lee C (2010) ‘The silence was deafening’: social and health service support after miscarriage. Journal of Reproductive and Infant Psychology 28, 274–286.
| ‘The silence was deafening’: social and health service support after miscarriage.Crossref | GoogleScholarGoogle Scholar |
Séjourné N, Callahan S, Chabrol H (2010) Support following miscarriage: what women want. Journal of Reproductive and Infant Psychology 28, 403–411.
| Support following miscarriage: what women want.Crossref | GoogleScholarGoogle Scholar |
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), sands (2019) ‘Pregnancy Loss.’ (The Royal Australian and New Zealand College of Obstetricians and Gynaecologists: Melbourne, Vic., Australia) Available at https://ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Patient%20information/Pregnancy-Loss_2.pdf?ext=.pdf [Verified 24 May 2020]
Thomas DR (2006) A general inductive approach for analyzing qualitative evaluation data. The American Journal of Evaluation 27, 237–246.
| A general inductive approach for analyzing qualitative evaluation data.Crossref | GoogleScholarGoogle Scholar |
Wong MK, Crawford TJ, Gask L, Grinyer A (2003) A qualitative investigation into women’s experiences after a miscarriage: implications for the primary healthcare team. The British Journal Of General Practice: The Journal Of The Royal College Of General Practitioners 53, 697–702.
