Coping with miscarriage : the impact of emotional/psychological support versus routine care

Abstract

Background: Miscarriage is generally defined as a clinical pregnancy loss before 24 weeks’ gestation. It is the principal pregnancy complication resulting in a psychologically traumatic experience generally further exacerbated by unsympathetic routine clinical care. Thus, the purpose of this dissertation was to examine the value and effectiveness of emotional/psychological interventions with the research question: “In women experiencing a miscarriage, does emotional/psychological support when compared to routine care help them cope through this distressing time?” of which PICO elements were Population: women who have had a miscarriage, Intervention: Emotional/psychological support, Comparison: Routine care and Outcome: Better coping with miscarriage Methods: Articles required to be full-text, peer reviewed research in English language, published between 2006 and 2021, evaluating better coping with the pregnancy loss, participants being women over 18 who experienced miscarriage up to 24 weeks’ gestation. Only non-pharmacological interventions were selected, including Meta-Analysis, Systematic Reviews, Randomised Controlled Trials, and Quantitative Studies. Articles which included pregnancy after miscarriage, multiple miscarriages only, and perinatal loss were excluded. Seven health science databases were used namely: Academic Search Complete, MEDLINE Complete, CINAHL Complete (EBSCO), Cochraine Database of Systematic Reviews (EBSCO), Cochrane Central Register of Controlled Trials (EBSCO), APA PsycInfo (EBSCO) and PubMed, together with Google Scholar to elaborate the initial search. Literature search resulted in 5 randomised control trials that met the inclusion criteria. The Critical Appraisal Skills Programme and Joanna Briggs Institute tools were used to properly appraise each key study. Results: Two of the studies had statistically significant results recognising the benefits of psychological intervention. after miscarriage. Two other studies did not show statistical significance, but their subgroup analysis yielded promising results for selected women and should be further investigated. The final study was inconclusive however it recognised that a structured bereavement intervention administered right after miscarriage may prevent despair. Thus, emotional/psychological support after miscarriage, particularly if implemented immediately and for selected women, aids in emotional healing. Implications and recommendations: Implications include the need for more evidence-based research using larger, diverse samples and different study designs, together with education targeting healthcare professionals to provide emotionally sensitive treatment and support. Recommendations include the setting up of an Early Pregnancy Assessment Unit, a national registry for miscarriages, and paid bereavement leave-for-miscarriage legislation.