Researcher, Cathy Maker, worked in correspondence with Dr J. Ogden – Department of General Practice, GuysKings and St Thomas School of Medicine, 5 Lambeth Walk, London SE11 6SP, UK – to explore women’s reasons for selecting either expectant or surgical management of first trimester miscarriage and to examine the impact of treatment upon them. A sample of 13 female patients whose ages ranged between 22 and 43 years were selected and interviewed from an Early Pregnancy and Gynaecology Assessment Unit at a London hospital. The thirteen women were diagnosed as having a first trimester miscarriage and opted for either expectant management (n = 5), surgical management (n = 5) or who had undergone both (n = 3).
Expectant management of miscarriage involves letting a miscarriage run its natural course and surgical management involves an operation for immediate removal of the stillborn.
The interviews in the study revealed that the choice of expectant management of miscarriage was motivated by desire for a natural solution and a fear of operation. Feelings of anxiety and a sense of an inability to be prepared for what they imagined the pain and experience to be. Some also described how their support had dwindled as the miscarriage progressed. In contrast, women who chose surgical management valued a quick resolution and focussed on the support from hospital staff, although some commented that their emotional needs had not always been met.
The researcher concluded from their study that if expectant management of miscarriage is to be more widely offered, women should be told not only of the likely clinical effect of letting a miscarriage run its course, but also how women experience this.
In Australia, a distinction is made at 20 weeks on miscarriages whereby they are then called stillbirths. This happens to about 1 in 4 to 1 in 5 Australian pregnancies. What is largely unknown, is how women feel about the decision making process during the management of miscarriage and how they feel after they have made a decision. Are women given enough information and counsel to be able to make the right decision for themselves as well as be made aware of the feelings they may go through from the outcome of their decision?
During the qualitative study, the researcher sat in on the ultrasound process and was present when the diagnosis was made and all women were then offered the choice of either expectant or surgical management. Post diagnosis, the women were taken to a counselling room where the researcher explained the study and gave them an information sheet and three weeks later, the participant was contacted by telephone and an interview was arranged.
Regardless of each patient’s treatment choice, the majority stated that they would have liked more time and information to make their decision. Being able to know more about how they might feel about a certain miscarriage management outcome, had a significant relationship with the ability to make the right decision for them. There was also a majority view on the need for emotional support beyond that received from the hospital staff members.
Management of miscarriage – The Obstetrician
Dr Gary Swift is a highly qualified Obstetrician & Gynaecologist who manages patients through pregnancy and miscarriage and who values the in depth emotional support needed in miscarriage.
Dr Gary Swift has a clinic on the Gold Coast located at Pindara hospital in Benowa that looks after the management of miscarriage. Contact with the clinic can be made by clicking on this link.