Negotiating the transition: caring for women through the experience of early miscarriage

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Aim.To explore women's experiences of having an early miscarriage in a hospital gynaecological unit.Background.Miscarriage is a global health issue affecting significant numbers of women and is usually considered a distressing experience. This distress is often interpreted as being characteristic of grief. Nurses and other health professionals in hospital and community settings are therefore expected to provide appropriate care to meet the physical and emotional needs of the woman.Design.A qualitative, ethnographic study of a hospital gynaecological unit in the UK.Methods.The primary method was 20 months of part-time participant observation. Data were also collected through documentary analysis of key documents in the setting and formal interviews. These were with eight women who had an early miscarriage and 16 health professionals (nurses, doctors, ultrasonographers) working in the unit.Results.Three clear phases emerged in the women's experience of miscarriage and hospital admission; first signs and confirmation, losing the baby and the aftermath. These were interpreted as being components of a process of transition. The hospital admission emerged as vital in these early phases in which the importance of nurses and other health professionals providing sensitive, engaged care to meet the emotional and physical needs of the woman was identified.Conclusions.The hospital setting emerged as highly influential in shaping the care that was given to women and influencing their experiences. Transition models were felt to be more appropriate than grief and bereavement models in guiding the psychological care given to women.Relevance to clinical practice.The experience of hospital admission and the actions of nurses and other health professionals is influential in how women negotiate the transition through miscarriage.

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