Background Recurrent miscarriage (RM) is a much-debated condition which affects 1–3% of women/couples of reproductive age. International guidelines vary in terminology, and how it is defined, e.g. two or three miscarriages. While some research has examined the lived/care experiences of women and men with RM, how the condition is defined has received limited attention. A definition reflects the medical evidence and values of a society at the time, thus warrants ongoing scrutiny. This study explores views of women and men with lived experience of RM and those delivering/managing services and supports on how RM is defined.
Methods We adopted a qualitative study design underpinned by social constructionism, incorporating semi-structured interviews, to facilitate an in-depth exploration of views. We used purposive sampling to recruit participants, ensuring perspectives from those working/receiving care in different geographical areas, settings (hospitals/clinics and primary/community care), hospital groups, hospital types/sizes and RM services (dedicated and non-dedicated, public/private) in the Republic of Ireland were included. Women and men with lived experience of at least two consecutive first-trimester miscarriages were recruited via health professionals and social media; other participants via the research team’s networks. Interviews were audio-recorded, transcribed verbatim, pseudo-anonymised, and analysed together using reflexive thematic analysis.
Interviews were conducted in the Republic of Ireland, where there is currently no recurrent miscarriage guideline and recurrent miscarriage is generally defined as three consecutive miscarriages. The research team engaged in reflexivity throughout the study. Members of the multi-disciplinary RE:CURRENT Project Research Advisory Group (including parent advocates) were actively involved in the study, including the generation of topic guides and the refining of themes.
Results We conducted interviews with 42 health professionals/service providers and 13 women and 7 men with lived experience of RM between June 2020 and January 2021. We generated three inter-related themes which describe participants’ views of how RM is defined/operationalised: (i) The need for a standardised definition of recurrent miscarriage: Finding a balance between research evidence, individual needs, and healthcare resources, (ii) The definition is a route to finding an answer and/or validating women/couples’ experience of loss, and (iii) Working around the definition – advocacy and impacts.
Discussion A more nuanced approach to defining RM is warranted, one which is evidence-informed and recognises the needs of women/couples and healthcare resources. Our findings reinforce international calls for standardisation, and a graded approach to miscarriage care in which women/couples are offered appropriate support following one, two and three or more miscarriages.
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