Navigating early pregnancy loss within Ontario's healthcare system: A qualitative exploratory study of the experiences of midwifery clients and midwives

Background: Miscarriage occurs in approximately 25% of all pregnancies. About 80% of all pregnancy losses occur in the first trimester. Patient experiences of seeking and receiving healthcare for early pregnancy loss can have long-term implications on their well-being. While individuals often present to emergency departments (ED) with early pregnancy loss symptoms, evidence suggests patient needs are not being met within this setting. There is a dearth of research on women’s experiences utilizing the midwifery care as an option for early pregnancy loss. Research Questions: This exploratory qualitative study examines two primary research questions: (1) What are the experiences of Ontario midwifery clients accessing and receiving healthcare in cases of early pregnancy loss (EPL); and (2) What are the experiences of midwives in providing early pregnancy loss care for their clients? The overall objective of this study is to understand how the healthcare-related experiences can be improved in cases of early pregnancy loss. Methods: Semi-structured qualitative interviews were conducted with midwifery clients (n=14) and midwives (n=10). Two analytic approaches were taken for the analysis of participant interview data: healthcare journey mapping and thematic network techniques. Findings: Both the healthcare trajectories and experiences of clients accessing and receiving midwifery care for early pregnancy loss varied considerably. Four main themes were identified as the aspects of midwifery care that made the biggest differences on clients’ experiences of receiving care for early pregnancy loss: (1) Accessing care for early pregnancy loss, (2) Continuity and following-through, (3) Compassionate and supportive care, and (4) Knowledge, information and choice. Overall, the findings suggest clients benefit from compassionate, individualized support during their early pregnancy loss. Midwives’ experiences constraints related to their workload, clinic culture, local resources available, and compensation model that impacted their ability to respond to clients’ needs and expectations. Conclusion: Interventions to improve client care should look beyond client-provider interactions and consider ways to improve midwives’ experiences and their ability to meet their client needs. Furthermore, to improve women’s experiences, a more coordinated, patient-centered response at a systems level is needed. As this is the first study to examine the midwifery model of care for early pregnancy loss, findings from this study contribute to recommendations for practice, policy, and research