Practice Bulletin no. 150: Early pregnancy loss.Washington (DC): ACOG; 2015

Barry M, Quinn C, Bradshaw C Exploring perinatal death with midwifery students using a collaborative art project. Nurse Educ Today. 2017; 48:1-6

Bacidore V, Warren N, Chaput C, Keough VA. A collaborative framework for managing pregnancy loss in the emergency department. J Obstet Gynecol Neonatal Nurs.. 2009; 38:(6)730-8

Baxter J, Baron M. A bereavement and communication study day for midwives. Br J Midwifery. 2011; 19:(2)116-19

Bennett SM, Litz BT, Maguen S, Ehrenreich JT. An exploratory study of the psychological impact and clinical care of perinatal loss. Journal of Loss and Trauma. 2008; 13:(10)485-510

Black D, Tufnell G. When is counselling indicated after a major traumatic life event?. Paediatrics and Child Health. 2006; 16:464-71

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol.. 2006; 3:77-101

Camarneiro APF, Maciel JCSC, Garcia da Silveira RM. Experiences of spontaneous abortion in primigravidae during the first trimester of pregnancy: a phenomenological study. Journal of Nursing Referência. 2015; 4:(5)109-117

Cox E, Briggs S. Disaster nursing. New frontiers for critical care. Crit Care Nurse.. 2004; 24:(3)16-22

Doody O, Noonan M. Preparing and conducting interviews to collect data. Nurse Res.. 2013; 20:(5)28-32

Evans R. Emotional care for women who experience miscarriage. Nurs Stand.. 2012; 26:(42)35-41

George MS. Stress in NHS staff triggers defensive inward-focussing and an associated loss of connection with colleagues: this is reversed by Schwartz Rounds. Journal of Compassionate Health Care. 2016; 63

Gergett B, Gillen P. Early pregnancy loss: perceptions of healthcare professionals. Evidence Based Midwifery. 2014; 12:(1)29-34

Gold KJ. Navigating care after a baby dies: a systematic review of parent experiences with health providers. J Perinatol.. 2007; 27:(4)230-7

Hollowaay I, Fulbrook P. Revisting qualitative inquiry: interviewing in nursing and midwifery research. Journal of Research in Nursing. 2001; 6:(1)539-50

National Standards for Bereavement Care Following Pregnancy Loss and Perinatal Death.Dublin: HSE; 2016

Jonas-Simpson C, McMahon E, Watson J, Andrews L. Nurses' experiences of caring for families whose babies were born still or died shortly after birth. International Journal of Human Caring. 2010; 14:14-21

Maker C, Ogden J. The miscarriage experience: more than just a trigger to psychological morbidity?. Psychology and Health. 2003; (18)403-15

McCreight BS. Perinatal grief and emotional labour: a study of nurses' experiences in gynae wards. Int J Nurs Stud.. 2005; 42:(4)439-48

McDonald G, Jackson D, Wilkes L, Vickers MH. A work-based educational intervention to support the development of personal resilience in nurses and midwives. Nurse Educ Today. 2012; 32:(4)378-84

Mollart L, Skinner VM, Newing C, Foureur M. Factors that may influence midwives work-related stress and burnout. Women Birth. 2013; 26:(1)26-32

Mulvihill A, Walsh T. Pregnancy loss in rural Ireland: an experience of disenfranchised grief. British Journal of Social Work. 2013; 3:1-17

Murphy F, Merrell J. Negotiating the transition: caring for women through the experience of early miscarriage. J Clin Nurs.. 2009; 18:(11)1583-91

Murphy F, Philpin S. Early miscarriage as ‘matter out of place’: an ethnographic study of nursing practice in a hospital gynaecological unit. Int J Nurs Stud.. 2010; 47:(5)534-41

Ectopic pregnancy and miscarriage: diagnosis and initial management [CG154].London: NICE; 2012

Neergaard MA, Olesen F, Andersen RS, Sondergaard J. Qualitative description - the poor cousin of health research?. BMC Med Res Methodol.. 2009; 9:(52)

Newbatt E, Beckles Z, Ullman R, Lumsden MA Ectopic pregnancy and miscarriage: summary of NICE guidance. BMJ.. 2012; 345

Newell R, Burnard P. Research for evidence-based practice in healthcare, 2nd edn. West Sussex: Wiley-Blackwell; 2011

Olesen ML, Graungaard AH, Husted GR. Deciding treatment for miscarriage—experiences of women and healthcare professionals. Scand J Caring Sci.. 2015; 29:(2)386-94

Papadatou D. In the face of death: Professionals who care for the dying and the bereaved.New York (NY): Springer; 2009

Pezaro S. Addressing psychological distress in midwives. Nursing Times. 2016; 112:(8)22-23

Pezaro S, Clyne W, Turner A, Fulton EA, Gerada C. ‘Midwives Overboard!’ Inside their hearts are breaking, their makeup may be flaking but their smile still stays on. Women Birth. 2016; 29:(3)e59-66

Polgar S, Thomas SA. Introduction to research in the health sciences, 5th edn. Edinburgh: Elsevier; 2008

Robinson J. Provision of information and support to women who have suffered an early miscarriage. Br J Midwifery. 2014; 22:(3)175-80

Roehrs C, Masterson A, Alles R, Witt C, Rutt P. Caring for families coping with perinatal loss. J Obstet Gynecol Neonatal Nurs.. 2008; 37:(6)631-9

Roulston K. Data analysis and theorizing as ideology. Qualitative Research. 2001; 1:279-302

The Role and Responsibilities of Maternity Support Workers.London: RCM; 2011

Early Pregnancy Loss, Management [Green-top guideline No. 25].London: RCOG; 2006

Rowlands I, Lee C. ‘The silence was deafening’: social and health service support after miscarriage. Journal of Reproductive and Infant Psychology. 2010; 28:(3)274-86

Sandelowski M. Whatever happened to qualitative description?. Res Nurs Health. 2000; 23:(4)334-40

Sands principles of good bereavement care. 2018. (accessed 6 November 2018)

Séjourné N, Callahan S, Chabrol H. Support following miscarriage: what women want. Journal of Reproductive and Infant Psychology. 2010; 28:(4)403-11

Titherly C. Pregnancy loss and the death of a baby, 15th edn. In: McDonald S, Johnson G (eds). Edinburgh: Elsevier;

Management of Miscarriage: Your Options.Wakefield: The Miscarriage Association; 2015

The Miscarriage Association of Ireland. About Miscarriage. 2010. (accessed 6 November 2018)

Wallbank S, Robertson N. Midwife and nurse responses to miscarriage, stillbirth and neonatal death. Evid Based Midwifery. 2008; 6:100-6

Wallbank S, Robertson N. Predictors of staff distress in response to professionally experienced miscarriage, stillbirth and neonatal loss: a questionnaire survey. Int J Nurs Stud.. 2013; 50:(8)1090-7

Warner A, Saxton A, Indig D, Fahy K, Horvat L. Women's experience of early pregnancy care in the emergency department: A qualitative study. Australasian Emergency Nursing Journal.. 2012; 15:(2)86-92

Zavotsky KE, Mahoney K, Keeler D, Eisenstein R. Early pregnancy loss and bereavement in the emergency department: staff and patient satisfaction with an early fetal bereavement program. J Emerg Nurs.. 2013; 39:(2)158-61

Midwives' experiences of caring for women with early pregnancy loss in an Irish maternity hospital

02 December 2018
Volume 26 · Issue 12



Midwives provide care for women experiencing early pregnancy loss, as well as support for women throughout childbirth. Research has predominately focused on women's experience of early pregnancy loss, with little research on how such loss affects midwives and care provision.


To explore the perceptions of midwives caring for women experiencing early pregnancy loss.


This study used a descriptive qualitative design with semi-structured interviews. A purposive sample of eight midwives, all of whom had relevant experience, were recruited from a maternity hospital in Ireland.


Themes identified were: ‘coping with the experience of early pregnancy loss’, ‘compassionate care for women and midwives’, and ‘what midwives found difficult’.


Repeated exposure to early pregnancy loss can have a profound emotional effect on midwives, with a potential for this to affect the care that women receive. Midwives identified the need for further education in the area of early pregnancy loss, time out during the shift to debrief, and counselling for staff. Structured support is needed for midwives and other health professionals where there is repeated exposure to early pregnancy loss.

Childbirth is considered a major highlight in human life (Bennett et al, 2008), but early pregnancy loss occurs more frequently than many realise. The loss of a pregnancy before 13 completed weeks is referred to as ‘early pregnancy loss’, ‘miscarriage’ or ‘spontaneous abortion’ (American College of Obstetricians and Gynaecologists, 2015). Early pregnancy loss accounts for over 50 000 annual hospital admissions in the UK and 15-20% of confirmed pregnancies are reported to end spontaneously in the first trimester, according to the National Institute for Health and Care Exellence (NICE) (2012). In Ireland, there is a reported early pregnancy loss rate of 20%, with approximately 14 000 women affected annually (The Miscarriage Association of Ireland, 2010). In maternity hospitals in Ireland, as in other parts of Europe, midwives are the main caregivers for women experiencing a miscarriage. There are limited evidence-based practice recommendations to guide the care of women experiencing early pregnancy loss, and very little is known of the experience of midwives as care providers for those who are bereaved (Gergett and Gillen, 2014). When health professionals experience difficulties supporting or connecting with women or couples, this can sometimes result in focusing on what is strictly necessary in terms of technical care (Camarneiro et al, 2015), potentially detracting from the care, compassion and empathy that people in their care need.

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month