Improving Midwifery Care for Women Experiencing Pregnancy Loss: A Clinical Guideline

Pregnancy loss is a common occurrence and has profound, long-term psychological, physical, social and financial impacts on women and their families. Women report negative experiences with healthcare providers during management of pregnancy loss, including confusing information, inappropriate language, lack of emotional care and lack of adequate follow up. Currently, the Birthcare Healthcare midwifery practice does not have a clinical guideline outlining management of pregnancy loss. The purpose of this multi-step project was to improve the care to women experiencing pregnancy loss through the development of a clinical guideline. First, a literature review was performed to identify best practices and available knowledge regarding optimal care for this population. Next, a 12-month chart review was performed of all pregnancy loss patients within this midwifery practice. Lastly, provider interviews were conducted, transcribed and analyzed for themes. The chart review revealed that over one-third of patients treated for pregnancy loss did not receive any type of follow-up care. Provider interviews highlighted several barriers to providing optimal care including inherent challenges of a group practice model and the need for role clarity between providers. Results from the chart review and interviews were used with the existing literature to develop an evidence-based clinical guideline. This guideline was then presented to the midwifery practice and evaluated for content and usefulness. One hundred percent of providers reported full intention to use the guideline in the upcoming six months, suggesting that a clinical guideline approach to the management of pregnancy loss could be useful in other midwifery practices.