Extra support ‘essential’ to help with pregnancy after recurrent miscarriage, say Tommy’s researchers

Researchers at the University of Warwick interviewed people attending a specialist recurrent miscarriage clinic between May 2021 and July 2021.

The study, partly funded by Tommy’s, found ‘overriding emotions…of anxiety and fear that the pregnancy was going to end in miscarriage again’.

The authors say: “These emotions impacted on participants’ mental health, leading to negative thoughts and self-doubt.”

The services offered at the clinic - including counselling, early pregnancy scanning and genetic testing for any abnormalities that might help explain the miscarriage - are described as ‘essential’ to help women and partners in this situation.  

Healthcare professionals should be aware of the psychological impact of couples’ previous miscarriages and ‘avoid concentrating solely on physical medical needs’, the study concludes.

The researchers suggest that women who have experienced recurrent miscarriage may be at greater risk of depression and anxiety during and after any subsequent pregnancy. They say more work is needed to investigate any possible connection between recurrent miscarriage and mental health issues before and after giving birth.

They also call for more research into the experiences of minoritised ethnic communities around recurrent miscarriage and support services.

The qualitative study involved 14 women and three partners who were asked to talk about their experiences of pregnancy after recurrent miscarriage.

They describe feelings of frustration, fear and pressure, as well as attempts to shut themselves off from what was happening.

One said: “When I found out I was pregnant there wasn’t any excitement…even with this pregnancy I was very cold and didn’t believe it was gonna happen.”

Another said: “I was always quite petrified of getting pregnant again […] I think it becomes programmed in your mind, to just expect the worst.”

Participants spoke about the additional anxiety caused by Covid-19 restrictions, when partners were not allowed to attend scan clinics.

This led some women to fear they might have to break bad news to their partners on their own, away from the clinic.

The authors say: 

“Excluding partners from early pregnancy scans, while necessary for infection control purposes during the initial phase of the pandemic, should not be allowed to happen again.

“It is unethical to treat only half of a couple and results in increased anxiety in both women and their partner which may have implications going forward in pregnancy.”

The researchers received ‘overwhelmingly positive’ feedback about the recurrent miscarriage clinic, with several participants saying it had given them the confidence to conceive again.

Comments included: “Everyone cares and it’s not just another person going in for another scan.”

All of the participants in the study were positive about cytogenic investigations (tests which can determine whether a miscarriage was caused by a genetic abnormality) even though not everyone involved went through the procedure.

“In a condition where a cause is rarely found, any additional information was highly valued,” the researchers say.

However, the participants were conflicted about what they might find out from the tests.

One said: “I guess it gives you hope if it’s normal, […] but then at the same time you feel a bit like ‘well, why did it happen then?’”

Kate Davies, Research, Policy and Information Director at Tommy’s, said: 

“This study highlights very clearly the painful and far-reaching impact of recurrent miscarriage.

“Hearing people talk so honestly about the toll it takes, and the difference it can make to have specialist support, is a powerful reminder of why we do what we do at Tommy’s.

“It’s why we have been campaigning for a ‘graded model of care’ to be implemented nationally. The model is currently being piloted by our research team in Birmingham, and recommends that everyone experiencing one miscarriage is at least offered support with their mental health, with increasing levels of support, tests and treatments if miscarriage sadly happens again.

“Our researchers at Tommy’s National Centre for Miscarriage Research will keep working to find out why miscarriages happen and what we can do to prevent them.

“And we’ll continue to invest in specialist recurrent miscarriage clinics, so that along with our NHS partners we can reach more of those who need reassurance and hope after loss.”

The lived experience of recurrent miscarriage. Women and their partners’ experience of subsequent pregnancy and support within an NHS specialist clinic: A Qualitative Study.