Stakeholder perspectives on recurrent miscarriage services and improvement priorities: Qualitative findings from a national evaluation

To explore views of stakeholders nationally regarding recurrent miscarriage (RM) services and support. Specifically, to examine existing (i) practices and experiences, and (ii) facilitators and barriers to providing the desired services and supports. From June 2020 to February 2021, we conducted qualitative, semi-structured interviews with people with lived experience of RM (≥2 consecutive first-trimester miscarriages within the preceding 6-24 months) or involved in the delivery/management of services and supports. We recruited participants using purposive sampling, and ensured perspectives from different geographical areas, hospital types, RM services, and disciplines were incorporated. Participants were recruited via professional networks and social media. Interviews were audio-recorded, transcribed, and analysed using reflexive thematic analysis. We conducted interviews with 42 health professionals/service providers, and 13 women and 7 men with lived experience of RM. Three inter-related themes (each of which comprised of several sub-themes) were generated from the data: (i) Dedicated staff, (ii) Dedicated space and time, and (iii) Dedicated funding and support. Participants’ accounts aligned with the provision of a standardised, dedicated, and adequately resourced and supported service in which women and men experiencing RM are offered appropriate, individualised, timely and accessible care and support – beginning following the first miscarriage, and in a graded manner. This requires several national-level actions, including prioritising RM care, adequately funding and resourcing health services, enhancing health professional education, greater care coordination between tertiary and primary care, and improving public awareness of, and addressing the silence and stigma around, miscarriage. In light of recent debates regarding how best to deliver RM care, and changing international guidelines, these findings provide timely and important information that should be used to inform service improvement efforts in Ireland and beyond.