Early pregnancy loss: A survey of healthcare experiences and perceived support in Germany

• Only 24% of women in Germany were offered all three EPL management options. • Over half of women received no emotional or psychological support after EPL. • Midwifery care was linked to higher emotional support and expectant management. • 86% of participants felt more psychosocial support was needed after EPL. • Strong interest in digital support formats highlights potential for innovation. Early pregnancy loss (EPL) affects over 15% of clinically confirmed pregnancies. Despite typically uncomplicated medical courses, EPL is associated with significant psychological burden. While international studies have documented gaps in EPL care, comparable data from Germany are largely absent. This study examined healthcare experiences of women following EPL in Germany. An online cross-sectional survey was conducted between February and April 2025. Recruitment took place via social media and peer support organizations. Women aged 18 and older who had experienced EPL within the past five years in Germany were eligible. Quantitative data were analyzed using descriptive statistics, binary logistic regression, and linear regression. Free-text responses were analyzed using structuring qualitative content analysis following Kuckartz. Of 720 participants, 633 were included in the analysis. Only 24.2% reported being offered all three management options (expectant, medical, surgical), 20% did not receive their preferred option. More than half of participants received no emotional or psychological support. Midwifery care was significantly associated with higher rates of expectant management and higher perceived emotional support. The results reveal discrepancies between guideline recommendations and the actual care experienced by women following EPL in Germany. The sample was predominantly highly educated and recruited via digital platforms, introducing likely self-selection bias; findings should therefore be interpreted with caution and may not be representative of all affected women. Woman-centered counseling, systematic emotional support, greater integration of midwives, and the development of digital support tools warrant further consideration to improve care quality.