Supporting patients who experience pregnancy loss in the primary care setting

Early pregnancy loss is estimated to affect one in four women in Canada. In British Columbia, more than 15,000 miscarriages occur annually. Many patients who have suffered pregnancy loss mention high amounts of emotional distress and a lack of mental and emotional support from healthcare providers in the period following their miscarriage. Screening for mental health concerns post pregnancy loss often falls on the primary care provider, and there are limited screening tools currently available to aide practitioners in assessing a patients mental health status post miscarriage. The Edinburgh Postnatal Depression Scale has been shown to be beneficial in screening patients who have experienced pregnancy loss, despite being designed for use during the perinatal period. Primary care providers must also take into account that grief after pregnancy is often not linear and can transcend past the typical 9 to 12 months of bereavement. Depressive symptoms are shown to be highest thirty months after loss, and symptoms of grief can reappear surrounding the estimated due date. Currently, most miscarriages are managed in the Emergency Department which can contribute to fragmented care, a decrease in longevity of care, and inadequate mental health support post discharge. While analyzing the current literature under both the trauma informed care framework and Donabedian model, we propose the implementation of standardized early pregnancy loss education for primary care providers. This standardization in education can decrease Emergency Department visits, hospital fees, and improve the mental health and well-being of patients experiencing pregnancy loss, while providing continuity of care throughout the patient’s grieving process.