title: Understanding the Experience of Miscarriage in the Emergency Department.
abstract: BACKGROUND
  Up to 20% of pregnancies end in miscarriage, which can be a significant life event for women with psychological implications. Because the only preventative measure for a miscarriage is risk factor modification, the treatment focuses on confirming the miscarriage has occurred and medical management of symptoms. Although women experiencing a miscarriage are frequently directed to seek medical care in emergency departments, the patients are often triaged as nonemergent patients unless they are unstable, which exposes women to potentially prolonged wait times. Research about miscarriages and emergency departments predominantly focus on medical management with little understanding of how emergency care shapes the experience of miscarriage for women.
  
  
  METHODS
  Seeking to describe the experiences of women coming to the emergency department for care while having a miscarriage, interpretive phenomenology-a form of qualitative research-guided this study. Eight women were recruited to participate in semi-structured face-to-face interviews of 60 to 90 minutes in length. Data were analyzed using hermeneutics and thematic analysis.
  
  
  RESULTS
  Five themes emerged: "Pregnant/Life: Miscarriage/Death"; "Deciding to go to the emergency department: Something's wrong"; "Not an illness: A different kind of trauma"; "Need for acknowledgement"; and "Leaving the emergency department: What now?". Participants believed their losses were not acknowledged but instead dismissed. These experiences, combined with a perceived lack of discharge education and clarity regarding follow-up, created experiences of marginalization.
  
  
  CONCLUSIONS
  This study describes the experience of miscarrying in emergency departments and provides insights regarding how nursing and physician care may affect patient perceptions of marginalization.
authors: Toronto, Ontario, Canada; Halifax, Nova Scotia, Canada. Electronic address: kmacwilliams@stjoestoronto.ca.
authors: Kate
authors: K
authors: MacWilliams
authors: Toronto, Ontario, Canada; Halifax, Nova Scotia, Canada.
authors: Jean
authors: J
authors: Hughes
authors: Toronto, Ontario, Canada; Halifax, Nova Scotia, Canada.
authors: Megan
authors: M
authors: Aston
authors: Toronto, Ontario, Canada; Halifax, Nova Scotia, Canada.
authors: Simon
authors: S
authors: Field
authors: Toronto, Ontario, Canada; Halifax, Nova Scotia, Canada.
authors: Faith Wight
authors: FW
authors: Moffatt
mesh_terms: D000022:Abortion, Spontaneous / Q000523:psychology*; D000328:Adult; D016529:Emergency Nursing / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D009674:Nova Scotia; D036301:Qualitative Research; D055815:Young Adult
keywords: Ectopic pregnancy; Emergency department; Loss; Miscarriage; Qualitative research; Spontaneous miscarriage