Recurrent pregnancy loss, psychological distress and wellbeing support for women: a mixed-methods analysis

Research suggests multiple experiences of miscarriage, also known as recurrent pregnancy loss (RPL), may be associated with compounded risk for adverse mental health impacts. However, there is a need for research evidence that offers clarity in relation to potential predictors of psychological distress and wellbeing among this neglected population of women. This paper aims to explore physical and experiential factors associated with miscarriage-related psychological distress and wellbeing among women who had experienced RPL.

Adopting a mixed methods approach, the paper presents a secondary analysis of data which assessed the perceived impact of miscarriage experience as measured by the Revised Impact of Miscarriage Scale (RIMS) in a cross-sectional survey of (n = 839) women in Northern Ireland and thematic analysis of qualitative interviews with a sub-sample of the women (n = 10) who experienced RPL.

Quantitative analysis indicated that women who experienced two or more losses reported significantly greater miscarriage-related distress when compared with those who experienced one miscarriage. This was true for the 'Devastating Event' and 'Loss of Baby' RIMS subscales, however, differences between groups related to 'Isolation and Guilt' were non-significant. Qualitative analysis identified themes consistent with the RIMS. These included potential predictors of distress such as devastating memories, anticipated loss and disenfranchised grief, as well as feelings of isolation and guilt stemming from social stigma and inadequate support.

The experience of RPL is extremely distressing, with the potential to lead to maternal morbidity. To support women's reproductive health and rights, compassionate healthcare that includes mental health and memory-making support are important during miscarriage and subsequent pregnancies.