From Clinic to Grave: Women's experiences of ‘pregnancy remains’ disposal following an early miscarriage in England, UK

National guidance, particularly that issued by the Human Tissue Authority (HTA) informs UK clinical practices around managing pregnancy remains prior to 24 weeks gestation. This guidance stipulates that women should be offered options for disposal: cremation, burial, or incineration. Based on 20 months of ethnographic fieldwork between April 2020-September 2022 in one National Health Service (NHS) Trust in England, including participant observation, observing clinical consultations about pregnancy remains disposal (n28) and interviews with women (n27), this paper argues that current clinical practices appear discordant with the views of some women experiencing miscarriage and therefore are not conducive to inclusive care. Most women had not considered what would happen to the pregnancy remains prior to the formal discussion around disposal in the hospital and found the discussion unexpected. Many participants expressed disbelief about disposal pathways offered with most suggesting they were inappropriate, particularly given the early stage of their pregnancy (≤12-week gestation). Some women expected the pregnancy remains to be treated as clinical waste and were surprised and, at times, upset to not have this option. The research provides further evidence of the diversity of responses to miscarriage including some women's dissatisfaction with practices around pregnancy remains disposal. It shows that some women would prefer to have a choice that does not include ceremonial disposal. A person-centred approach to pregnancy remains disposal is recommended to accommodate a diverse range of attitudes. This should include incineration as a disposal option to ensure practices do not imply meaning of the pregnancy tissue that conflicts with women's perspectives, including their notions of foetal personhood or its absence. The study can inform and refine local and national practices as well as develop consistency across NHS Trusts.