Management of miscarriage: a matter of choice? A mixed- methods research study in Northern Ireland

Miscarriage, defined in the United Kingdom as the loss of a pregnancy before 24 weeks’ gestation, remains the most common gestational complication, affecting 13–15% of all recognised pregnancies. Despite established NICE guidelines outlining three management options—expectant, medical, and surgical—little is known about how these approaches influence women’s emotional wellbeing or sense of autonomy. This mixed-methods study explored women’s experiences of miscarriage management and their emotional needs when attending hospital facilities in Northern Ireland (NI). A cross-sectional online survey and semi-structured interviews were conducted between January and April 2021. Participants (N = 723) were women aged over 16 years who had experienced a miscarriage in NI within the preceding five years. Quantitative data were analysed descriptively, while qualitative data were thematically analysed. Findings revealed that 42% of participants experienced expectant management, 14% medical, 28% surgical, and 16% a combination of treatments. Notably, 52% of respondents reported that they were not given a choice of management, with 36% stating that healthcare professionals made decisions without clear explanation. Among those who were not offered a choice, 40% were dissatisfied with the information received, and 44% felt insufficient time was allowed to discuss options. Conversely, women who were offered choice reported higher satisfaction, clearer communication, and greater perceived emotional support. Thematic analysis identified three central themes from the qualitative data: choice and autonomy, importance of being informed, and time for decision-making. The study highlights a gap between national guidance advocating informed, patient-centred care and women’s lived experiences of miscarriage management in NI. Lack of autonomy and inadequate communication were associated with emotional distress and feelings of disempowerment. Healthcare professionals should ensure women are provided with comprehensive information, sufficient time for decision-making, and genuine choice in treatment whenever medically feasible. Further research is required to examine the long-term psychological impact of different miscarriage management approaches and to inform best practice in compassionate, patient-centred care.