Understanding women's satisfaction with miscarriage management: the role of shared decision-making, preparedness and emotional experiences BMC Reproductive Health

Abstract Background: Miscarriage is the most common complication of early pregnancy, yet relatively little quantitative evidence has compared women's experiences across different miscarriage management approaches. This study examined whether shared decision-making, preparedness, emotional experiences during miscarriage management, and satisfaction with care differed according to management type, and identified factors associated with women's overall satisfaction. Methods: A cross-sectional online survey was completed by 322 women in England who had experienced a first-trimester miscarriage within the previous three years. Participants reported receiving expectant, medical (home/hospital), or surgical management. Measures assessed shared decision-making and preparedness, support during decision-making, emotional experiences during miscarriage management (loneliness, isolation, relief and comfort), satisfaction with treatment and care, and follow-up support. Group differences were examined using chi-square tests and one-way analyses of variance with appropriate post hoc comparisons. Hierarchical multiple regression identified predictors of treatment satisfaction and overall satisfaction with care. Results: Women undergoing expectant management consistently reported poorer experiences than those receiving surgical management, including lower shared decision-making and preparedness, reduced support during decision-making, greater loneliness and isolation, lower relief and comfort, and lower satisfaction with their treatment and overall care. Shared decision-making and preparedness were the strongest independent predictor of both treatment satisfaction and overall satisfaction with care. After accounting for shared decision-making, the association between management type and satisfaction was substantially attenuated, indicating that decision-making experiences explained much of the observed difference between management approaches. Greater loneliness and isolation independently predicted lower overall satisfaction with care, whereas greater relief and comfort independently predicted higher satisfaction with treatment. Conclusions: Women's experiences of miscarriage management are influenced not only by the treatment received but also substantially by how decisions are made and the support provided throughout the care pathway. Improving shared decision-making, realistic preparation, communication, and ongoing support, particularly for women choosing expectant management,may substantially enhance patient experiences regardless of the management approach selected.