Views of knowledge users on recurrent miscarriage services and supports in the Republic of Ireland: a qualitative interview study

Objectives Women and men/partners who experience miscarriage often report poor care experiences within health services around the time of miscarriage and beyond; less is known about recurrent miscarriage (RM) care. Research is needed to explore the potential targets for improvement, in addition to identifying factors that support or hinder service improvement efforts and the implementation and/or sustainment of desired models of RM care. This study aimed to explore the views of knowledge users regarding RM services and supports; specifically: (a) practices and experiences and (b) facilitators and barriers to providing desired services and supports. Study design We adopted a qualitative study design underpinned by constructivism, incorporating semistructured interviews. Data were analysed using reflexive thematic analysis. Setting Participants were recruited across the Republic of Ireland, incorporating perspectives from different geographical areas, hospital types and RM services. Participants We interviewed 13 women and 7 men/partners who had experienced ≥2 consecutive miscarriages, and 42 people involved in the delivery and/or management of RM services and supports, between June 2020 and February 2021. Results We generated three themes from the data: (1) dedicated staff; (2) dedicated space and time and (3) dedicated funding and support - prioritise RM. Our analysis supports the need for a standardised, dedicated and adequately resourced and supported service. One in which people experiencing RM are offered appropriate, individualised, timely and accessible care and support - beginning following the first miscarriage, and following a graded model. Implementation requires several multilevel actions, including prioritising RM care, adequately funding and resourcing services, enhancing health professional education and support, care coordination within and between hospitals and primary care and improving public awareness of, and addressing stigma surrounding, miscarriage. Conclusions Our analysis provides context to 'good' and 'poor' care experiences and identifies what facilitators and barriers exist to affecting change in RM care within healthcare and broader systems. In light of recent debates regarding how best to deliver RM care, and changing international guidelines, this work provides timely and important knowledge that should be harnessed to inform service improvement efforts in the Republic of Ireland and beyond.