Objective
The aim of this study was to examine the impact of medical and psychological interventions on women's distress after early miscarriage.
Methods
This was a prospective study of women attending for a routine scan at 10–14 weeks of gestation and found to have a missed miscarriage. An intervention group of 66 women had medical investigations to ascertain the cause of miscarriage, and at 5 weeks after the scan, they all had a medical consultation to discuss the results of the investigations. These 66 women were randomly allocated into a group which received further psychological counselling (MPC, n=33), and a group which received no psychological counselling (MC, n=33). They were compared to a control group of 61 women who received no specific postmiscarriage counselling. All participants completed preintervention and postintervention measures and 4-month follow-up questionnaires.
Results
The scores on the outcome variables decreased significantly with time for all three groups. In group MPC, compared to controls, there was a significantly greater decrease over time in the levels of grief, self-blame, and worry and, compared to MC group, a significantly greater decrease in grief and worry. In group MC, compared to controls, there was a significantly greater decrease in self-blame. In the MC and MPC groups, those with an identified cause of the miscarriage had significantly lower levels of anxiety and self-blame over time than those with a nonidentified cause.
Conclusions
Psychological counselling, in addition to medical investigations and consultation, is beneficial in reducing women's distress after miscarriage. However, absence of an identifiable cause of miscarriage led to the maintenance of the initial anxiety levels, which should have otherwise decreased with time.
Miscarriage is the commonest pregnancy complication [1]. It is both physically and psychologically a traumatic experience [2] and [3]. High levels of anxiety, depression, and grief may persist in some women long after physical recovery has occurred [4], [5], [6] and [7]. It has been proposed that follow-up care, by the general practitioner (GP), health visitor or the hospital, should be offered to all women after a miscarriage [6], [7], [8], [9], [10], [11] and [12]. This could provide the opportunity for provision of information, explanation, advice, and reassurance and may lead to a reduction in women's distress, as suggested by several uncontrolled studies [11], [12], [13], [14] and [15].
To date, there have been two controlled studies [16] and [17] examining the impact of psychological counselling shortly after miscarriage. One of these studies utilized grief counselling [17], whilst the other included provision of psychological debriefing based on the trauma framework [16]. Although the women perceived these interventions as helpful, formal evaluation of distress revealed no significant impact of such counselling on emotional adaptation. A possible reason for such an outcome may lay in the fact that no medical information concerning the miscarriage was provided as part of counselling. The majority of women desire to be provided with medical information concerning their loss, including the possible explanations of the cause of the miscarriage and the impact on future pregnancies [6], [7] and [8]. Without such knowledge, the anxiety may not be fully alleviated and may preclude psychological adjustment. In a previous, uncontrolled study [15], we found that, in women who received medical and psychological counselling several weeks after miscarriage, the levels of distress at 4 months after the loss were much lower than those reported by other investigators following just a psychological intervention.
The aim of the present study was to establish the impact of the provision of medical and psychological counselling following miscarriage on women's distress. We also examined whether psychological outcomes varied between women in whom medical investigations resulted in an identifiable cause of the loss and those where no such cause was found.
