Early miscarriage as ‘matter out of place’: An ethnographic study of nursing practice in a hospital gynaecological unit

BackgroundEarly miscarriage has been conceptualised as loss and bereavement where nurses are urged to provide sympathetic, psychological care for women. However, the reality of women's experience is also about blood, ‘dirt’ and failure which are under explored in the literature.ObjectiveTo explore the management and care of women having an early miscarriage within a hospital setting.DesignA qualitative, ethnographic study.SettingA gynaecological unit consisting of an early pregnancy clinic and two gynaecological wards in a general hospital in an urban area of Wales, United Kingdom.ParticipantsThe first group was a purposive, volunteer sample of eight women who had experienced an early miscarriage and were admitted to hospital for active management of their miscarriage. The second was a purposive, volunteer sample of 16 hospital health professionals actively involved in the care of women having an early miscarriage. This included 10 nurses, three doctors and three ultrasonographers.MethodsThree main methods were employed. Firstly, 20 months participant observation working alongside gynaecological nurses in a gynaecological unit. Secondly, documentary analysis of key documents such as nursing care plans. Finally, in-depth interviews with women who had experienced early miscarriage and hospital health professionals involved in their care.ResultsThree key categories emerged; ‘first signs and confirmation’, ‘losing the baby’ and ‘the aftermath’. ‘First signs’ relates to the women's experiences when first realising that their pregnancy is under threat. ‘Losing the baby’ further explores women's accounts of their experience and the ‘aftermath’ relates to the long term impact of miscarriage on them and their lives. This paper focuses on the women's experiences of the physical manifestations of miscarriage in ‘losing the baby’. Drawing on anthropological literature and the concepts of dirt and pollution, it is argued that miscarriage for both women and health professionals can be considered as ambiguous and that miscarriage and the early passage of the foetus can be seen as ‘matter out of place’.ConclusionThis exploration of how women were managed in a hospital setting reinforced the notion of the ambiguous nature of miscarriage and supports the position that miscarriage may be considered as atypical bereavement. Furthermore, an analysis is offered of the significance of the vaginal blood loss as polluting and gives insights into how nurses manage this ambiguity.