Exploring the barriers to outpatient miscarriage management: Perspectives of private Ob/Gyns and Emergency Medicine physicians

Despite advances over the past decade in both outpatient uterine aspiration and medical management, miscarriage in the United States is largely treated surgically in the operating room.  Compared to operating room procedures, outpatient aspirations are equally safe or safer, quicker, more cost effective, and more acceptable to some women. There is little research that explores why miscarriage is usually treated in the operating room or what barriers and facilitators clinicians face in providing miscarriage management in ob/gyn and hospital settings. This exploratory qualitative study seeks to fill this gap in the literature. Specifically, we aim to:

  1. Explore private ob/gyns’ and Emergency Medicine physicians’ miscarriage management practices; 
  2. Identify barriers and facilitators to offering miscarriage management in different clinical settings, focusing on performance of office-based aspirations and procedures performed in an emergency department procedure room; and
  3. Determine the role that insurance reimbursements provided for miscarriage management services in different clinical settings play in the treatment options provided to women.

To investigate these aims we are conducting in-depth interviews with a minimum of 24 people in eight ob/gyn private practices and hospital emergency departments, and conducting in-person observations at a minimum of four of these facilities. Data gathered through the in-depth interviews and observations will be critical for developing and/or modifying evidence-based interventions targeted at changing current miscarriage management practices in ob/gyn and hospital settings and for ensuring women have access to comprehensive treatment options that reflects their preferences.