How Do You Support Early Pregnancy Losses? The Miscarriage Management Training Initiative: Improving Care for Women

Purpose for the Program: Early pregnancy loss (EPL) is a common pregnancy complication. Historically, surgical dilation and curettage in the operating room setting has been the standard of care for EPL. Evolving knowledge and research have led to a paradigm shift in which three alternatives have been recognized as safe and effective treatment options. Reviews of the research have concluded that women's preferences should be key determinants of management when one option is not medically superior to another. Miscarriage Management Training Initiative (MM-TI) is an evidence-based intervention designed to facilitate the woman-centered approach to EPL by expanding the range of safe and effective options available, including the use of the manual vacuum aspirator (MVA), for office-based management. Designed as a systems change approach, this intervention stresses training a cross-section of primary care disciplines in hospital and clinical settings. Proposed Change: Training registered, advance practice nurses, and allied healthcare staff to provide comprehensive care for EPL in an office-base setting has the potential to reduce costs, provide evidence-based and community standard services, and expand access, especially for underserved women. By practicing patient-centered care, it also has the potential to address the myriad of emotions women experience after EPL. Implementation, Outcomes, and Evaluation: The MM-TI was first implemented with physicians, nurses, and allied healthcare staff in family medicine residency programs in Washington State. Our primary outcome was self-reported practice of MVA after the training. The evaluation demonstrated a significant program effect (preintent and postintent to practice MVA, controlling for individual and site-level confounders). The evaluation also showed a significant correlation between clinical and administrative support staff knowledge of MVA and the physician intent to practice MVA. The MM-TI has now expanded to other states and broadened the scope to include obstetrician-gynecologists, nurse managers, nurse–midwives, nurse practitioners, and allied healthcare staff. Our preliminary qualitative assessment with stakeholders in Washington State pointed to the importance of clarifying scope of practice for miscarriage management and for MVA usage in particular. Implications for Nursing Practice: Nurses play key roles in caring for women who experience EPL. These roles include providing direct services for EPL, education, counseling, systems management, training staff, assisting the healthcare provider, and providing patient-centered care.