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New model of care for recurrent miscarriage proposed which would see people receive appropriate care and support following their first miscarriage
The Pregnancy Loss Research Group (PLRG) at University College Cork is calling on decision-makers to implement a new model of care for people who experience miscarriage and recurrent miscarriage. This would see people offered appropriate, individualised, timely and accessible care and support, after their first miscarriage as well as for recurrent miscarriage.
The proposed model of care – outlined in a new policy brief published by the PLRG and presented at a briefing held at Leinster House earlier today alongside the Miscarriage Association of Ireland and Féileacáin – was informed by findings from the Health Research Board-funded RE:CURRENT project which evaluated recurrent miscarriage services in Ireland. The team of researchers, led by Professor Keelin O’Donoghue (Consultant Obstetrician at Cork University Maternity Hospital and PLRG Lead), conducted a series of research studies which informed their recommendations.
After a first miscarriage, they propose that people should be provided with information (including that for any future pregnancy), sign-posted to peer support groups, screened for risk factors and referred to other services as needed. Following a second miscarriage, people would receive an appointment at a miscarriage clinic which could be medical or nurse/midwife led. They would have appropriate investigations and treatments, and have plans made for any subsequent pregnancy, including supportive care (e.g. reassurance scans). Individuals would be referred for specialist care if necessary (e.g. based on test results, or medical history). After a third miscarriage, people would receive an appointment at a medical consultant-led clinic; they would have additional investigations and treatments as needed, have genetic testing undertaken on pregnancy tissue, receive screening and care for mental health issues and future pregnancy risks, and have plans made for any subsequent pregnancy. In practice, this would require all hospitals to have a staff member dedicated to miscarriage care. This midwife/nurse would ensure the coordination of care for people who experience miscarriage across their hospital – including early pregnancy clinics, emergency rooms and wards – as well as links with primary care. They would also be responsible for follow-up and ensuring that necessary supports are provided.
Speaking about the model of care, Professor O’Donoghue said:
While our evaluation identified some good practice in recurrent miscarriage care nationally there was much variation in service provision across the country. Almost one in four women who participated in the RE:CURRENT care experience survey rated their overall recurrent miscarriage care experience as poor and almost one in five said the care they received was much worse than expected. Implementing our proposed model of care would help to ensure that people receive an agreed standard of care, regardless of where they live or are looked after and regardless of their financial means, which would be tailored to their individual needs.
As outlined in a paper recently published by the researchers in BMJ Open, implementing of such a model of care in practice requires dedicated staff, dedicated space and time, and dedicated funding and support. Several commitments and actions across the health system are needed, including prioritising miscarriage and recurrent miscarriage 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.
The RE:CURRENT project was conducted with the support of a 22-person Research Advisory Group, including people with lived experience of recurrent miscarriage, health professionals, and people involved in the administration, governance and management of maternity services. Jennifer Uí Dhúbhgáin, Chair of the Miscarriage Association and Member of the RE:CURRENT Research Advisory Group, welcomed the proposed model of care, adding:
The new model of care proposed by the PLRG for those who experience miscarriage and recurrent miscarriage is very welcomed and is something the Miscarriage Association of Ireland fully supports. Unfortunately, all too often we hear from women and men who have felt that the standard of care they were given fell well short of what they had expected. This in turn adds to their trauma, leaving them with not only questions about the care they were given, but also feelings of anger, frustration and upset as to what they see as failings in their care. To have this new model of care introduced from the first miscarriage to recurrent miscarriage will ensure that those going through miscarriage will receive the appropriate care and support from an early stage through the provision of information, care and support. It will also help to break the silence around miscarriage, lift the stigma that exists and bring about recognition for what is a very real loss and grief. The implementation of such a model of care would be a huge step forward in miscarriage care and support.
Notes to Editor
Miscarriage is the spontaneous loss of a pregnancy before it reaches viability. Most miscarriages occur in the first 12 weeks of pregnancy. Recurrent miscarriage is the loss of two or more consecutive pregnancies in the first trimester. At a population level, 10.8% of women will have had one miscarriage, 1.9% will have had two miscarriages and 0.7% will have had three or more miscarriages. Miscarriage has physical, psychological and economic impacts.
Research studies quoted:
- Flannery C, Hennessy M, Dennehy R, Matvienko-Sikar K, Lucey C, Ui Dhubhgain J, O'Donoghue K. Factors that shape recurrent miscarriage care experiences: findings from a national survey. BMC Health Services Research. 2023;23:317. https://doi.org/10.1186/s12913-023-09347-1
- Hennessy M, Linehan L, Flannery C, Cotter R, O'Connell O, O'Donoghue K. A national evaluation of recurrent miscarriage care services. Irish Medical Journal. 2023;116(1):P713. https://imj.ie/a-national-evaluation-of-recurrent-miscarriage-care-services
- Hennessy M, Dennehy R, Matveinko-Sikar K, O’Sullivan-Lago R, Ui Dhubhgain J, Lucey C, O’Donoghue K. Views of knowledge users on recurrent miscarriage services and supports in the Republic of Ireland: a qualitative interview study. BMJ Open. 2025;15:e094753. https://doi.org/10.1136/bmjopen-2024-094753.
Further research findings available at: https://www.ucc.ie/en/pregnancyloss/researchprojects/recurrent/
Clinical guidelines and information resources to improve miscarriage and recurrent miscarriage services and supports have also been developed and published based on findings from the RE:CURRENT project and will support the implementation of the proposed model of care. These include:
- Information booklets on miscarriage and recurrent miscarriage
- Multi-lingual videos on recurrent miscarriage
- An appointment letter template for recurrent miscarriage clinics
- A checklist for use by staff within emergency rooms/departments when people initially present with signs or symptoms of miscarriage
- Case studies to assist maternity services to enhance physical spaces within hospitals/units
- National clinical guidelines for first trimester miscarriage and recurrent miscarriage.
All of the resources are available on the Pregnancy and Infant Loss Ireland Website (www.pregnancyandinfantloss.ie), with information booklets, videos and clinical guidelines also available on the Cork Miscarriage Website (www.corkmiscarriage.com).
Resources for individuals, families, health professionals, and anyone who needs information and support about pregnancy and/or infant loss
- Pregnancy and Infant Loss Ireland Website: pregnancyandinfantloss.ie
- Cork Miscarriage Website: corkmiscarriage.com
- Miscarriage Association of Ireland: miscarriage.ie
- Pregnancy Loss Research Group Website: ucc.ie/pregnancyloss.
For more on this story contact:
- Professor Keelin O'Donoghue: k.odonoghue@ucc.ie
- Marita Hennessy, PhD: maritahennessy@ucc.ie.