“Just Stay Home and Wait It Out”: Exploring Challenges Accessing Care for Miscarriage in Indiana

INTRODUCTION: Qualitative research on miscarriage in the United States primarily draws on the experiences of participants recruited from healthcare settings which may fail to robustly illuminate how people navigate to care. We aimed to explore the miscarriage experiences of Indiana residents, identify barriers to access, and generate recommendations to improve comprehensive miscarriage management and information across the state. METHODOLOGY: We used community-based recruitment methods and conducted semi-structured, in-depth interviews with 26 participants who had experienced at least one miscarriage in Indiana between 2018 and 2023. We audio-recorded and transcribed the interviews, and then we used Dedoose to manage our data and carried out content and thematic analysis. RESULTS: Participants described significant challenges locating both information and care about miscarriage. When they reached out to health care providers, women were instructed to "wait it out" or go to the emergency department (ED). These recommendations were inconsistent with participants' needs and desires. Participants reflected negatively on their experience at the ED, emphasizing the high financial and emotional costs associated with the visit. Only participants who discovered their pregnancy loss during prenatal care appointments reported being offered active intervention. DISCUSSION: Our findings suggest that some women in Indiana lack access to information and comprehensive treatment options for miscarriage. This funnels non-emergent patients to the ED where patients incur significant financial and emotional costs. Developing strategies to support miscarrying women inside and outside of the ED appears warranted.