Barriers to and Facilitators of Moving Miscarriage Management Out of the Operating Room

Amanda Dennis Liza Fuentes, Boston Medical Center Ella Douglas-Durham Daniel Grossman, University of California, San Francisco

First published online:

| DOI: https://doi.org/10.1363/47e4315
Abstract / Summary

Miscarriage care can safely and effectively be offered in appropriately equipped offices and emergency departments. However, it is often treated in the operating room, which limits access to timely, cost-effective and high-quality care.


Between May 2013 and January 2014, in-depth interviews were conducted with 30 staff holding diverse roles at 15 medical offices and emergency departments with the aim of exploring barriers to and facilitators of offering miscarriage care, and identifying methods for expanding care. On-site observations were also conducted at four facilities. All data were transcribed, iteratively coded and analyzed using qualitative techniques.


Similar barriers to and facilitators of providing miscarriage care were identified across facility types. Barriers were physician preference for providing care in the operating room, the similarity of miscarriage management and abortion procedures, the limited availability of support staff, difficulties integrating miscarriage management into patient scheduling and flow, and uncertainty about responding to women's emotional needs. Facilitators were a commitment to evidence-based medicine, insurance coverage of miscarriage, offering other procedures of similar complexity and the minimal resources needed for miscarriage care. Resources needed to expand miscarriage services included a medically trained “champion,” best practices for implementing services, persistence and patience, training, clear protocols, and systems for tracking equipment and supplies.


Miscarriage care was viewed as neither resource-intensive nor technically complex to provide. Although it may be emotionally and politically challenging to offer, effective strategies are available for expanding the scope of miscarriage care offered in multiple settings.

Perspectives on Sexual and Reproductive Health, 2015, 47(3):TK, doi: 10.1363/47e4315

Author's Affiliations

At the time this research was conducted, Amanda Dennis was an associate, Ibis Reproductive Health, Cambridge, MA. Liza Fuentes is senior project manager, Ella Douglas-Durham is a research assistant and Daniel Grossman is vice president for research, all at Ibis Reproductive Health.


The views expressed in this publication do not necessarily reflect those of the Guttmacher Institute.