By: Holly Reyes
Editor’s Note: Compassionate care following pregnancy loss includes attention to both physical and emotional needs. Holly Reyes, DO, now a psychiatry resident, prepared this research review while participating in the FACTS elective as a medical student at Noorda College of Osteopathic Medicine. The original study, “Psychosocial Care of Pregnancy Loss in the Emergency Department,” by Rebecca Mattson and Shandeigh N. Berry, found that targeted staff education improved self-reported knowledge and supportive care skills across seven domains of miscarriage care. For clinicians who incorporate fertility awareness-based methods (FABMs), this review underscores the importance of pairing fertility evaluation and cycle charting with compassionate communication, grief support, and appropriate referrals for women and couples experiencing loss. To learn more about miscarriage, we offer multiple presentations through different parts of our online CME course.
Introduction
Miscarriage is a common yet deeply distressing event that can have significant short- and long-term psychological consequences for women. Pregnancy loss has been associated with increased risks of depression, anxiety, post-traumatic stress disorder, and sleep disturbances. National guidelines emphasize the importance of team-based, compassionate care for women experiencing miscarriage, recognizing that the emotional impact can be as profound as the physical effects. However, while emergency department (ED) staff are well trained to manage acute medical and psychiatric emergencies, many ED health professionals report feeling underprepared to address the unique emotional and psychological needs of patients experiencing pregnancy loss.
“National guidelines emphasize the importance of team-based, compassionate care for women experiencing miscarriage, recognizing that the emotional impact can be as profound as the physical effects.”
The ED is often the first point of care for women undergoing miscarriage, placing ED staff in a critical position to shape the patient’s experience during an emotionally vulnerable time. Recognizing this gap in training, the Institute of Reproductive Grief Care partnered with two EDs to develop and implement a structured curriculum focused on the psychosocial care of pregnancy loss. This initiative aimed to identify which ED staff members are most involved in caring for patients experiencing miscarriage; evaluate the short-term effects of targeted training on clinician confidence and preparedness; and assess the effectiveness of a survey tool designed to measure the impact of these educational interventions.
Methodology
The study was conducted in two large California EDs, where an interdisciplinary miscarriage care training program was delivered to the staff. The training included didactic lectures, case-based discussions, role-playing exercises, and instruction on using a miscarriage home kit. To evaluate the intervention’s impact, participants completed pre- and post-training surveys using Likert-scale questions. The surveys assessed multiple domains, including emotional support, communication, cultural sensitivity, clinical preparedness, discharge planning, bereavement care, community support, and clinician self-care.
Results
A total of 88 participants completed the pre-intervention survey, 65 completed the post-intervention survey, and 5 completed the six-month follow-up survey [1]. Most participants were nurses (62.6%), followed by ED technicians (12.8%), chaplains (7.7%), patient care assistants (7.7%), social workers (5.1%), and radiology technicians (5.1%). Paired sample t-tests demonstrated statistically significant improvements across all measured subscales, including emotional support, patient-centered care, discharge planning, bereavement care, community support, staff support, and communication. In addition, patient perceptions of these same domains improved. Cronbach’s alpha values indicated good internal consistency for most subscales, supporting the survey instrument’s reliability.
Discussion
The results of this study demonstrate that targeted education on psychosocial care for pregnancy loss can significantly improve ED staff confidence and knowledge. Statistically significant improvements were observed not only in clinician self-assessmentS across multiple domains but also in patient perceptions of care, underscoring the meaningful clinical impact of the intervention. These findings suggest that even relatively brief, structured educational programs can enhance the quality of emotional support provided to women experiencing miscarriage in the ED setting.
“The results of this study demonstrate that targeted education on psychosocial care for pregnancy loss can significantly improve emergency department staff confidence, and knowledge… (and) patients’ perceptions of care, underscoring the meaningful clinical impact of the intervention.”
One strength of this study is its interdisciplinary approach. Pregnancy loss care in the ED often involves multiple team members, including nurses, technicians, chaplains, and social workers. By including a broad range of staff, the intervention reflects the team-based nature of emergency care and acknowledges that psychosocial support extends beyond physician-patient interactions alone. Additionally, using multiple teaching modalities, lectures, case studies, role-playing, and practical tools likely contributed to the observed improvements by addressing different learning styles and reinforcing real-world application.
However, the study also has notable limitations. The sample size was relatively small, particularly for the six-month follow-up survey, limiting the ability to assess long-term retention of skills and knowledge. The authors also note limited matching between pre- and post-intervention surveys, which may weaken the conclusions. Additionally, the unpredictable nature of ED workflows and shifting staff schedules could have influenced survey participation and responses. As with many educational interventions, self-reported improvements may not fully capture all actual changes in clinical behavior.
Future research could build on these findings by examining patient-centered outcomes more directly. For example, studies could assess whether patients cared for by clinicians who received this training experience reduced short- or long-term psychological distress, improved satisfaction with care, or increased engagement with follow-up resources. Longitudinal studies would be particularly valuable in determining whether psychosocial interventions in the ED can mitigate the long-term emotional sequelae of pregnancy loss. Another important question raised is how similar training programs could be adapted for other medical specialties. Clinicians in family medicine, obstetrics and gynecology, and even psychiatry can encounter patients following pregnancy loss. Integrating this type of training could enhance continuity and quality of care across settings.
This study is particularly relevant to fertility awareness–based methods (FABMs) and family planning, as pregnancy loss is a reality for many couples actively attempting to conceive. Women who use FABMs often have a heightened awareness of their cycles and early signs of pregnancy, which may lead to earlier recognition of miscarriage—and in some cases increased emotional investment in their pregnancy. Regardless of the etiology of miscarriage, it is essential for healthcare professionals involved in fertility care to be knowledgeable and confident in addressing the emotional trauma associated with pregnancy loss.
For FABM clinicians, recognizing signs of miscarriage and responding appropriately is a critical aspect of comprehensive care. Whether supporting patients in the outpatient setting or referring them to emergency care, FABM clinicians must be prepared to guide couples through both the physical and emotional dimensions of loss. During the FACTS elective, significant emphasis is placed on cycle tracking, identifying underlying causes of miscarriage, and medical management aimed at preventing future losses. However, even with optimal care, miscarriage remains a possible outcome. The elective teaches that major risk factors for miscarriage include a history of prior miscarriage and advanced maternal age—meaning that many women seeking FABM consultation may already have experienced one or more losses.
“For FABM clinicians, recognizing signs of miscarriage and responding appropriately is a critical aspect of comprehensive care.”
This article highlights the importance of medical staff confidence and compassion when caring for women at higher risk of miscarriage or those actively experiencing pregnancy loss. The ability of staff to provide empathetic, patient-centered psychosocial care can be perceived by patients and may influence how they process grief and engage with future reproductive care. By emphasizing education and emotional preparedness alongside clinical management, this study reinforces the need for a holistic approach to women’s health and family planning, particularly in moments of profound vulnerability such as pregnancy loss.
REFERENCES
[1] Mattson R, Berry SN. Psychosocial Care of Pregnancy Loss in the Emergency Department. J Emerg Nurs. 2026 Jan;52(1):18-23. doi: 10.1016/j.jen.2025.10.005. PMID: 41490899.
ABOUT THE AUTHOR
Holly Reyes, DO is a psychiatry resident at Novant Health New Hanover Regional Medical Center in Wilmington, North Carolina. She earned her medical degree from Noorda College of Osteopathic Medicine in Provo, Utah, and completed her undergraduate studies at Franciscan University in Steubenville, Ohio. She is interested in community health and serving underserved populations.
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