Bismillah hir Rahman Nir Rahim,

Assalamu alaikum!

Interviewer: Thank you all for your precious time and to be part of this research.

As soon as we spread the word, before taking consent we will discussed about the

experiences of pregnancy loss. So, The actually since you all were doing work we

were talking and laughing, I was getting to know a little bit about the experience of

the people, so those of you who have lost your pregnancy, It is important to know

what is the response of those who have been affected by the loss of pregnancy, so

that it is better to know the response of the people who have lost the pregnancy and

the responses that is less here.

What was the experience of the patients and what did you do regarding the loss of

the pregnancy

The one who want to say voluntarily I will give them chance them

Yes miss

R1: Thanks for giving me chance I will discussed about the patients. The patients

whoever been through the miscarriage asked WHY? Their first question is why?
Why this happened to me. I was taking care properly. I had done all scan. You had

given me investigations I had done timely visits. Took medicine and folic acid as

well, I had done all the things properly. Maintained the diet. But still, why does it

happen to me. Patients asked about the reasons. 100% patients asks for the reasons

WHY? I followed all the instructions given by doctor. That is the main question.

So, we guide the consultants that the 99% miscarriage in 1st pregnancy is due to it

is not formed naturally or it is a chemical pregnancy.

Interviewer: Miscarriages, abortions, automation these all the aspects of pregnancy

loss. You had to focus on these all.

R1: Human IUD had been also included in these

Interviewer: Yes, yes

R1: Some patients in starting have miscarriage understand the situation but god

forbid in later stages miscarriages happens. Still births, IUDS. Directly their main

focus is we had done the routine checkups, scans, and all. Why it happens. They

ask the reasons. According to their situations and gestational age the doctors do

their counselling accordingly. In starting may be its chemical pregnancy or may be

its not formed naturally that’s the reason of miscarriage. Then in IUD’S there is a

long list. Is it hypertension, GDM, or what’s the reason or any pervious history and

then doctor guide them accordingly

R2: Basically I’ll talk about IUD’S

IUD’S like HTN, GDM, and .These are the reasons for IUD’s. There are so many

complications in these and patients did not know it well. From starting till end they

don’t feel the movement. The patient also complains about they don’t feel the

movement. In starting we explain them after 20 weeks movement started and still

at 9th month they feel the slight movement and they stay at home. They don’t feel

the movement but they stay at home. Their old age family member’s share their

own past experiences. Nothing will happened. In this way IUD’S are formed. 20

weeks and miscarriages basically were not formed. Sex was not formed properly

Due to any abnormality miscarriages happens

I agreed with Saniya

They asked reasons why? Most of the patients after doctor counselling it is not

formed and they replied we are taking all the things properly. Something’s we
should left on god and it is nature. Patient didn’t understand this. Most of the

patient didn’t understand this phenomena

Interviewer: Now anyone from both of you tell me

R3: That is enough. What should I tell? Patient didn’t care themselves. Still births,

pre term babies or any abnormalities it’s difficult to live. In this cases termination

occurred or we need to do termination. In this circumstances we need to explain

the reasons behind this all. Multiple abnormalities can also lead to termination

R1: I’ll add some points. NND it comes after. After asking proto we do termination

and discussed after anomalous scan. Like anencephalic, spinebifedia in this

conditions we should terminate. But again it’s wish of couple. We have seen

through our experiences that the pregnancy was continued and was delivered and

now kid had been 12 years old and now she is surviving. In anencephalic survival

rate is 0%. In this condition those who are too religious like Mowlana opposed this

with all and continue this and there is no such thing in Islam, The main thing is to

do counselled them. Consultant guide them. Our role is to give them moral support

and guide them properly.

R2: I’ll add some points in it. The chances of miscarriage is due to nutrition. If

patient is not taking nutrition properly so it can lead to miscarriage. They were not

taking diet due to any of reasons. There are many issues in family. Might be they

have social issues, stress. Stress is the biggest cause of miscarriage.

R1: I’ll add one thing here. It has been observed after COVID pandemic. The

vaccines which are administered like sinovac and Sinopharm. Almost 1%

miscarriage chances has been increased. I don’t know the reason behind it. We had

noticed these new changes. Bleeding had been occurred after vaccination (might be

after 1st or 2nd dose). Few days back I have seen after administration of vaccine.

Bleeding occurred and they abort. Patient said after administration of vaccination

these types of conditions had been seen frequently. These are the comments of

patients.

R3: Rubella has been biggest cause of miscarriages. Those who have rubella –ve

are at the risk of miscarriages. Whenever we gave investigations to them we gave

rubella test to them. Since few years thyroid has been the cause of miscarriage.

During the clinics of Doctor Zaib. After assessing thyroid level. Whose thyroid

antibodies are increased and they are prone to miscarriages.

R1: I’ll add last thing. RH factor is very important. If RH – which means

antibodies had been developed this could be main reason. It can be due to

compability of blood group A or B

Interviewer: This is very healthy and interesting discussions. I have so many

questions. This is all about your experiences. Now tell me about what are the

experience of female. Who are going through this? What are their feelings?

R1: Spefically if we talk about our community. Pakistani population miscarriage

has been such a big issue. In laws blamed them it is due to your mistake. You have

been to your mother’s home. You had eat something there. That’s why miscarriage

has been happened. Patients complains this type of issues. The families blame them

but it shouldn’t be done. This has been in our community.

Interviewer: Any experiences in your wards

R1: Our society is so much educated and advanced. They focused on now in that

house 4 miscarriages had happened or above 4 miscarriages so someone had done

black magic on them. Seen som3vconcepts in patients as well. It is rare but still it

happens.
R2: After so many miscarriages some patients are well educated but there in laws

belongs to illiterate population. They pressurized too much on patients. Although

patients were educated but they tell their own experiences. Their old age family

members share their experiences and tell them we have seen so many miscarriages.

Whenever we investigate the reasons of miscarriages. All of them didn’t implement

or do the related test. Some are financially burdenized. We allowed them to do

investigations from any of hospital of their choice.

R1: I’ll add one thing here recurrent abortion those who have 4 or more than 4

miscarriages. There is a test apla. Which is compulsory this test shows the blood

coagulation factor. When doctor explains them it is too costly. Even though if we

are on their place we also can’t afford this test. Those patients who got positive

Apla test. So, doctor advised them to take Injection clexane and Tab Ascard during

whole pregnancy. Recently seen patient whose test was positive so doctor advised

her to administered Injection Clexane but she was financially not stabled. Even,

She came to me I can’t afford it. Doctor told it’s compulsory and you have to use

it. We work in a center where we need documentation and justification about all the

things and we are answerable for all this. So, she said I can take Injection Clexane
from somewhere else it is too costly. There should be direct coordination with

companies those who can’t afford can get discounts and the patient with recurrent

abortion. There should be some substitute of this

Interviewer: Excellent! Great until now you have shared the services as well as

experiences as a health care provider what’s your perception regarding the loss of

pregnancy. What care should be provided in all this? As a health care provider

what is the expectation and role and how we should care them respectively? I need

your ideas and opinions

R3: After discharged process from our hospital we will provide them proper

guidance that before conceiving do a proper checkup and then do family planning

after all investigations and discovered the main reason behind this all. They should

have regular visits with their consultants. Your husband should also involve in the

discussion with doctor and he should also knew about the consequences.

Interviewer: Mash Allah Nice thoughts!

R1: I’ll add one thing here as being a midwife we already provide them moral

support but we guide their family members as well. We guide them related to diet
and main focus should be on family planning. We also guide them that don’t

conceive before 4 to 6 months. After abortion they gone through painful

menstruation and loss of electrolytes, minerals and vitamins from the body. Body

need 3 to 4 months to came in its normal state. Folic acid and multivitamins should

use regularly till you didn’t get the doctor’s appointment.

Interviewer: Thanks for your precious time and your views are highly appreciated

your views are needed for this study purpose. You are cooperating too much with

us. Kindly share your views in this point of you.

R1: There is no mistake of you or your husband. No one will do miscarriage

intentionally and it’s up to god as well. You didn’t entered in your old age time you

are young you have time and you can conceive again. Patients gave us positive

feedback after explaining them in a way. Next time they come on follow up with

confidence and they implemented advises and planned after 3 to 4 months. Also

saw that they conceived a healthy baby after this all.

R2: We have Dr Riffat she tell them about miscarriage don’t be sad. All the females

sitting here in hospital went through 2 to 3 miscarriages. Through this patient got
the support and will power and Doctor also gave them a moral support as well.

Patient’s husband came to us and asks about is there any mistake of my wife or

anything else. Husband and in laws pressurized them too much. We as a nurse and

doctor explained them it is by god itself and some medical point of view.

R3: After multiple miscarriages doctor starts the Tab Ascard. And some families

are too concerned related to Tab Ascard. Why doctor started the Tab Ascard it is

mainly for High blood pressure. Then we explain them ascard is used as a blood

thinner. We advised them for the gap of 3 to 4 months.

R1: Latest experience patient conceived after IUF and till 12 weeks pregnancy was

smoothly and suddenly and lower net placenta was shown in the scan and then

bleeding started and patient shows concerned. I guided her be positive and you had

conceived after treatment. Don’t lose the hope you can conceive again. So that

patient took this feedback in a positive way and now she delivered a healthy baby.

Interviewer: Now you all shared the perception and ideas. As a health care provider

you have shared experiences and how did you fulfilled your role as a health care

provider. Are you happy with these all or satisfied with your role?
R1: I have so many experiences and we learned from our JD and we get

appreciation and positive feedback as well. As a health care worker we gave 100%

accordingly.

R2: Most probably we have covered all the things up till now and learned things

from our JD We have covered all the things. We are not updated new research if

there is any changes or any errors .kindly conduct sessions for our knowledge

enhancement.

R1: Kindly give us life time certificate or anything like this which shows we are

authorized

Interviewer: Excellent. Now we will talk about this and my next question was

related to this. As a health care provider what challenges did you faced regarding

the patients or females? Kindly explain the challenges are you facing during this

work and how can you overcome these challenges

R1: In our setup we try to maintain the privacy of patients. Whenever it is possible

for us to give them privacy we gave them. Sometimes patients feel uncomfortable

and in case our relatives were that place they will also feel uncomfortable. This
type of patients should be kept in isolation and they can undergo in depression as

well. I have also did the care properly but can’t conceived the baby like her. This

type of patients should be kept under isolation and maintain their confidentiality

and should take them to another room. If there is a census of 100 patient so we

can’t maintain her privacy and but we gave 100% in this aspect. But there should

be separate room for it.

Interviewer: You have taken privacy as a positive challenge and they should be

kept in another room. What are the other challenges we can talk about it?

R2: There is a challenge related to culture as well. In our culture abortion had been

considered as a taboo. It is very important to guide their families and attendant

that miscarriage is not related to culture. If you are willingly doing it so it’s another

thing. It’s a challenge for us to guide them about the culture and practices.

Interviewer: Others please share your views as well here. As we are talking

continuously and every ones opinion is compulsory as well. Do you have any

suggestion in your mind you can discussed here as well? Tell me about those
females who suffer from pregnancy loss as we were talking about it. Did you had

participated in any of the course or training related to loss of pregnancy

R1: It’s the first time we got the opportunity here about detailed discussion about

this topic otherwise this topic is not highlighted or focused anytime.

Interviewer: During your curriculum did you studied about loss of pregnancy or it

was included in your curriculum or you had studied somewhere else?

R1: No, specifically we didn’t studied about this topic we took antenatal class here

where nurses were explained about all and related to patients.

Interviewer: Did you had attended any such training?

R3: No, we didn’t attended none of training but learned a lot from cases.

R2: In my 20 year career there is no such training. I had studied here and also got

experience from here

Interviewer: What should be done for your training if a module will created what

should be included further in it. Kindly please tell it’s your component. Share your

ideas here
R1: As we discussed earlier about apla test they should tell us about the indications

of this test and role of Injection Clexane. What are there co-morbid, indications

and contraindications?

R3: They should tell us about the lacking and what are our mistakes. So we should

avoid these in future. If there is any case so they should discussed with us every

time

Interviewer: What should be done for enhancing your expertise?

R4: Every case had a different study and had a different root cause. If there is any

case study in clinic so not that day, might be before the study or after the study.

They should arranged a session for us. This enhances our information, awareness

and the ability to do counselling of patient. This also enhances our counselling

skills as well. In this way patient will be satisfied from nursing care as well as from

consultant expertise. Secondly, the miscarriages rate and chances will reduced if

we will get awareness and education which will be proper and authentic. This will

reduced the ratio of miscarriages

Interviewer: You discussed very well. You provided information related to health

care provider now tell me about those females who came with loss of pregnancy

what should be done for them who are suffering from anxiety or depressed. What

activities should be arranged for them?

R1: As we discussed in starting we took them in isolation room and do counselling

that it’s not your husband or your fault. Its natural phenomena. We will advised

them for pre pregnancy conception and tell them before conceiving you should

firstly visit the doctor. After miscarriages many females came before conceiving so

they can prevent themselves from loss.

R2: We can guide their attendant with the help of patient. Make changes in the

environment of your house. From hospital we should trained them about the

changes in their homes. Don’t stressed about it. Don’t show this to patient.

R4: According to hospital policy we took patient to post-operative room from

gynae ward and we as well as doctor do their counselling. There is a main role that

patient should counselled by family not by individual. This should include nursing

service, health care worker who dealed with this case. After been discharged from
hospital how should she maintained herself as health care worker , physiological as

well as mental health , family and husband support teaching should be given to

them . We should create layouts as we create teaching material. In this

circumstances we should create material on gyne. We gave teaching to post-

delivery patient. We should prepared teaching about antenatal and post natal and

teach them in a class. Thank you so much

Interviewer: What you expect for yourselves in curriculum

R2: Learning layout, our consultant oriented RMO’S by the session or case so they

should include ourselves in this case as well. Early Teop’s 10 to 25. These are

topics which we need awareness. How should patient care themselves mentally and

physically in IUD’S and early TEOP ‘S? Nursing and doctor care plan and should

aligned both nurses and doctor on teaching

Interviewer: Lastly, if anything missed and it should be part of our discussion then

we will winded up our session.

R1: We will emphasized on husband counselling and some couples wished that the

termination should be kept confidential

Interviewer: Thank you so much for your precious time and healthy discussion.