The Miscarriage Care Initiative Spreads to St. Louis


The Miscarriage Care Initiative (MCI) expands access to evidence-based, patient-centered early pregnancy loss (also known as miscarriage) care in primary care settings.  Our vision is to support family physicians and health care organizations to integrate all three forms of early pregnancy loss management – expectant, medication, and manual vacuum aspiration (MVA) management – into their clinical practice.

RHAP worked with Affinia Healthcare in St. Louis, Missouri on the Miscarriage Care Initiative starting in the summer of 2018.  Drs. Baum, Tepe, and Pachalla at Affinia Healthcare describe how participating in this program impacted their work.

“Affinia Healthcare is a large FQHC in St. Louis, Missouri that serves 43,000 patients per year in an integrated model of medical, behavioral, and dental health. Within primary medical care, we have a large women’s health department that performs around 1600 positive pregnancy tests per year and delivers approximately 800 babies. Early pregnancy loss is a very common occurrence, but stigma prevents many patients from talking about this experience. Without any support, it can be traumatizing and emotionally exhausting. Affinia Healthcare is a trauma-informed care organization with a mission to provide high quality health care. Many patients are comfortable in our office with the team that normally cares for them. They appreciate being able to access services in this familiar setting and avoiding the hospital experience and cost. Offering the full spectrum of early pregnancy loss care in a safe and comfortable environment is an example of how the health care we provide aligns with our trauma-informed and patient-centered ideals.

Through RHAP’s Miscarriage Care Initiative, we were able to bring together a diverse team from our staff to integrate all the aspects of full spectrum early pregnancy loss care. Our team was co-led by an OB/GYN and a Family Medicine physician.  Our organization’s chief medical officer (an OB/GYN) led administrative logistics and the entire team collaboratedwith  nursing staff, pharmacists, and administrative staff. RHAP provided support in the form of sharing draft materials, ensuring deadlines, sharing best practices and articles, and providing technical assistance. Together, we’ve achieved every aspect of the program goals, including integrating medication management using mifepristone and misoprostol as well as aspiration procedures.

Within just one year of starting the MCI, we have completed approximately 10 early pregnancy loss procedures. The current polarized climate often prevents patients from accessing the reproductive health care they need, which is why we’ve worked so hard to establish high quality standard of care therapies. This has made the difference for patients like KW. KW, a long-time patient with Affinia, was thrilled when she found out she was pregnant. She scheduled her ultrasound and prenatal care visits with our team. Before her first appointment she started spotting and went to the hospital where an ultrasound showed signs of an early pregnancy loss. We brought her back to our office one week later and confirmed that she was no longer pregnant. Our team used a patient-centered and trauma informed approach to counsel KW on her options, and she decided to try watching and waiting. When this didn’t work, she was able to come to our office where she had been receiving care and get an aspiration procedure. Through participating in the MCI, we were able to develop the systems, policies, and supports that KW required to receive sensitive and high quality care from clinicians she already knows and trusts. She didn’t have to go to a different office, deal with unfamiliar clinicians, or get saddled with the large bills that often come with going to the hospital. We also have the pleasure of continuing to provide care to KW, who is again pregnant, and now with a viable pregnancy. KW, and many patients like her, are why we were so thrilled to work with RHAP and participate in the Miscarriage Care Initiative. 

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