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Despite this, the psychological consequences of rEPL are often overlooked, particularly when considering future reproductive health or approaching subsequent pregnancies. The SARS-CoV-2 pandemic led to significant reconfiguration of maternity care and a negative impact on the perinatal experience, but the specific impact on women\u2019s experience of rEPL has yet to be explored. This study aimed to examine the impact of changes to early pregnancy loss care and social restrictions during the pandemic on women\u2019s experience of rEPL.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A qualitative interview study design was employed, with semi-structured interviews conducted virtually. A total of 16 women who had suffered two or more early pregnancy losses (\u2264\u200914 weeks gestation) during the SARS-CoV-2 pandemic in the United Kingdom participated. Data were recorded, transcribed, and analysed by hand, following a Classical Grounded Theory Analysis, appropriate for cross-disciplinary health research.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Iterative and inductive analysis generated the theory \u2018Knights in Shining Armour and (M)others in Life Jackets\u2019, which describes women\u2019s experience of advocating for care alone, when suffering rEPL during the pandemic. This theory was derived from the way in which three emergent themes inter-related: (1) Dismantling Validation; (2) Preserving an Identity of Motherhood; and (3) Support Waning.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>This study affirms recent findings of devalued maternity care during the pandemic, and magnification of pre-pandemic issues with EPL care, such as a lack of support or perceived empathy.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12889-024-20882-2","type":"journal-article","created":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T09:52:55Z","timestamp":1738144375000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Knights in shining armour and (M)others in life jackets: Women\u2019s experiences of advocating for care alone when suffering recurrent early pregnancy loss during the SARS-CoV-2 pandemic"],"prefix":"10.1186","volume":"25","author":[{"given":"Flora E.","family":"Kent-Nye","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kayleigh S.","family":"Sheen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen","family":"Burgess","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Munira","family":"Oza","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura A.","family":"Magee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Davor","family":"Jurkovi\u0107","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sergio A.","family":"Silverio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,1,29]]},"reference":[{"key":"20882_CR1","doi-asserted-by":"publisher","first-page":"331","DOI":"10.2147\/IJWH.S100817","volume":"9","author":"H El Hachem","year":"2017","unstructured":"El Hachem H, Crepaux V, May-Panloup P, et al. 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All participants provided informed consent to participate.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and consent to participate"}},{"value":"N\/A.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"This work was formed as a sub-study of The PUDDLES Study, which has looked at the experiences of late-miscarriage, stillbirth, neonatal death, and associated care during the SARS-CoV-2 Pandemic. PUDDLES is one of many UK-based studies which feeds directly into PIVOT-AL. At a meeting of PIVOT-AL in November 2021, two areas of research were identified as being unaddressed by current or ongoing pandemic-related portfolios of research: early pregnancy loss and early elective abortion care. This study was therefore devised in response to a call from PIVOT-AL for researchers to plug this lacuna. The PUDDLES programme of work has been discussed with members of the NIHR ARC South London Patient and Public Involvement and Engagement [PPIE] meeting for Maternity and Perinatal Mental Health Research (July 2020; June 2021), which has a focus on co-morbidities, inequalities, and maternal ethnicity; a meeting with the Chief Midwifery Officer and the Maternity Transformation Team of NHS England and NHS Improvement (July 2020), at a meeting focused on multi-morbidities and maternity safety; and an NIHR ARC South London Work in Progress Meeting (October 2020), focusing on maternity and perinatal mental health research. This work has also been discussed at PIVOT-AL national collaborative meetings (November 2021; April 2022; September 2022), a research collaborative which is leading on the national response for policy makers during the pandemic; and to NHS England and Improvement\u2019s Chief Midwifery Office (December 2021), which focused on early insights from new research on maternity services to inform service COVID-19 recovery. Further input was received PPIE members at King\u2019s College London\u2019s Department of Women & Children\u2019s Health Maternal and Perinatal Mental Health Systems & Policy Research Group Meeting (October 2021) and the Department\u2019s PPIE Group for Perinatal Bereavement, Trauma, & Loss (March, June, & October 2022). To ensure sensitivity and appropriateness of recruitment materials and interview schedules, and to aid recruitment, The PUDDLES Study team originally worked with the International Stillbirth Alliance, Tommy\u2019s Charity, and Sands. Subsequently, PUDDLES \u2013 Early Pregnancy Loss has worked in conjunction with Petals: The Baby Loss Counselling Charity, The Ectopic Pregnancy Trust, and The British Pregnancy Advisory Service. Through all these engagements, we received feedback on recruitment, study design, and interpretation on findings from both lay and expert stakeholders, including members of the public, those with lived experience, health and social care professionals, researchers, and policy makers.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Patient and Public Involvement and Engagement"}},{"value":"This manuscript was derived from the Master\u2019s Thesis of Ms. Flora E. Kent-Nye, who was awarded Mary Seacole Prize at King\u2019s College London for being the cohort\u2019s Highest Achieving Student, and the thesis itself won the 43rd Annual Conference Master\u2019s Prize from The Society of Reproductive and Infant Psychology. None of the authors have any other competing interests to declare in relation to this manuscript.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"367"}}