Aims and objectives: the aim was to examine whether women in the UK are supported to make high-quality decisions about miscarriage management and to identify factors associated with decision quality. The objectives were to: identify factors associated with decision quality, miscarriage management options offered and the extent to which these align with current national guidance; investigate the extent to which women feel able to make informed, high-quality decisions about their care; and evaluate women’s experiences of decision making in miscarriage care, including how informed, supported and confident they felt in their choice.

Methods: a cross-sectional mixed-methods study of women who had accessed care for a miscarriage at ≤12 weeks’ gestation across the UK in the previous 18 months. Decision quality was measured using the decisional conflict scale (DCS), with regression used to identify predictors. Free-text responses were analysed using reflexive thematic analysis.

Results: 115 women responded to the survey. Mean DCS score was 36.10 (SD=25.99), below the 37.5 threshold for clinically significant decisional conflict, although 44.3 per cent of participants scored above this cut-off. Lower conflict was associated with one being offered a preferred option, receiving verbal explanation and being offered more than one management type. Half of participants were offered only a single option, most often expectant management. Thematic analysis identified supported choices, marked by genuine choice and adequate information, and restricted choices, where expectant management was often presented as default.

Conclusion: experiences of decision making varied considerably. Findings highlighted the need for consistent preference elicitation and clearer processes to support shared decision making in miscarriage care.