How you can support the Better Miscarriage Care campaign

 Better miscarriage careIf we're going to manage to effect real change in miscarriage care, we're going to need the collective might of Mumsnet to swing into action. We're asking everyone to:

UPDATE, June 2014: For latest news on our campaign, please click here.

NHS policy is largely set at a local level, and while national political pressure is important, it won't get very far unless your local hospitals, GPs and community midwives hear about the changes we want to see.

So, we've laid out some template letters below to get you going. As ever with letter-writing campaigns, if you can personalise your letters and emails, it makes them even more effective (some campaigners say one personal, handwritten letter is worth about 1,000 template emails).

Write to your MP

Please note: when you contact your MP using the WriteToThem widget, it's crucial you do so in your own words, or your email won't be sent - WriteToThem's software will weed them out as spam.

So, here's a suggestion of some of the things you might like to mention in your email, but please don't copy and paste them; instead, use your own words, and where possible (if you feel comfortable doing so) use details of your own experiences.

  • One in four pregnancies ends in miscarriage, meaning that it happens to hundreds of thousands of women every year
  • Clear clinical guidance from NICE and the Royal College of Obstetricians and Gynaecologists is often not followed
  • Lots of hospitals and individual healthcare practitioners do provide careful, sympathetic care, so it's not that these things aren't possible

Pick out the Miscarriage Code of Care points you think are most significant, and say why they matter to you. Ask your MP to say that they will publically commit to help deliver the code of care by raising it with local hospital trusts, strategic health authorities and primary care trusts, or perhaps by giving an interview to your local paper about it.

When sending a letter, please remember to include the Mumsnet Miscarriage Code of Care. And please remember to include your full name and full postal address, including post code; many organisations will not reply to you unless you do.

Last but not least, we think it's important to show some MN love and appreciation to the many individual healthcare professionals and hospital trusts that are getting it right in this area. If you've had great care locally, why not write a letter to the hospital or GP practice concerned expressing your appreciation, and asking them what they think they can do to help others follow their example?

Letter to health secretary Jeremy Hunt
To: The Rt Hon Jeremy Hunt, MP
Department of Health
Richmond House
79 Whitehall
London
SW1A 2NS

Dear Mr Hunt,
As you may know, the online parenting site Mumsnet has recently launched a campaign to improve the care given to women (and their partners) facing miscarriage. I'm writing to you to ask whether we can count on your leadership and support in this campaign.

One in four pregnancies is lost to miscarriage, meaning hundreds of thousands of women go through this distressing event every year. Mumsnetters have been supporting each other through miscarriage since the site was launched, and over the years thousands of women have shared their experiences.

The anecdotal weight of this evidence, gathered over the years, is considerable - and saddening. While some healthcare practitioners are excellent, and some hospital trusts have made great strides, there are still far too many instances of poor care, ineffective management and practitioners who fall short when empathising with parents grieving the loss of a baby.

The scale of these experiences was made clear in a recent Mumsnet survey, which showed:
• Nearly two-thirds (63%) of women who miscarried at home following a hospital scan said they weren't offered adequate pain relief
• Nearly half of all women treated in hospital (48%) were treated alongside pregnant women, or women with newborn babies, causing unnecessary distress
• Over a fifth of those referred for a scan (21%) had to wait three or more days
• Over a third (35%) of those who needed a surgical procedure after miscarriage had to wait four or more days
• Over a quarter of those who had information from healthcare staff (29%) rated the information they received as poor or inadequate

National care standards do exist - both the National Institute of Clinical Excellence and the Royal College of Obstetricians and Gynaecologists having published careful guidelines that cover many of the most important points -but the sad truth is that they are often not adhered to. Women still hear themselves being referred to as 'habitual aborters', despite RCOG strongly advising that this term should not be used. Parents in a state of extreme distress are being told that a miscarriage is 'for the best'. Women are waiting unacceptably long times for scans and surgical procedures, and are often expected to spend this waiting period on antenatal or postnatal wards, surrounded by women happily anticipating or celebrating the birth of their babies.

Mumsnet has used its members' experiences to come up with a five-point code of care, which all care providers should be able to adhere to without great organisational disruption. A copy of the code is attached.

I'm writing to you to ask you to support this campaign. As the person with ultimate responsibility for the NHS in England, your support could bring real change. It would send a strong signal to the hundreds of thousands women affected, and to local health authorities and trusts, that care, support and treatment for miscarriage must improve.

I look forward to hearing from you,
Yours sincerely,
Mrs/Ms/Miss/MrMumsnetter


Please customise this letter depending on where in the UK you live

  • Wales People living in Wales should address their letters to: Lesley Griffiths AM, Minister for Health and Social Services, Welsh Government, 5th Floor, Ty Hywel, Cardiff Bay, CF99 1NA. Email: correspondence.lesley.griffiths@wales.gsi.gov.uk
  • Scotland People living in Scotland should address their letters to: Nicola Sturgeon MSP, Cabinet Secretary for Health and Wellbeing, St Andrew's House, Regent Road, Edinburgh, EH1 3DG. Email: Nicola.Sturgeon.msp@scottish.parliament.uk
  • Northern Ireland People living in Northern Ireland should address their letters to: Edwin Poots MLA, Minister of Health, Social Services and Public Safety, Room C5.10, Castle Buildings, Stormont Estate, Belfast, BT4 3SQ. Email: private.office@dhsspsni.gov.uk


Other people and organisations to contact


Letter to local health personnel

Dear XXXXX,
As you may know, the online parenting site Mumsnet has recently launched a campaign to improve the care given to women (and their partners) facing miscarriage. I'm writing to you to ask whether we can count on your support in this campaign, and whether you would consider adopting the Miscarriage Code of Care as a standard to which your [[trust/practice][ will publically commit.

One in four pregnancies is lost to miscarriage, meaning hundreds of thousands of women go through this distressing event every year. While some healthcare practitioners are excellent, and some hospital trusts have made great strides, there are still far too many instances of poor care, ineffective management and practitioners who fall short when empathising with parents grieving the loss of a baby. [[If you have personal experience, please add some detail about it here]]

The scale of these experiences was made clear in a recent Mumsnet survey, which showed:

  • Nearly two-thirds (63%) of women who miscarried at home following a hospital scan said they weren't offered adequate pain relief

  •  Nearly half of all women treated in hospital (48%) were treated alongside pregnant women, or women with newborn babies, causing unnecessary distress 

  • Over a fifth of those referred for a scan (21%) had to wait three or more days

  • Over a third (35%) of those who needed a surgical procedure after miscarriage had to wait four or more days

  • Over a quarter of those who had information from healthcare staff (29%) rated the information they received as poor or inadequate.

As you will know, national care standards do exist - both the National Institute of Clinical Excellence and the Royal College of Obstetricians and Gynaecologists having published careful guidelines that cover many of the most important points - but the sad truth is that they are often not adhered to.

Women still hear themselves being referred to as 'habitual aborters', despite the RCOG strongly advising that this term should not be used. Parents in a state of extreme distress are being told that a miscarriage is 'for the best'. Women are waiting unacceptably long times for scans and surgical procedures, and are often expected to spend this waiting period on antenatal or postnatal wards, surrounded by women happily anticipating or celebrating the birth of their babies.

Mumsnet has used its members' experiences to come up with a five-point code of care, which all care providers should be able to adhere to without great organisational disruption. A copy of the code is attached.


I'm writing to you to ask you to support this campaign. As the person with ultimate responsibility for [[my local hospital/my local GP practice/my local Primary Care Trust/my local Strategic Health Authority]], your support could bring real change.
I look forward to hearing from you,

Yours sincerely,
Mrs/Ms/Miss/MrMumsnetter
 

Mumsnet Miscarriage Code of Care

  1. Supportive staff: GPs, Early Pregnancy Assessment Unit (EPAU) and A&E staff should be trained in communication and listening skills (including things NOT to say to women who are miscarrying) and the psychological effects of miscarriage. Follow-up appointments and/or counselling for those who feel they need it should be routinely offered after miscarriage.
     
  2. Access to scanning: access to scanning facilities in the case of suspected miscarriage should be easier in cases where scanning is clinically indicated. This could mean Early Pregnancy Assessment Units (EPAUs) opening seven days a week and/or portable ultrasound and trained medical staff being available in A&E and gynaecological units. When women have miscarried at home and have experienced severe symptoms, they should be offered a scan to check that there are no ongoing complications. Where medical staff do not believe that a scan is clinically indicated, or that it would be unlikely to produce reliable results, this decision should be communicated to the patient with tact and understanding, and with a full explanation of the reasons.
     
  3. Safe and appropriate places for treatment: women undergoing miscarriage or suspected miscarriage should be separated from women having routine antenatal and postnatal care, or women terminating an unwanted pregnancy. Waiting times in confirmed as well as threatened pregnancy loss, but, in particular, for women who need surgery, should be kept to a minimum and not be spent in antenatal or labour ward settings.
     
  4. Good information and effective treatment: everyone who has a miscarriage confirmed should have the the available options explained to them. What each option involves, the amount of pain and discomfort that might be experienced, and the likely timescales for each should be explained clearly, sympathetically and honestly either by trained medical professionals or in a leaflet. Women miscarrying at home should be offered appropriate prescription pain relief. In the case of miscarriage occurring in hospital, HCPs should discuss with the parents what they wish to happen to the remains of the baby (ie it should not be disposed of routinely without prior consultation). Consideration should be given to renaming the surgical procedure Evacuation of Retained Products of Conception (ERPC), as many parents find this confusing and upsetting.
     
  5. Joined-up care: community midwife teams and GPs should be informed immediately when miscarriage has occurred, and subsequent bookings and scans cancelled, to avoid women who have miscarried being chased by HCPs for 'missing' pregnancy appointments. HCPs should be mindful of a woman's previous miscarriage/s when assessing her needs during subsequent pregnancies, acknowledging any extra anxieties and dealing with them empathetically.


Although this code is based mostly on the experience of Mumsnetters who have miscarried in-utero pregnancies pre-24 weeks, we think many of its points apply equally to women experiencing stillbirths and ectopic pregnancies.

Last updated: 17-Jun-2014 at 9:53 AM