Better Miscarriage Care: write to your local NHS Trust or practice
Many Mumsnetters report being forced to wait in the same area as pregnant women when suffering suspected miscarriage or miscarriage, contrary to current guidelines.
If you have experienced this, you can copy and paste the below letter to complete and send to your local NHS Trust or practice.
I recently had to attend [trust/practice] because of a [suspected miscarriage/miscarriage].
While waiting for treatment I was seated alongside (understandably) happy, pregnant women. This arrangement compounded the sadness and anxiety [please adapt as appropriate] I felt about what was happening, and I am writing to request that you provide a separate waiting area for women suffering suspected miscarriage or miscarriage as current guidelines recommend.
The Royal College of Obstetricians and Gynaecologists, The Management of Early Pregnancy Loss, Green-top Guideline No. 25, 2006, page 3 states:
"The EPAU service should be comprehensive, and ideally sited in a dedicated area with appropriate staffing. There should be direct access for GPs and certain patient groups. EPAUs should have access to transvaginal ultrasound with staff appropriately trained in its use."
The Department of Health, Health Building note (HBN09-02) states:
"This (early pregnancy care) is a very anxious time for women, and the facilities must above all be easily accessible and designed with these sensitivities in mind. For reasons of privacy and dignity, patient spaces in a dedicated EPAU should be physically separate from the antenatal clinic and the pregnancy assessment unit."
As you may know, the online parenting site Mumsnet has launched a campaign to improve the care given to women (and their partners) facing miscarriage.
[England only] A survey of over 1,400 users in September 2011 found that nearly half of all women treated in hospital (48%) were treated alongside pregnant women, or women with newborn babies, causing unnecessary distress, and an FOI request in October 2012 found that 33% of hospitals that responded did not separate miscarrying women from those receiving routine outpatient antenatal or postnatal care.
Ensuring safe and appropriate places for treatment is a key measure of Mumsnet's wider five-point Miscarriage code of care (attached).
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, I feel the situation I faced at [trust/practice] fell short of the treatment and care needed by parents grieving the loss of a baby.
Please let me know what action you will take to ensure national guidelines are implemented to provide a physically separate waiting space for women who are miscarrying or suffering from a suspected miscarriage, and that your trust will publically commit to adopting the Mumsnet Miscarriage Code of Care as a standard.
You might be interested to read a fuller discussion on this issue here - https://www.mumsnet.com/Talk/am_i_being_unreasonable/1922788
Mumsnet Miscarriage Code of Care
This code has been drawn up after extensive consultation with Mumsnetters, and professional and campaigning organisations working in this area of care. If implemented by NHS care providers, it could help to lessen the trauma of early pregnancy loss for parents.
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 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.
The code relates directly to England and Wales, but many best practice guidelines can equally apply to Scotland.
Last updated: about 3 years ago