MNHQ here: we're after some examples of good miscarriage health care

[RowanMumsnet]

Hello all

As (hopefully) lots of you will know, we're running an ongoing Miscarriage Care Campaign, asking healthcare providers deliver care that matches up to the five points of our code - which are:

1. Supportive staff
2. Access to scanning
3. Appropriate treatment spaces
4. Good information and effective treatment
5. Joined-up care.

Andy Burnham has , and Norman Lamb (the LibDem Health Minister) has personally signed up and is going to try to get it into the LibDem manifesto.

(We're still working on Jeremy Hunt for the Conservatives: if you'd like to add your voice asking for their commitment, have a look here.)

One of the things that would be really useful now is to know which hospitals and healthcare trusts are delivering good miscarriage care.

So if your personal experience of healthcare during your miscarriage was good (as much as these things can ever be), we'd be really grateful if you could tell the us which hospital and/or healthcare trust is, in your opinion, getting it right.

This will help to persuade the politicians that it can be done, and needn't cost enormous sums to get right.

If you'd rather do this off-board, do please email us at [email protected] and put 'FAO Rowan' in the subject line.

Many thanks
MNHQ

I had a msc in 2011 at what was Fairfield in Gr Manchester. They were brilliant, separate waiting areas, kind and thoughtful staff, wonderful care.

I had a mmc at 11+5 weeks, I was referred to the EPU at barnsley hospital after spotting and was seen within a Couple of hours from calling my midwife. I was examined and had my bloods taken but wasn't offered a scan and was told by one of the nurses (very sympathetically) that they aren't offered routinely unless they feel it is an emergency (I.e ectopic), she said they would try and book me on the next available one but wouldn't be the same day. However, I was given one for the next morning at 10am.

The next day we went back and sadly were told there was no heartbeat and the baby had died around 8+5 weeks. We were then taken to a separate room, were brought a drink and the sister went through the options available. During the scan the sonographer asked if we'd like to see the baby which we did and afterwards when we saw the sister she gave us a picture which the sonographer had taken. This meant so much. I rang later that day after reading the leaflets to say which treatment I wanted and opted for medical management.

They couldn't fit me in til the day after next and we were told to arrive 8-9am. As soon as I got into the ward I was in tears and the nurse came up to me and put hers arms around me and walked me to my own room. I also had my own toilet so didn't have to worry about anyone using it after me or trying the door etc whilst I was there. The ward was separate to maternity ward so didn't see any heavily pregnant ladies or newborns etc. I think there were other ladies in early pregnancy on the ward but I didn't bump into any so wasn't aware of any.

The staff at barnsley hospital made all the difference, they really helped me cope with such a traumatic experience and I was treated so considerately and with a lot of respect. I was made to feel like they really cared about me and my husband (who also stayed overnight with me and they fed him too) and it was more than just a job to them. They told me if I needed anything, even just to talk, just to press my buzzer, not even go out to look for someone, and they would come straight to my room.

We were given a 'parents wishes' form about what we wanted to happen to our baby, we choose the cremation at grenoside, sheffield, as this is a special place for me. We could have attended the cremation at barnsley but I wanted it to be grenoside. I was given a leaflet on counselling which is offered at the hospital and when I was discharged they asked if I would like a memory box which I received.

Overall I feel very lucky to have barnsley as my local hospital as the staff there are amazing. The only improvements I can suggest are:

1. Having a scan on 1st visit to EPU.
2. Better advice about going back to work/having time off/getting sick note etc
3. Communication between hospital and my GP so GP knows situation
4. A follow up call from the hospital/GP/ or a counsellor would be useful (although I know this is not necessarily the hospitals remit) as I am 1.5 weeks on and finding it more difficult now it is all sinking in etc.
5. More counselling resources - I called to make an appointment but there was nothing free until December!

Generally these are more practical improvements and the staff (at all levels) at barnsley couldn't have been kinder.

Helen x

Hello

Thank you very much for these. It's good to know that there are some units getting it right. (We take your point, Madrigals, about patchy care though.)

Please do keep posting - one way to account for the patchiness that Madrigals mentions is to see whether we get a few back-pats for particular hospitals from different posters. Going on what's been posted so far, Barnsley and the Lister Hospital seem to be doing particularly well?

As you say care must be patchy as my experience at Wansbeck Hospital (about 3 years ago) for a 12 week MMC was good.

I have a mixed report for the John Radcliffe Hospital in Oxford.

I had my second MMC confirmed there but only after a week of waiting, and then they cancelled my surgical management at the last minute, asking me to go back 2 days later. That was awful.

But when I did finally have the procedure it was handled wonderfully. Efficient, polite, and calm and I was treated separately from continuing pregnancies. All the staff were fantastic.

I had one at Christmas 2007. I thought I was around 12 weeks but when scanned (at St Mary's in manchester) it showed that it had stopped growing at around 7 weeks.

Good experiences.

1 Caring and conscientious staff. Nothing was too much trouble for the nurse looking after me.
2 When dh called the EPU and told them in a panic that I was lying on the bathroom floor, barely conscious and blood was pouring out they calmed him down and instructed him on what to do next. (I lost over a pint of blood and needed several transfusions). The ambulance arrived within 5 minutes.
3 rather than rushing me into theatre for a d&c which was causing me even more distress they gave me a private room, a commode and had a nurse check on me every 10 minutes. They also gave me morphine which helped calm me somewhat. I was in severe pain which I wasn't expecting and was pleased to see that they don't mess about with paracetamol if you clearly need something stronger.
4 they let dh stay by my side and gave him food and drink ( they weren't supposed to apparently)
5 they saved my life. I was devastated to lose my much wanted baby but at least I was still here to care for my other children.

Bad experiences.
1 being told by my GP in a rather blaise manner that I'm probably miscarrying but if not to go back to arrange maternity care. Otherwise to go about my day as normal. All said in a manner as if I said id stubbed my toe. She then rushed me out.
2 waiting for a scan on what was clearly the designated day for sexing scans. I felt bad sitting there on a towel trying not to catch anyone's eye. I know it was an emergency but a different room to wait in would've been less stressful.
3 being asked about my "abortion". I'm pro choice. What a woman decides to do to her body is her choice and nobody's business but to me an abortion is something you choose. An mc isn't. I know they refer to mc's as that sometimes but I really think they shouldn't. Not to the patient concerned.
Also the same goes for other medical terms such as "product of conception". Maybe Find out beforehand if the woman wants medical or non medical terms to be used?
4 Wait until the mc is definitely happening before asking me to fill in a questionnaire about it. I didn't know if I was miscarrying or not when it was handed to me.
5 6 years ago the advice I was given when it was confirmed that I would indeed have an mc was to go about my day as normal. Being treated like a vacuous shopaholic when I felt a pop while Xmas shopping in M&s made me feel terrible. I was trying to take my mind off the fact that I was yet to pass the "product of conception". No one could have predicted the severity of the bleeding. I wasn't thinking straight. I even cleaned up the mess I made in the shopping centre toilet before waddling to the car. These days I hope they give women "permission" to go home and wait, curled up in a sobbing hormonal ball if they so wish.

RHCH in Winchester were amazing with both of my mmc. After the first 12 week bad scan, we were taken straight to a deprecate room to wait; a nurse came first and offered drinks and condolences, a doctor followed soon after to explain next steps; he was so sympathetic I felt sorry for him! Erpc was arranged two days later and again, care was great. In recovery, I didn't need pain reeling but wanted a hot water bottle so the lovely male nurse heated up two saline bags and put them in a pillowcase forme.
Second mmc was dealt with at the EPU, so seperate from the happy scans. Care was excellent again, I chose yo have pessary and go home to miscarry as the theatre wait was 4 days. That was the only failing for me; if they could have done it there and then, I'd have done it. The aftercare was excellent too. I've since had a baby, now 9 months and their maternity services are excellent too.

I had an ectopic pregnancy earlier this year at 7 weeks, not a MC I know but equally as traumatic.

I was rushed in by ambulance as an emergency late at night, after suffering crippling pains.

I had been to see my gp the day before and complained that the pains I was having were not normal early pregnancy pains, he was very understanding and advised that if they got worse then go to the gynaecology unit.

So that is what I did, it took some persuading from my partner to the ambulance staff not to take me to general a+e because they thought it was my appendix. They agreed to take me to gynae in the end and I think that saved my life as the ectopic had already ruptured by then.

At the hospital the staff were amazing, took me into a quiet room and scanned me straight away. Within half an hour I was rushed into surgery and woke up the next day.

The doctors explained everything to me, what happened, the procedure and how lucky I was to have got there in time. It was all very surreal. The care I received from all of the medical staff was amazing, they were very understanding and did actually care about my feelings.

The aftercare was equally fantastic, I had to go for weekly blood tests to check my HCG levels were dropping. I would go into a private room with a nurse to have my bloods done and she would call me in the afternoon with the results and book me in for the following week if needed. The nurses were on hand to give advice and support, which actually helped me a lot. This went on for about five weeks until my levels dropped and I was discharged.

I firmly believe that if it wasn't for the NHS staff, I wouldn't be pregnant with DC2 now or worse, I wouldn't even be here.

This was at Southport & Ormskirk NHS Trust.

I am having a miscarriage at the moment. As soon as I started bleeding lightly (last Thursday afternoon ) I phoned my surgery who got me an appointment at Royal Sussex County Hospital Brighton EPU the following morning. Although the EPU is a bit unfortunately placed on the top floor of an ancient tower block in a tiny windowless room, I was treated kindly and as quickly as possible by the nurse, sonographer and the doctor, who in fact called me the same day to let me know my blood test results and invite me to come back the following week if I still tested positive. I was given lots of information leaflets during this process so I understood the possible things that were happening to me.

Today I have seen my own GP also in Brighton. He was very kind, gave me some stronger painkillers and signed me off work straight away. He also insisted that I come back to see him if I need to talk.

So far I cannot fault Brighton & Hove for their caring attitude and the speed at which I have been seen. I hope with my whole heart that this never happens to me again but if it does I feel that I am in safe hands with B&H.

I'd a miscarriage in September 2013. I'd light bleeding, but 'knew' there was something wrong by the crippling headache I had. The receptionist in my doctor's surgery was appalling - she kept telling me they had no appointments left to see a GP (even though I was asking if I should be seen by GP or go to A&E) and asked me to explain just why I needed to be seen urgently by a doctor in front of a queue of ten people. I ended up in tears and she kept banging away with awful questions in a loud voice about personal things while I held my toddler and cried. Doctor wasn't terribly sympathetic but referred me to EPU next day.

Lewisham EPU was marvellous. Separate waiting area for women who need early scans. I was scanned quickly and told compassionately it was bad news. I was given a private room to call my husband. I was given a lot of information on my options and then given the time to go away and think which was best for me. When I decided on an ERPC (they apologised for the term and said they were in the process of changing usage) I got in first thing next day. I had to stand in a queue of mixed surgical patients (not enough seating). But once inside they separated us from the other patients and we were brought through to a very calm surgical prep ward. Staff who carried out the ERPC were very reassuring and afterwards the care was great. I was given adequate pain relief.

However, once discharged back to my GP's care I found myself back at the mercy of the terrible receptionist and patchy GP care. I've since changed practices.

Edinburgh EPU

Supportive staff. Sensitive. Easy to access without bumping into other pregnant women waiting for scans etc.

I mc our first Dc in March 2013. DH and I had no idea what to do so called NHS helpline. The initial help we received from NHS helpline was very. Unhelpful. Eventually DH made me go to A&E at Hudderfield Royal Infirmary about 11pm. From the moment I got there the doctors and nurses where beyond kind, considerate and very caring.

Huddersfield Royal Infirmary did not have the facilities to help me so immediately arranged a transfer to Calderdale. I was seen that night by an obstetrician and they kept me in over night (on a drip). I remember the evening nurse, who was kind beyond belief. I will never forget her coming in and sitting with me whilst I cried for fear of losing the baby. At that point we had no idea whether or not I had lost the baby.

The following morning they took me in for scans and confirmed the mc. DH was on the way into hospital and missed the scan. Unfortunately the morning nurses weren't so compassionate and put me in a room on my own having just discover I had lost our baby. The obstetrician from the previous night came to check on me and found me alone in the room. She wasn't happy and arranged for someone to stay with me whilst my DH made his way to hospital.

When I look back and compare my experience with others, I was very lucky. My SIL had a mc and went to the same hospital (Huddersfield) and she received applauing and very unsupportive care. She was 14 weeks and they sent her home with paracetamols and told her to wait for everything to pass. No scan, no referral, nothing.

Babykonitsway - I'm afraid I disagree with you there, entrance involves walking into maternity triage, next to the door where people are leaving with the newborns, and usually walking past a heavily pg woman outside to have a final cigarette... Staff nice enough but a different message from each one (eg "you'll get an early scan in your next pg", then "oh no we won't scan you without bleeding", when you are indeed pg again.)
Still, obviously good to have an EPU at all.

slightlyconfused

I have posted this before on MC threads re being treated in the same unit as obviously pregnant women: I know I am quite likely a minority here but during/after my MCs I found it comforting to see other pregnant women, almost as 'proof' that it IS indeed possible for pregnancies to happen (even though it seemed impossible for me). I find it hard to explain, but it was almost as if I needed proof that nature/biology was still doing what it had always done?

It must be hard for busy and overstretched units to get all aspects of this right for every single woman and her particular issues.

As ever IMO the one key issue is good communication and being listened to.

Your are entirely right, Madrigals - I was a bit clumsy in what I said and I know I am a bit of a minority in my examples. Of course the service should set up for what the majority of women find helpful.

The point I was trying to make was that being listened to and having some measure of control is so important what wrt how the experience affects you longterm.

My MCs are now between 5-10 years ago and apart from the sadness every time which I remember well, I cannot say that I have longterm effects from them for which I am grateful and for which I credit at least partially the care I had.

grateful for

Thanks again all. It's really good to read about examples of good care.

slightlyconfused85 - so sorry to hear that you're going through this right now. Best wishes from MNHQ

FWIW we agree that most of this isn't about buildings and equipment - it's about good training and empathetic staff, and joined-up communication between different services within the NHS. Having examples of trusts that are achieving this helps us to show the politicians that it can be done - and is being done, in some places.

Please keep 'em coming - corroboration is very useful. (And thanks madrigals for that link.)

Thanks
MNHQ

I have just had a SMM at St Marys Paddington London.

Overall was treated so well.

1. arrived on theatre ward, was immediately taken to a private consulting room (i.e. no waiting in the general waiting area with 20 other people, whilst emotional, bleeding and in pain)!
2. Theatre nurse, Doctors all treated me with dignity and respect. Not one, mentioned the 'miscarriage' or SMM - thank goodness. All very calm, asked me if I had questions etc.
3. Woke up on recovery, had the most considerate nurse who looked after me for well over 8 hours in recovery due to problems. Cannot fault the service, attention and professionalism.