Miscarriage and the NHS - help me prepare

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I had a private scan yesterday where I was measuring only 2mm and no heartbeat was identified. I spoke to a midwife today who said I have to be scanned again in a week but to expect the worst. I spoke to her a bit about managed miscarriage options and what to do if the miscarriage occurs naturally.

On the latter, I was pretty shocked when she said that if I feel really unwell or bleed heavily that I should go to A&E. Knowing how busy my local A&E is I really do not want to end up there and I don't understand why care isn't provided in the Early Pregnancy Assessment Unit. Is this the case everywhere? I know it is beyond my control as to whether I do need urgent help but any tips people have who have found themselves (sadly) in that situation would be appreciated. I cannot imagine how awful it must be to be bleeding heavily and in pain and waiting for 6 hours.

If a miscarriage doesn't happen on its own, I'll have to look at my other options: medical or surgical. Similarly, what have your experiences of these on the NHS been?

For context, I had a MMC before but was living in a different country. There I had medical management on a special ward. I was able to stay over night when it didn't work and was given a D&C the morning after.

Lastly, has anyone accessed any mental health/ counselling support for miscarriage on the NHS? I'd guess it's not available but forgot to ask.

I know the NHS is really struggling but I do have this (possibly outdated) fear that services for miscarriage are awful and we have to advocate for ourselves a lot. Hence me wanting to be as prepared as possible.

Thanks in advance for your help. And sorry if this message sounds cold/ pragmatic. I am very upset and also really nervous about what's inevitably in store for me.

You will need a referral to EPU and that is through your GP, 111 or in an emergency, A&E. You've been given the right advice. With both my miscarriages I went to A&E but was up on EPU within approximately an hour or so.

Miscarriage counselling is hit and miss within the NHS. Most perinatal teams aren't commissioned to cover loss, especially not early loss. Talking Therapies will see people, you can usually self refer. You will get the best support from community organisations. The Worst Girl Gang Ever is a good place to start.

I'm sorry for you loss x

Also just to say it sounds like this pregnancy was very early - whilst it doesn't change the impact of your loss, physically I really wouldn't panic too much about a hugely traumatic experience awaiting you.. my early losses passed with no trouble or extra support needed, not even paracetamol. The grief was by far the worst part but the physical impact was really minimal.

I had a MMC picked up at a dating scan and was sent straight to EPU. Pregnancy stopped at 5/6 weeks.

Had to have 2 scans a week apart at the EPU. They were lovely and booked medical management but was on a general day ward. However they did tell me what to expect if things happened naturally. Staff again were lovely and told me not to answer question 14 on the preop questionnaire when they handed it to me ( the are you/do you think you are pregnant).
It's trick as EPU isn't all pregnancy loss so they are managing early scans and high risk pregnancies as well as losses.
I definitely preferred being at home over this period than stuck on a ward.

Thank you so much @TheQuietestSpace. So sorry to hear about your losses. It is however reassuring to hear about your swift referral to the EPU. And thanks so much for the recommendation - I'll check it out.

I was also wondering about the physical aspect. I should be around 7 and a half weeks but as you say, I am measuring tiny. I am probably a bit more nervous about hemorrhaging as I did when I gave birth to my DD although I suspect that probably doesn't mean anything when it comes to likelihood of heavy blood loss during for a miscarriage in future pregnancies.

Thank you again - your input has already made me feel less alone and more informed!

Thanks @LostMySocksand sorry for your loss. It sounds like you had decent support and care - shame about having to play the game on the questionnaire but at least it was helpful for you. I do really think it sounds like EPUs need to have more dedicated resource for loss but understand there are such limited and contested resources!

Definitely understand your preference for being at home. I'm worried because I have a toddler and she's been upset about me being in bed during the day with pregnancy sickness etc. I think either I'd have to go somewhere else or she would if there's potential for me to be in pain / lots of blood.

Thanks again

I was turned away from A&E when I had mine. The reception booked me in for EPU a week later

Oh no @mill1969is that because you didn't have excessive bleeding/dizziness etc?

Hey there, so sorry to hear your news. The NHS only supervise the MC after they’ve confirmed it on the re-scan - then they offer you options such as expectant, medical or surgical and you’ll be well supported.

If you MC before a re-scan or have any treatment to bring it on however you are expected to have it at home and only go to A&E if complications arise. These are things like bleeding through a pad every hour, fever, dizziness etc. A&E will refer you to EPU then or if it’s serious complication you will get treated. They do prioritise in A&E triage severe blood loss so don’t worry about waiting around.

I had my MC at 8 weeks before a re-scan to confirm though was expecting it. I had severe period cramps all night and popped a lot of paracetamol and then terrible pain and diarrhoea when I passed the sac/embryo. The terrible pain did not last long and as soon as I passed the sac it just stopped. My bleeding was manageable eith just maxi pads so I didn’t need A&E. I did call EPU and got a prescription for a stronger painkiller dihydrocodeine but by the time my DH picked it up the pain and MC was over. So don’t want too long to ask for pain relief like I did.

All in all I had one evening of mild cramps, a night of severe cramps but I still managed some sleep and then a few hours in the am of more painful cramps and bleeding before it stopped. My bleeding wasn’t very heavy tbh and only lasted another few days. A rescan in a week showed I had cleared all the tissue except a tiny bit which came out in my period that started 3 weeks later.

Stock up on maxi night pads, paracetamol and a hot water bottle. I also slept with a towel on my bed in case I flooded but it was never heavy enough to even stain my underwear. At the first sign of it starting call EPU for a prescription for stronger painkillers and keep an eye on how frequently you’re changing pads.

I hope it’s quick and as painless as possible.

Also do reach out to Tommys or the Miscarriage Association (nhs give you leaflets when MC is confirmed). You can call the helplines (number online) and they are wonderful and supportive to help you with the mental/emotional fallout.

They said they don't 'do' miscarriages in A&E as they don't have scanners so you have to wait for an appt with EPU

Thank you so much for sharing your experience@houwseevryweekend. I'm so sorry you had a loss as well and I'm grateful for the tips and advice.

I had two miscarriages last year. The first I bled through 3 night pads in an afternoon so I presented at a and E early evening. When I arrived the board said there was a 5h wait but I was sent straight to a different part of a and E where the waiting room had just 3 people in. I was seen in about 10 minutes. They did my observation, took some blood to measure my HCG and haemoglobin. They said I could wait for the blood tests to determine if I could go home and wait for my scan at the epu the next morning or if I needed to be admitted for observation. They said the bar for admission was quite high and as my observations were ok I was likely to be ok at home. I decided to go back home and they would call me if my bloods came back off and I required monitoring. We were there for about 45 minutes in total.
The scan the next morning showed no pregnancy so I lost it with the very heavy bleeding the day before. As the pregnancy had never been observed by scan they decided to monitor my HCG until it was back to normal as a pregnancy of unknown location was a possibility although highly unlikely. It halved between my trip to a and E and being seen at the epu and took 3 weeks to get back to normal.

The second miscarriage was observed as I was having scans through the rainbow room at the epu. I started bleeding the day before the last scan to confirm the loss. I was given the options of taking pills to help it along. I decided to give my body a few days to do it's thing and they phoned me 2 days later to see how I was getting on. I had an evening of very heavy bleeding the night after the scan when I passed the pregnancy. It was within the same parameters of the last miscarriage so felt comfortable managing it at home and didn't go to a and e. I had been told that if the very heavy bleeding lasted longer than last time and the epu wasn't open to present at a and E.

I hav just seen your comment about your daughter. I was around my daughter (4y) during both losses. I passed both pregnancies in about 36h from the start of bleeding. The first time I managed a day out with her and the second time I went to her Christmas play. I popped her in front of the TV whilst I had to sit on the toilet with the heavy bleeding the first time for about 20 minutes, the second time my partner was doing bedtime when the very heavy bleeding started. There was quite a short window of time where I wasn't up for parenting each time....much shorter than the time in the previous weeks when I had been incapacitated with pregnancy sickness!

Night pads and leggings or shorts to make sure they are held in place.