I’ve just been denied medical management of a failed abortion

[Tinyteatime]

I had a medical termination last Saturday, 7 weeks pregnant after my coil failed. Thought it had passed relatively easily so came away on a short holiday with my family luckily only 1.5 hours away from home. Started heavy bleeding and bad cramps yesterday, came to a&e as as advised by the BPAS clinic as I was flooding a pad and blood leaking through my trousers. Passed some very large clots. Internal scan reveals what they think is a foetal heart beat still in there. I’ve been in hospital one night and they said they would do the surgery on me this morning. I’ve just been told that all the doctors available won’t perform the procedure due to religion. This in the U.K. in 2019, in a hospital that offers abortion services. They’ve said I can stay another night and have it tomorrow, I have a breastfed baby that I’ve already been away from for one night, I’m in pain, bleeding and I’ve already had sepsis last year from a womb infection whilst giving birth so I’ve raised infection risk as a concern. I feel so angry about this. Would they deny women treatment for miscarriage? Or is it because there may still be a foetal heartbeat present? Is it simply because I’ve chosen to end the pregnancy myself? How in an nhs hospital can women be denied healthcare like this?

You have however forgotten that the MN population believe that they own drs and we aren't allowed to have opinions, religious beliefs, families that might interfere with our ability to work full time or antisocial shifts, or in fact any life at all outside a hospital. I think they would actually have us sleep in empty body drawers in the mortuary so that we are on hand the second they step through the door to attend to their every whim.

Cross your legs women and only have your babies between the hours of 9 to 5, Monday to Friday. And for heaven sake, just don't be bothering us with the messy and bloody miscarriages.

Your shifts are 12 hours. You can now elect to work more than 48 hours p/w.

Personally, the first question I would ask anyone in a clinical setting now is how many hours have you worked this week before you treat me.

This is the absolute crux of it. She wasn't presenting with a miscarriage, she was presenting with a threatened miscarriage following TOP ie a live fetus. Therefore further management to end the pregnancy would have involved further TOP.

If the fetus hadn't been live, there likely would have been no issue

I distinctly remember the OP saying that there was a question mark over whether the radiographer had seen a heartbeat during the ultrasound on day one. On day two there was no foetus to be found, only retained products. She believed that the radiographer’s insistence on “maybe” seeing the flicker of a heartbeat was a blatant attempt to be obstructive.

So, the scenario you describe isn’t quite what happened.

Then, it seems, a radiographer who had religious objections to abortions and knew of their close colleagues' religious objections to abortions, did their utmost to find a foetal heartbeat which probably wasn't there, in order to hand off the OP's treatment to a different ward so that they wouldn't have to be involved at all in the OP's post-abortion complications

Very much entering the realms of conspiracy theory here. I can assure you, medics have better things to do than to plot between themselves how best to make the OP suffer.

Agree with just checking

This is the absolute crux of it. She wasn't presenting with a miscarriage, she was presenting with a threatened miscarriage following TOP ie a live fetus. Therefore further management to end the pregnancy would have involved further TOP.

Where you there?

And what does a further TOP mean?

A miscarriage requiring an erpc is exactly the same as someone who has retained products post an abortion. Nature doesn't always get rid of the embryo. Medicine doesn't always cure cancer.

@Haworthia a question mark would suggest they didn't know whether it was live or not. In the absence of a clinical, life-threatening emergency, they were able to assume it was. If the OP had needed life saving surgery right there and then, even conscientious objectors would have gone ahead and done it.

Not wanting to perform TOP on personal grounds doesn't mean we stand back and watch you die on principle

@placemats live fetuses are not referred to as retained products. This is part of what is confusing the thread. No one refused to remove RPOC, they refused to remove a potentially live fetus

So was the 'flicker' that the slightly inexperienced sho saw ever actually confirmed as a live fetus? Apologies if it was I can't see it on the thread.

You did not do the scan. You were not there. Your comments are not those of a health care professional.

@cushioncovers I think it's still in doubt as to whether or not the fetus was live. I think it's reasonable for someone who objects to performing TOP to err on the side of watchful waiting if in doubt, if the patient is clinically stable

Ah ok I see.

Show some empathy for the patient. Read the notes and listen to the patient.

@placemats no you're right, I wasn't there, but the clinical professional who was diagnosed a potentially live fetus. I think we can probably give him the benefit of the doubt, as a trained professional, rather than assuming that he was deliberately out to mislead and misdiagnose his patients?

The fact remains that OP said that her operation was scheduled for the next morning, then she was told to wait, and was told that this was because the scan (carried out by a junior doctor rather than a sonographer) could be interpreted as a heart beat, therefore none of the medics on duty would do an ERP because of religious reasons.

They did not say they were postponing it because she was now stable and had thus slipped down the list of procedures. They said they were not doing it for religious reasons. Explicitly said this to her.

It wasn't a TOP.

@FermatsTheorem the fact she was stable must have been implied though. As I said, even a conscientious objector would have performed the op if it was immediately necessary to save the patient's life

It wasn't a TOP

At the time it was performed it wasn't, but it may have been if it had been done at the time of OPs arrival (or strictly speaking it would have been a termination for medical reasons if it had been needed to save her life)

@FermatsTheorem The fact remains that OP said that her operation was scheduled for the next morning, then she was told to wait, and was told that this was because the scan (carried out by a junior doctor rather than a sonographer) could be interpreted as a heart beat, therefore none of the medics on duty would do an ERP because of religious reasons.

Don't get me wrong, I'm not saying the OP had a gold standard treatment path, it must have been very distressing for her, I'm just saying none of this is negligence or malpractice as other posters have implied

I'm just saying none of this is negligence or malpractice as other posters have implied

You have no access to the medical notes, how can you possibly say this?

It may not be negligence, but it may well be, but that wasn't your opener was it? Just

Just assumptions based on 'guidelines', a search engine and your own opinion.

Just assumptions based on 'guidelines', a search engine and your own opinion 20 years of medical practice

Fixed that for you, @placemats

"But Graphista clinical need was met. She had the procedure as a non urgent elective, which was what her situation called for." It was UNNECESSARILY delayed in a patient with a higher risk of infection generally and sepsis in particular - which ANY Decent hcp wouldn't fuck around with!

"she was presenting with a threatened miscarriage following TOP ie a live fetus." There's no evidence of this in my opinion and I suspect many others. An US carried out by a prejudiced dr with vague claims of a "flicker" is very far from definitive evidence.

Frankly from what the op described it very much sounds like there bias influencing practice, misleading assessment of diagnostic practice and possibly even outright lying (with careful arse covering) re what was found on the scan. And then misleading even deliberately inaccurate assessment of the patients clinical need.

Damn right if I were op I'd be complaining!

I hope op continues to recover well and speedily but quite honestly that cannot yet be assumed will be the case and if she does develop further complications those hcps will be praying she doesn't complain because they could rightly be in serious shit!

I'm pro choice politically pro life personally as in I don't think I'd have an abortion myself. But I've supported friends who've had abortions inc one who was having a very traumatic late one for medical reasons. I've also treated patients who've had abortions.

I NEVER considered it REMOTELY my place to not only judge them for their decisions but refuse or obstruct their treatment! It's an outrageous attitude for an hcp to have.

I've also had to treat paedos, rapists and wife batterers, even a particularly nasty white supremacist twat who was extremely angry and spouting venomous hate filled bile the whole time, even treating wounds of theirs that were inflicted by their victims. I hated their actions and had no sympathy for them being injured but I still carried out my duties and then raged/vented in private.

And they were ACTUAL criminals who did abhorrent things, that were often the reason they needed treatment.

But no hcp would be allowed to object to treating them purely on moral grounds.

There was an Indian dr on rota who ended up refusing to be the one to treat the racist twat, but that was because he was endangering her by being awkward and thrashing about whenever she went near him, but he was bloody mindedly not admitting he refused her treating him (horrible situation).

This is BRITAIN in 2019 the situation op was faced with should absolutely not be happening!

It's unprofessional, it's cruel, misogynistic, outdated bullshit!!

"If the OP had needed life saving surgery right there and then, even conscientious objectors would have gone ahead and done it. "
I'm genuinely concerned that wouldn't necessarily be the case with the hcps op encountered which is why it's important she does complain.

your own opinion-- 20 years of medical practice

You mean 20 years of arrogance. Fixed that for you!

justchecking is right. I also have 20 years of medical practice. none of this is negligence or malpractice, it really isn't. Its a completely miserable experience for the OP, but no-one has done anything wrong.

Failed abortions are common with medical abortions, they should have a seamless process here for that possibility.

I wouldn’t blame a dr for this, no one should force a dr to perform an abortions if they object, but if your clinic does them, you should expect full-service care!

Interestingly, the number of doctors willing to do abortions has risen along with use of the abortion pill, because the messiness and emotional labour is endured by the patient and not the doctor. It’s why I’d always go with surgery, low failure rate compared to medical abortion

placemats, she isn't being arrogant. Someone said the same about me upthread. It just beggars belief some of the ideas that are held on this forum, and when well informed and experienced people (and I'm going to assume that just checking is actually a dr) try to explain how it really works (based on experience and 2 decades of working in the system) they get told they are arrogant.