*****warning – discusses miscarriage****
I didn’t expect to write this post. Ever. It happened five years ago and I was – and am – fine.
But I’ve been following Mumsnet’s Miscarriage Care campaign. I’ve read about other women’s stories. I’ve heard experiences which have left me in tears: not, necessarily, at the loss of a child, but at the lack of compassion shown. I don’t think that it should be like this.
I was, and am, one of the lucky ones. I never had any problems conceiving. All seven times. Three of those resulted in my three beautiful children. Three ended, in that brutally efficient way nature has, fairly early on; decisively and without the need for any medical intervention.
But the seventh, before my youngest, was different. I reached nine weeks without any apparent trouble, but then I started bleeding. I assumed the worst, but my midwife, over the phone, was cautiously optimistic, while telling me what to watch out for. I went on holiday with my extended family, to Center Parcs, as planned. Without too many graphic details, I was pretty sure that I miscarried while I was there. When we came back, I felt increasingly unwell. It was a Friday night. I checked the warning signs my midwife had given me, and I ended up at A&E.
At this stage, I had no real hope of the pregnancy. I was very sad, but I was resigned to the loss. My concern and my reason for going to hospital were the pain and bleeding which my midwife had warned could indicate complications.
I was on my own as my husband had to stay with our other children. I was seen, after a reasonable wait, among the Friday night A&E crowd. The doctor was visibly annoyed that I was there, and made several remarks which let me know he thought I was trying to jump a queue to be seen. There was no prospect of a scan till early the next week, he said, before he examined me. And then he told me, brusquely, that he had no way of knowing whether or not I had miscarried, even when I explained what had been happening over the past few days. At this point, tired, hormonal and now desperately confused, I burst into tears. The doctor looked at me sobbing, sighed, and said in a slow, deliberate voice “I can’t tell you if you are still pregnant. You will just have to wait. Why are you crying?”
So I left A&E, with tears running down my face, and I waited for a taxi among the other discharged patients heading home or back to the pub. I went to bed, still in pain and bleeding, with no idea of what to think, but with a stubborn grain of hope I hadn’t had before.
I got my scan eventually, five days later, in the antenatal unit, surrounded by bumps and the memories of happier earlier visits.
I had lost the pregnancy, as I had always known that I probably had.
There’s nothing that anyone could have done to change the outcome. There’s a lot that could have been done to change how it was handled. If circumstances – or I – had been different, I can’t help but think that the experience in the hospital would have made the loss of the pregnancy even harder.
I still count myself one of the lucky ones. I went on to have another baby, and the bleeding in that pregnancy was dealt with much more sensitively. My experience was not among the dreadful ones I have read about, and I have had some wonderful antenatal care over the past nine years. Too many women suffer needless additional distress after or while miscarrying, though.
This is why I have asked Jeremy Hunt, Andy Burnham and Norman Lamb to support Mumsnet’s 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
All women experiencing miscarriage should receive clear and honest information, sympathetically delivered. Women should be given information about all the available management options – expectant, medical and surgical – and should be able, clinical considerations allowing, to choose the method of management that best suits their circumstances. Women miscarrying at home should be offered appropriate prescription pain relief. In the case of miscarriage occurring in hospital, doctors should discuss with the parents what they wish to happen to the fetus (i.e. it should not be disposed of routinely without prior consultation).
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 sympathetically.