Do we need more care and compassion for women experiencing miscarriage?

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Like many miscarriages, mine began with a spot of blood. It was nothing more than a tiny speck, but it sent my heart plummeting to my stomach. It was the beginning of the end of my first pregnancy and I was distraught.

I didn’t know what to do, I was only 6 weeks along and I was painfully aware of the odds. I called my GP surgery and explained what was happening. They advised me to come in as soon as possible.

My regular GP wasn’t available. Her colleague was cold and clinical, filling in an ultrasound referral while I sobbed, gulping for air like a wounded child.

This was the first of a series of interactions with medical professionals that left me feeling patronised and dismissed. To them I was just a statistic, an every day event, no big deal. None of them acknowledged what I was feeling: that I had lost a baby.

This is a common experience. In fact, it is so common that Mumsnet, the UK’s largest parenting website, has just launched a campaign calling for more care and compassion for women who are having or have had a miscarriage.

“Thousands of women have used Mumsnet to share heartbreaking stories of miscarriage care falling short. We believe the National Health Service should provide effective, responsive care and treatment to the one in five pregnancies that ends in miscarriage, but while some trusts provide great care, unfortunately, others do not,” explain Mumsnet.

A survey of 1000 Mumsnet users found that the treatment and support of women following a miscarriage failed to meet official guidelines. This included having to wait over 24 hours for a scan and being treated alongside women with healthy pregnancies.

So are things any better in Australia? Professor Steve Robson is vice President of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. He says that the treatment of women experiencing early pregnancy loss is something that the medical profession takes very seriously.

“We put a very high premium on communication management and providing support,” he says.

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“All trainee obstetricians have to attend a specialised communication skills workshop that covers how to interact with patients and how to provide support,” Dr Robson explains.

These skills are tested in role-play situations using actors and marks are allocated based on how well they interact with their patients.

“We take it very seriously,” he says. “The management of early pregnancy loss is a high priority.”

Although medical professionals such as obstetricians are given training on how to support women through early pregnancy loss many Australian women are unsatisfied with the level of care they received when they miscarried.

Anna* was 11 weeks pregnant when she started bleeding. Alarmed that something was wrong she went straight to her local hospital. But the doctor that she saw in emergency did not take her case seriously and refused to refer her for a scan.

“It was horrible,” she says. “I was made to feel like an idiot who didn't know her own body.”

It is not uncommon for women to be left feeling dismissed and patronized says Anne Bowers, a parental supporter and spokesperson for Sands Australia, a charity for bereaved parents.

Bowers also says that another thing women feel distressed by is the very medical terminology that is used. “Terminology such as aborted pregnancy, or referring to the lost baby as an embryo can be very upsetting,” she says.

“What the medical profession often fail to address is that miscarriage is a hugely emotional experience, it’s not an illness or a procedure,” Bowers explains. “Many women see miscarriage as the loss of their baby.”

What women want

The Mumsnet miscarriage code of care asks for the following measures to be introduced by the health system, to lessen the trauma of pregnancy loss. They include:

1. Supportive staff
GPs and hospital 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.

2. Access to scanning
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.

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.

4. Good information and effective treatment
All women experiencing miscarriage should receive clear and honest information, sympathetically delivered.

5. Joined-up care
Information shared sensitively between midwives and GPs, for continuity of after-care and to avoid women being hounded or billed for missed appointments.

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