Tommy’s National Centre for Miscarriage Research, based at the University of Birmingham, has for a number of years been providing evidence to call for more consistent care for women experiencing baby loss before 24 weeks.
In a big step forwards the Government are taking notice of the recommendations outlined as part of the Pregnancy Loss Review, including making a commitment to evaluate the results of the ‘Graded Model of Care’ pilot, designed and conducted by researchers in Birmingham.
Currently, access to miscarriage care can vary depending on where you live. Women and birthing people are normally expected to have three miscarriages before they qualify for care or pre-conception advice that could prevent the loss of another baby. Mental health or bereavement support is patchy and the scale of the problem is not fully understood because miscarriages are not recorded consistently.
There is no scientific logic behind waiting until a woman has had three miscarriages to provide care. We don’t wait for someone to have three heart attacks to take them seriously.
Professor Arri Coomarsamy, OBE, Director of the Tommy’s National Centre for Miscarriage Research and Professor of Gynaecology and Reproductive Medicine, University of Birmingham
The Graded Model of Care would go some way to changing this. Designed to make sure families can access standardised, best practice care when they experience miscarriage, the model sets out that:
- Women and birthing people should be seen by a healthcare professional after a first miscarriage, screened for mental health, and provided with guidance and information to reduce the risk of future miscarriage.
- After two miscarriages they would have an appointment in a nurse or midwife-led clinic in an Early Pregnancy Unit and have access to further tests, including blood count and thyroid function, referred for specialist care if there is a need, and have access to early reassurance scans in future pregnancies.
- Following a third miscarriage they would have a consultant-led appointment at a recurrent miscarriage clinic, and further advanced tests and treatments.
The new care guidelines we’ve created and implemented in a pilot study at Birmingham Women’s Hospital show how we can practically provide best practice care which is backed by the latest research – we'll be evaluating its success at the end of this year. It’s an extremely welcome development to see our care model recommended in the Pregnancy Loss Review and the potential of our work recognised by Government. But change for the hundreds of thousands of people impacted by miscarriage in the UK each year will only come with the Government's continued support and with increased investment to ensure specialist nursing staff and resources are available.
Professor Arri Coomarasamy OBE
The Pregnancy Loss Review recommends that NHS England should work with the Royal Colleges to develop standard primary and secondary care clinical guidelines for miscarriage to include the Graded Model of Care. It also recommends the Royal College of Gynaecologists and Obstetricians update their Green Top Guidelines for recurrent miscarriage to bring these into alignment.
We’re delighted to be one step closer to introducing a system of compassionate, flexible, care for all. For too long we’ve had a postcode lottery of care depending on where you live, as well as a system which fails to recognise the serious mental health impact of miscarriage on women, birthing people and partners. It is simply not acceptable that people must wait for a third devastating and traumatic miscarriage until they qualify for any sort of support and care which may find answers and treatments which might help them bring home a baby. We’re pleased to see the Pregnancy Loss Review also recommends that guidelines must be flexible to accommodate and prioritise different factors such as older maternal age, infertility, recurrent loss, and other medical conditions. Ensuring everybody receives equitable care does not mean ‘everybody receives the same care’ - it means creating a system that understands individuals’ needs and the care that’s right for them.
Kath Abrahams, Tommy’s Chief Executive
As many as one in five pregnancies result in miscarriage, but while miscarriage is the biggest cause of pregnancy loss, it is also the least understood and so further research in the area is vital.
