Key recommendations – ten changes to make the experience of miscarriage less traumatic
GPs, Early Pregnancy Unit (EPU) and A&E staff should be trained in communication techniques (including things NOT to say to women who are miscarrying), basic counselling skills and the psychological effects of miscarriage.
Access to scanning facilities in the case of suspected miscarriage should be easier. This could mean Early Pregnancy Units (EPUs) opening seven days a week and/or portable ultrasound and trained medical staff being available in A&E and gynaecological units at all times as standard.
Women undergoing miscarriage or suspected miscarriage should be separated from women having routine antenatal and postnatal care, or women terminating an unwanted pregnancy. EPUs should be sited in hospitals' gynaecology, rather than antenatal, departments or next to A&E departments, to ease women's referral route.
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.
Consideration should be given to renaming the surgical procedure Evacuation of Retained Products of Conception (ERPC) as many parents find this confusing and upsetting.
Everyone who has a miscarriage confirmed should have the three options explained to them: 'natural' miscarriage; medication to speed up the natural process; and surgery. What each option involves and the likely timescales for each should be explained clearly, sympathetically and honestly either by trained medical professionals or in a leaflet.
In the case of miscarriage occurring in hospital, doctors should discuss with the parents what they wish to happen to the foetus (i.e. it should not just be disposed of routinely).
Follow-up appointments and/or counselling should be routinely offered after miscarriage, and those who are miscarrying naturally at home should have the option of a scan to check that there are no ongoing complications.
Information about pregnancy and miscarriage should be held centrally so that all pregnancy-related appointments can be automatically cancelled. Failing that, community midwife teams and GPs should be informed immediately when miscarriage has occurred.
Further consideration should be given to routine blood tests for chlamydia/lupus, blood clotting disorders and antiphospholid syndrome.