"Early Pregnancy & Miscarriage"

I phoned the RAH maternity unit during early hours recently. I spoke to a midwife and explained that I’d experienced a gush of clear fluid at 11 weeks pregnant which had woken me and was worried I was having a miscarriage. The midwife asked if I was certain it wasn’t urine, which I was. They put me on hold to speak to another midwife on duty and when they came back, said they couldn’t be sure it wasn’t urine and that I should put a sanitary pad on, cross my fingers and hope for the best. They said if I started to have bleeding or contractions which I couldn’t cope with, then I couldn’t be seen at the maternity unit because it was the weekend and that I should present to A&E.

Bleeding/cramps started next morning so I did go to A&E, to wait for 3 hours to be seen while in the waiting room miscarrying and to be told I shouldn’t have been sent here, there is nothing they can do and they can’t scan you to confirm you’re miscarrying, and they don’t know why the maternity unit tell women to come to A&E. The A&E consultant told us our only option was to find a clinic who would scan me privately to confirm that I was in fact miscarrying (no pregnancy tissue had passed at this point).

We did find a private clinic in Glasgow and when scanned there that afternoon, the sonographer said they couldn’t locate a pregnancy in the womb. At 11 weeks this was a concern, so they wrote down the number of every Early Pregnancy Unit in Glasgow and asked us to urgently call each one until we could find someone in the NHS who could scan me that day and rule in/out an ectopic pregnancy.

We phoned each one and left a voicemail for each as we couldn’t get through. After an anxious few hours with no response, we went to A&E at the Royal Infirmary. I got myself in front of a nurse at the reception and explained what we’d been told at the clinic. We were seen on the gynaecology ward by a consultant within half an hour. I was scanned, the miscarriage was confirmed and our care continued at the Royal Infirmary from there, which was excellent. The staff on the gynaecology ward told us they have abdominal and internal scanning facilities available 24/7 and couldn’t understand why the RAH wouldn’t have referred me to there instead. 

The experience highlighted to me:

1. The difference in both compassion and treatment at Early Pregnancy Units (EPUs). I feel the way I was treated by the EPU at the RAH during a vulnerable time of need lacked care and compassion. I understand that there is nothing that can be done to reverse a miscarriage, but to take no steps to help with diagnosing one (and telling a patient to simply put a pad on and hope for the best) feels cruel. I felt my description of loss of fluid was dismissed when asked twice if I was sure I hadn’t just wet myself. 

2. How poor the planning is at the RAH for miscarriage care in Early Pregnancy. I was told upsettingly when I called the RAH that night that because I hadn’t yet had a 12-week scan (which was days away at this point), I couldn’t be seen there and would just have to go to A&E. Again, this made me feel like both my concerns and my pregnancy were being dismissed, and deemed not worthy of an in-person assessment. To then go to A&E and be told that I shouldn’t have been sent there just compounded the feelings of helplessness in what was already a vulnerable and scary situation. 

I have since been lucky enough to have fallen pregnant again and reluctantly have kept my care at the RAH. This is my third pregnancy post-12 weeks. My feeling is that post-12 weeks care is generally excellent. But pre-12 weeks, I feel like women are being let down.

During week 7/8 of my current pregnancy, I phoned EPU to raise concerns about cramps and spotting and to ask for a scan. I was told I didn’t meet the criteria for a scan, that they don’t do reassurance scans and just to keep an eye on things and phone again if they get worse. I have friends who have been cared for at other hospitals, and in each case where they’ve raised early pregnancy concerns or history of at least one miscarriage, they have been seen in person and scanned. This would seem to be such an obvious thing to do to either confirm concerns or put anxious, hormonal, pregnant women's minds at rest. 

Sincerely hoping that feeding back on my and my partner’s experience can influence some change to ensure care for women in early pregnancy experiencing potential miscarriage symptoms can be improved at the RAH.