"Early pregnancy care - could be better"

Over the last two years I have had three miscarriages, and so have spent a lot of time on G1 and have seen many members of staff. Overall, the experience has been very mixed.

After my first miscarriage, I submitted a complaint through PALS, which G1 never responded to. I had called several times during the pregnancy with concerns about bleeding and was dismissed, so that when I went for my 12 week scan I was informed my baby had died over a month before. I subsequently had a very painful medical management, with a three hour delay on receiving analgesia. When I rang with concerns about bleeding, I was dismissed again and it was over a month later that I was finally seen and diagnosed with retained products of conception which required surgery a week later.

When I had bleeding early in my second pregnancy, I was given a scan, but as it was so early it was inconclusive. Serial blood tests confirmed a likely viable pregnancy along with a follow up scan. As per guidance, I asked for progesterone to support the pregnancy, which I was not allowed. Unfortunately, another missed miscarriage took place. On this occasion, I was offered information on bereavement support and the medical management was an easier experience. My main concern during this pregnancy was the continued challenge in getting through to the ward.

In my third pregnancy, I requested a scan for reassurance, given my previous losses, as had been promised to me, but this was declined. At a private scan, I was told that I had lost the third pregnancy and was referred to G1. When I attended there a week later (the earliest available appointment) the nurse asked why I hadn't had an NHS scan - which of course I had asked for and been refused. Unfortunately, when I came in for the medical management, I had not been booked into the en suite room as promised and had to pass the pregnancy in a toilet on the corridor, without my partner for support and wait outside the toilet until someone could come and collect it. 

I am now in my fourth pregnancy, and have again had mixed experiences. I have struggled to get through on the phone, usually ringing constantly for at least 15 minutes, sometimes longer, to get through. I have been lucky enough to have scans for reassurance and been prescribed the progesterone I asked for, and many of the staff have been understanding and supportive, considering my past history and the trauma from my care experience there. However, having been advised to call if I had any concerns about the pregnancy, when I did ring because of bleeding and loss of pregnancy symptoms (my only signs of my previous three miscarriages) I was advised to wait until the following week before they would consider doing a scan, because its not good to do too many scans in early pregnancy. When I asked why, I was told it is because of the radiation, which is of course concerning misinformation to be given. 

I have since had some bleeding whilst on holiday and received an excellent service, hence providing my story now. It is so disappointing that my local service has fallen so short of what has been offered to me elsewhere. 

My suggestions would be:

1. Better communication via the phone triage service - I have never gotten through the first time I have rung, and despite suggesting this service be reviewed in my PALS message two years ago, this has continued to be a challenge in this pregnancy.

2. Training for staff - a sister providing telephone advice should be aware that ultrasound is not a scan involving radiation for example. I have received such different advice - some saying to call if I lose pregnancy symptoms, some saying that is normal, some saying that bleeding is normal (and that I should only call if bleeding more than 1 pad an hour) and others saying I should have been seen when I started spotting. I have seen a doctor on only one occasion, who was able to answer the questions I had efficiently and confidently. 

3. In an ideal world - more scan availability. Ultimately, the only way of knowing that a pregnancy is progressing in the early stages is by a scan. Bleeding, cramping and loss of pregnancy symptoms can be normal, but it equally can indicate miscarriage. Had my concerns been taken seriously at every stage in my first pregnancy, for example, my miscarriage could have happened in June 2023, rather than experiencing the series of complications which led to treatment finally being complete in September 2023.