"Poor maternity care"

In January, I had a medically managed miscarriage. I initially attended RAH A&E IN December, there they did all they could as the early pregnancy unit (EPU) was not open at the weekend. On the Monday, I was contacted and initially offered the Wednesday which I strongly declined as I felt being left 5 days wondering if my pregnancy was viable or not was cruel. My husband was offshore unable to get home & being my first pregnancy, I had no idea about any pregnancy pathways & felt I had to fight to get an answer to a simple question - is my baby okay? After numerous complaints, I was finally given an appointment for the Tuesday. 

My first point - As per nice guidelines 1.2.1, there should be a 24/7 approach to EPU for situations such as this so scanning and management can be completed urgently. Why is this not possible in NHS GGC? And if it is only Monday-Friday, why are these woman who attend A&E with bleeding in early pregnancy not given an urgent appointment on the Monday?

Once we got into EPU at QEUH, I was mostly met by friendly and compassionate staff. We had to wait a further week prior to confirming it is officially a miscarriage which in the end, it was.

Once it was officially diagnosed, we were directed to a nurse to understand my options. Again, being my first pregnancy I had no idea what was happening & being 11 days on since my initial A&E visit we were tired, angry, anxious, scared and fed-up. The nurse advised the options: either wait for it to pass naturally, have a medical management or have a suction procedure. When asked about what my best option was at that time I was told only I can make that decision. Some more direction would have been useful, as they are medical professionals with an abundance of knowledge and skills. We didn’t feel the information given to us in person was very helpful or in-depth, and when asked what I could expect when it passes, I was told it will be like period cramps and then I will pass a small mass. I was then given a leaflet for a miscarriage awareness website and told to read up on my options.

At this point, we felt the information and discussion was substandard at best. We were told to seek guidance from the miscarriage awareness website and that this website would contain more useful information. The website was much more informative than the information given in person & had a variety of case studies from woman who report their experiences with their miscarriages. Contrary to the earlier advice I was given, not one case study mentioned period cramps - because why would they? The medical management is ensuring the uterus contracts to expel the tissue. From my basic biology, this will be different from the lining of your womb shedding or similar to period cramps. Some case studies reported it was worst than childbirth pain, had to have gas and air lay on the floor in absolute agony all night. I was beyond terrified - going from being told it was like period cramp pain to reading it was worse than childbirth pain was a shock. Granted everyone has different pain thresholds but even with the highest pain threshold, advising a woman it is period cramps is false.

This is my second point, please do further training in having those difficult conversations with your patients. They deserve to know more about the truth rather than read about it from home on a website.

When we attended the day of the medical management, we were passed from department to department, before finally arriving in the right place. I’d been in so much pain the night before that the ward staff wanted to re-scan. We were then sent down to the ultrasound room and made to wait. Whilst there we were surrounded by people coming out with lots of pictures of their babies, and could hear people whooping in the ultrasound rooms. As much as these people should be absolutely ecstatic with their happy news, our world was falling apart and it was absolutely gut wrenching to be witness too. Why is there nowhere protected for people suffering miscarriages to go?

We must stress this is not a complaint but constructive feedback for the future where some sort of quality improvement would benefit the miscarriage process. It’s known, that miscarriage happens to 1 in 3 - so why is the process not streamlined? As a duty of care for these woman and their partners, it should be clear cut from the beginning. They should be given clear & realistic information, rather than a watered down version and not sent home to read the truth. Nobody should be made to sit in an ultrasound department surrounded by happy faces going into see their baby while their heart is broken. They shouldn’t have to tell someone (who is just trying their best) that you cannot wait for a further 48 hours for an appointment time, as we do not have the strength to wait 4 days to understand our babies future.

As a staff member of a clinical team within the NHS, I fully understand there are constant pressures; But being a patient for the first time, I didn’t feel informed or supported during my darkest hours. The NHS is a lifeline when you need it, but I felt that came 4 days too late.

My feedback is to try ensure EPU services are available all year round. I hope that the necessary process means they don’t need to be surrounded by others who, quite rightly, are euphoric at their scans. Furthermore, the information process should be clear & concise ensuring proper information is provided every time, no matter if it’s their first, second or third time going through a miscarriage.