Miscarriage care in Scotland: delivery framework

Foreword

The loss of a baby, no matter at what stage of pregnancy, has a profound and lasting impact on women and their families. To all who have experienced such a tragedy, I offer my deepest sympathy.

The Scottish Government recognises this impact and is clear that women and families who have experienced pregnancy or baby loss, must be provided with the right information, care and support taking into account their individual circumstances.

I understand that not all women and families want to talk about their miscarriage; however, sometimes they choose to remain silent due to the stigma or perceived stigma they feel surrounding their loss. It is vital that as a society we break that stigma and begin normalising conversations about miscarriage and the compassionate care and support women, and their families should expect to receive at this difficult time.

Women and families deserve the best care. That is why we enshrined miscarriage in our Programme for Government and set out our commitment to introducing a graded model of miscarriage care, so that women do not wait until a third miscarriage to receive tailored support, including access to progesterone prescriptions; and ensuring that separate spaces are available in maternity units for women who suffer a miscarriage.

We also committed to the introduction of a Memorial Book and certificate for those who have experienced a pregnancy or baby loss prior to 24 weeks. I am pleased that the Memorial Book and certificate became operational in October 2023. National Records of Scotland administer this service, which is free of charge, completely voluntary and historical applications are welcomed, as are applications for more than one loss.

I know that there is already a lot of work underway within NHS Boards to improve their provision in relation to miscarriage care and I’m delighted that we are now able to publish this Delivery Framework for Miscarriage Care, and a Progesterone Pathway, which will help and support NHS Boards to implement the Programme for Government commitments and deliver sensitive and compassionate care.

I am deeply grateful to the Chairs of the Short-Life Working Group and Writing Group for leading this work and I want to thank the members of both groups for their time, input and dedication on the Delivery Framework for Miscarriage Care and Progesterone Pathway as well as their support for women and their families following a miscarriage.

Implementation of the Framework and Progesterone Pathway will help ensure that early pregnancy care is equitable so that no women are disadvantaged regardless of where they receive their care.

Jenni Minto, Minister for Public Health and Women’s Health

Services which provide care for women with problems in early pregnancy are of fundamental importance. The care received can make a difference for the future of every woman accessing early pregnancy services. It is vital that there is both equity of access and provision across Scotland. Sitting at the interface between gynaecology and obstetrics, the huge numbers of women requiring these services mean that those involved in providing these services and their importance and impact cannot be underestimated. Scotland, as an early adopter of the concept of Early Pregnancy Units, run by nurses and midwives, has a long history in providing dedicated specialist miscarriage care. This document, produced by a committee of experts, stakeholders and patient representatives, is designed to consolidate good practice in miscarriage care throughout Scotland, regardless of location.

Colin Duncan, Professor of Reproductive Medicine and Science at the University of Edinburgh

Professor Justine Craig, Chief Midwifery Officer for Scotland

Co-Chairs of the Short Life Working Group on Miscarriage Care