Miscarriage care in Scotland: delivery framework

Background

The Scottish Government committed through the Programme for Government 2021 – 22 published on 7 September 2021 and the Programme for Government 2023 – 24 published on 5 September 2023 to: improving miscarriage care so women do not wait until a third miscarriage to receive tailored support; supporting access to progesterone when indicated; providing separate spaces in hospitals for people who suffer a miscarriage, and launching the Memorial Book of Pregnancy and Baby Loss Prior to 24 Weeks. Further information can be found in Annex B (Programme for Government) and Annex C (Memorial Book of Pregnancy and Baby Loss Prior to 24 Weeks).

These Programme for Government commitments built on previous publications and commitments to develop:

• a miscarriage service tailored to the needs of women, taking forward the findings of the Lancet series, Miscarriage matters, and supporting the development of individualised care plans after a woman’s first miscarriage.
• ensuring that maternity departments have dedicated facilities for women who are experiencing unexpected pregnancy complications.

The Memorial Book of Pregnancy and Baby Loss Prior to 24 Weeks was launched by the former First Minister on 4 October 2023 and is now operational. The scheme is administered by National Records of Scotland, working with Scottish Government, to give recognition and comfort to those who want to record their loss. Further information on the Memorial Book of Pregnancy and Baby Loss Prior to 24 Weeks can be found at Annex C.

As part of the work to fulfil the Programme for Government commitments, Scottish Government analysts carried out a scoping exercise across all 14 NHS Boards into the availability of services within Boards for miscarriage and unexpected pregnancy complications. A national report and 14 individual NHS Board reports have been produced with senior board review and sign-off following analysis of responses of the scoping exercise and these will help inform improvements to miscarriage services. The reports were published on 29 November 2023 and the findings were presented at a Scottish Government ‘Miscarriage Event’ for health professionals and third sector stakeholders on the same day. Links to the National and 14 individual Board Reports can be found at Annex B.

The Scottish Government put workstreams in place to inform this Delivery Framework for Miscarriage Care in Scotland, and all workstreams fed into its development. These include:

• development of an NHS Scotland protocol for progesterone to ensure that women who have had at least one previous miscarriage, and present with early pregnancy bleeding, are offered vaginal micronised progesterone, where it is clinically indicated, in line with relevant Royal College of Obstetricians and Gynaecologists (RCOG) and National Institute for Health and Care Excellence (NICE) guidelines (Annex B).
• development of comprehensive patient information, in collaboration with Tommy’s charity, in addition to updating information for health professionals and the wider public. A working group was established with wide representation from charities and health professionals to help develop these national information resources. This information is available via the NHS inform platform and in digital and physical leaflet format I think I'm having a miscarriage: leaflet and After a miscarriage and Miscarriage: dads and partners.
• commissioning Public Health Scotland (PHS) to collect meaningful miscarriage data, which will provide a more accurate picture of the number of miscarriages in Scotland. Initial work is concentrating on establishing data collection for miscarriages presenting to EPU/EPAS settings.
• ensuring implementation of the National Bereavement Care Pathway (NBCP) NBCP Scotland in all 14 NHS Boards. Further information on the NBCP can be found at Annex C.
• updating information on NHS inform about preconception care following a loss which links to information on Tommy’s website. This information sits on the Women’s Health Platform and is contained within a section on planning a pregnancy.
• exploring, with NHS Education for Scotland (NES), what additional training is necessary and can be developed for health professionals in relation to miscarriage care.
• initiating work to map mental health services following a pregnancy and baby loss so that, where indicated, women can access appropriate mental health support should they require it in addition to bereavement care. Considering how counselling and psychological services (including third sector organisations) could be expanded/improved so that, where indicated, women can access the appropriate mental health support following a miscarriage.

When I tell people I’m a Midwife, a lot of people tell me what a wonderful job I have. It’s true, it is a wonderful job, but sometimes, along with joy, there’s also grief and pain. We need to provide care and support to the families who have experienced the loss of a baby and while we can’t lesson the grief we can ensure that care is delivered in a sensitive environment by staff who are best equipped to provide the care and follow up. As part of the Writing Group, we set the standard for the provision of evidence based care and in doing so will hopefully make a difference to the women and families accessing care in our services.

Jacqueline Whitaker, Head of Midwifery, NHS Shetland

We welcome the announcement of a Delivery Framework for Miscarriage Care and Progesterone Pathway in Scotland, which will ensure that everyone affected by pregnancy loss before 24 weeks gets the high-quality care and support, they need.

Clea Harmer, Chief Executive,

Sands