Next steps - first trimester miscarriage
Aim to provide kind and empathic care, give clear information sensitively. Listen carefully to the words that the woman and partner use and take those words and their fertility history into consideration when responding.
Women and partners tell us they felt they were not always treated with compassion by all staff they came into contact with and their previous experiences were not always taken into account.
What do we need to do?
- All staff with whom a woman may be in contact about early pregnancy problems should acknowledge the anxiety she may feel and listen and communicate sensitively.
- Give clear information about what is happening and carefully discuss
management options or recommendations – including risks – if appropriate. - Provide written information and give time for decision making wherever possible.
- Discuss how the place of care – home or in hospital, early pregnancy, gynaecology or maternity ward – and geography may affect the management options available.
- Acknowledge any concerns the woman and her partner may have.
- Sensitively explain any reasons for a delay in further care – e.g. further scans, booking theatre time. Acknowledge that uncertainty and delays can be difficult. Provide written information and signpost online information where appropriate.
- In the Emergency Department, transfer a woman to the appropriate unit/ward as soon as possible or offer support to go home. Provide information about accessing and/or an appointment for further treatment or assessment.
- Provide clear information about possible pain and bleeding, and the possibility of miscarrying before the next appointment, and whom to contact if symptoms worsen before the next appointment.
- If the woman opts for expectant management or medical management at home, explain honestly what she might experience regarding pain
and bleeding during and after the miscarriage. Remember to offer analgesics or advice on over- the-counter options and on the likely need for extra-absorbent sanitary pads. - Acknowledge that waiting for the miscarriage to happen can be difficult and that the process itself may be distressing and provide details of whom she can contact if she needs support.
- In all cases, advise the woman sensitively that she may miscarry while on the toilet and offer information regarding pregnancy remains - see Miscarriage Association's Guidance for miscarriages that occur at home.
- Inform the woman that she can usually change her mind about the management option and provide the appropriate contact details if she does.
- Ensure that all staff seeing the woman and partner during and after the process of miscarriage are aware of what is happening and communicate sensitively, using appropriate language and terminology.
- Aim for continuity of carer where possible.
- Ask if the woman or couple are wondering what they might see when she miscarries and be prepared to talk this through. Offer to tell the woman and partner what their miscarried pregnancy might look like - see the Miscarriage Association’s Guidance on management of miscarriage.
- Ask the woman if she would like the pregnancy loss form completed to alert staff who provide further or future care - a template form is available - or use another means to alert staff such as a teardrop sticker or digital icon.
- Provide information about histology or post mortem examination if appropriate - see After the loss.
- Discuss the options for cremation and burial - see After the loss.
- Describe the help that support organisations can offer and provide contact details if the woman or her partner wishes to have these.
Lack of information, lack of respect, I was bleeding six weeks later, I didn’t know if this was normal no one had mentioned this might happen or explain this is what you may see (lots of blood). No information about when you go home.
I told the professionals my history, I knew my own body and that what was happening was not right but I was ignored and advised that I would be monitored for twenty-four hours as I was not in pain, my husband intervened and I was taken in. A surgeon later admitted to my husband I could have died from loss of blood.
How will we know we have achieved our aim?
Women and partners will tell us they were treated with respect and kindness by staff and received clear information which was sensitive to their individual needs.
Staff will say they feel confident and competent in dealing with women and partners who exhibit any of a range of emotional responses to their situation and in giving clear information.
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