Before discharge
Aim to ensure women and partners understand possible or likely physical symptoms and know whom they can contact – as well as when and how – whether a healthcare professional or support organisation.
Women and partners often tell us they are shocked and distressed by the intensity of symptoms that they had not been prepared for, and they were not always clear who could support and care for them following discharge.
What do we need to do?
- Ensure the woman is told about the possibility or likelihood of continuing or increasing pain and bleeding, which she may find distressing, and when and how to contact a healthcare professional. Discuss lactation and milk suppression if appropriate.
- Provide information on continuing care/follow up for this pregnancy loss and, if known and appropriate, on the hospital’s policy for offering investigations into possible causes.
- Provide information, if appropriate, on the hospital’s policy for early scanning or testing in pregnancy after this loss.
- Discuss with the woman and partner the emotions they may experience, so they know that feelings of grief and loss are common and understandable, but so too is acceptance and in some cases, relief. Avoid the word ‘normal’ in case they don’t feel this way.
- Offer contact with the spiritual care/chaplaincy team.
- Promptly inform primary care staff and all relevant departments that the woman has experienced a miscarriage, ectopic or molar pregnancy, so that future associated appointments are cancelled.
- Offer to mark the woman’s notes to alert staff who provide further or future care, e.g. with
a teardrop sticker or digital icon. If the loss was from a multiple pregnancy, offer to use the ‘Butterfly Sticker’, available from the Twins Trust, and ensure staff recognise this as identifying women and partners of a surviving baby who have suffered the loss of a baby/babies from a multiple pregnancy. - Ask the partner if they would like their own GP to be informed and if so, take details and action this.
- Before the woman and partner leave the hospital, give them the contact details for primary care and secondary care staff and local and national support organisations.
- Advise all women and partners on how to request a follow up appointment with the unit (if available) and/or their GP. If you offer a follow up appointment, explain what to expect from it and if possible, book the appointment allowing sufficient time for the woman and partner to ask questions and talk about their experience.
- Offer referral to a recurrent miscarriage clinic if appropriate.
- Offer to cancel the Baby Box delivery if it has already been requested, and the woman, partner or a family member wishes. The box can be cancelled by calling 0800 030 8003. The call can be made either by the parent, a family member or a nominated health professional. However there is no need to cancel if they prefer to have the box.
- Consider NICE guidance on antenatal and postnatal mental health and SIGN guidance on perinatal mood disorders.
Feedback
- Discuss with the woman and partner how they can give feedback about the bereavement care they received. If the woman and partner give consent to be contacted for feedback, let them know how and when they will be contacted about this and document consent to participate.
- Let women and partners know they can give feedback to hospitals and other healthcare services and share their stories via Care Opinion.
Lack of information when you go home, basic change pad but nothing else what do I do? Surely they could provide a booklet with different scenarios in it. Something explicit, both verbal and a written leaflet with more detail.
The miscarriage clinic gave me information but only after three miscarriages, support group posters in GP surgeries would help.
I was referred to a psychologist after my second miscarriage who referred me to a bereavement counsellor. Why couldn’t the GP have done this earlier? GPs did not know about support groups.
How will we know we have achieved our aim?
Women and partners will tell us they felt informed and knew what might happen next and whom to contact for any further care and support they needed.
Staff will say they feel confident and competent to provide clear information, identify contacts for further care and signpost support organisations.