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18 March 2013

bpas blog: ‘We don’t choose to miscarry. We should at least get a choice about how it is handled.’

Katherine O'Brien discusses the difficulties many women face when trying to access medical management of miscarriage.

On 25 February the Miscarriage Association launched their campaign to get people talking about miscarriage. At bpas, we often see women who are experiencing a miscarriage or at risk of miscarrying and wanted to highlight the difficulties many women face when trying to access medical management.

The National Institute for Health and Clinical Excellence (NICE) have recently published a new guideline on the care of women who miscarry in the early stages of pregnancy. The aim of the guideline is to ensure all women are able to access the best possible information, care and support they need, wherever they live, at whatever time they need it. The recommendations include setting up a seven-day service for women with complications in early pregnancy, and ensuring that all women are fully informed at every stage and given the time to discuss any concerns or questions that she might have.

These moves are of course welcomed. However, many were disappointed to see NICE also recommend that women’s choice about medical treatment should be restricted. For the first 7-14 days, NICE recommends that the first line strategy for women with a confirmed diagnosis of miscarriage should be“expectant management.” This means no medical or surgical management, just “letting nature take its course.”

The Miscarriage Association, who support people who have been affected by miscarriage and work to promote good practice in medical care, have criticised this restriction of women’s choice, stressing that most women have a definite preference for one management method or another, and this enforced waiting can be extremely distressing.

On Mumsnet, which is running a Better Miscarriage Care campaign, women have been expressing their anger over this recommendation:

“Waiting 14 days is barbaric. That’s is why I went privately the day after my miscarriage at 11 weeks was confirmed, I could not wait the 14 days the NHS had offered me.”

“Carrying a baby you know to be dead is awful. I have never felt any kind of healing could begin to take place until the miscarriage is over and you stop being pregnant. I felt like my body had become a grave the one time I waited ten days to miscarriage naturally. Time just stopped.”

“The recommendation re: 7-14 days waiting for expectant management are particularly cruel: how can you function for that long, particularly in a working environment, waiting for “nature to take it’s course”.... I could not face the wait & was worried about having a natural miscarriage while trying to look after a toddler.”

1 in 5 pregnancies will end in a miscarriage. For many women and their partners this can be frightening and lonely time. To remove a choice, to force women to wait for a treatment that they know they want and prolong any kind of distress, seems like a cruel way of raising standards in an area of care that so many women will one day need.

“We don’t choose to miscarry. We should at least get a choice about how it is handled.” bpas blog, 18 March 2013

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