The independent ‘Pregnancy Loss Review’ was commissioned by the Secretary of State for Health and Social Care. The review focuses specifically on baby loss before 24 weeks’ gestation, and aims to improve the treatment, care and support for anyone experiencing this type of loss.
Following five years of fact-finding and research by an expert Committee, Co-chairs Zoe Clark-Coates and Sam Collinge published their report on 22 July 2023, and all 73 of its recommendations have subsequently been accepted by the Government.
The Origins of the Review
The loss of a much-wanted baby is devastating, no matter at what stage of pregnancy it occurs. Early loss is commonly viewed as a ‘clinical episode’ by healthcare professionals, which can have the effect of minimising the loss. As a result, the care and treatment, both emotional and physical, offered to both the patient and to their partner, may not be sufficient or forthcoming, compounding their trauma and grief.
There is often no clear pathway for treatment, with women being bounced between locations and services. The Committee heard ‘harrowing accounts of women being made to wait in public spaces, often bleeding through their clothing, while sitting alongside pregnant individuals and their partners. Disturbingly, we heard from many women who had miscarried at home on how they were advised to retrieve their baby’s remains from the toilet and how they had been advised to store their baby’s remains in a Tupperware container in their fridge at home until their local early pregnancy loss unit was open, which was often for multiple days.’
There is clearly much that needs to be done and the report has a long list of recommendations, both for immediate and for long-term implementation.
The Committee’s Vision for a Future System
In its vision for improving the care of people who experience pre-24-week baby loss, the report describes a future system in which they hope:
- everyone receives high-quality education about pre-24-week baby loss before they become pregnant through the statutory relationships, health and sex education (RHSE) curriculum
- all groups of people – regardless of race, colour, age, gender, sexual orientation or religion – have their voices heard and choices upheld
- there is clarity about whom to call and where to go when pain and bleeding occur at any stage of pregnancy, and what to expect during and after baby loss
- access to compassionate clinical care in appropriate healthcare settings is available 24 hours a day, 7 days a week through networked services
- all parents receive clear and consistent information and support, enabling them to make decisions about their physical and mental health care needs during and after baby loss
- care is compassionate, individualised and respectful of personal, cultural, religious and language preferences, and parents and their babies (including baby loss remains at any gestation) are cared for with dignity and respect
- regardless of gestation, all bereaved parents are offered choices regarding creating memories of their baby and options regarding marking their loss, such as funerals or memorial ceremonies, as appropriate
- women and partners experiencing loss are routinely offered mental health support following a loss, and have access to specialist counselling and mental health services, where appropriate
- bereaved parents can, on request, receive a baby loss certificate from the government, whether their loss was recent or historic
- following a baby loss, individuals and couples are supported to understand why the loss occurred, and are offered a follow-up appointment to discuss the results and implications of any investigations. A robust management plan must be in place for subsequent pregnancies – this may include referral to a specialist consultant obstetrician or gynaecologist
- all healthcare professionals working in baby loss services receive multidisciplinary mandatory bereavement care training and information, including education on the importance of psychological wellbeing and self-care for staff to ensure they can provide the highest quality of care. Staff should be allocated time to attend, and their compliance should be monitored
- employers recognise the impact of baby loss on employees and human resources (HR) policies are updated to support their staff
- there are systems in place for employers to manage the potential impacts on the mental health and wellbeing of all staff employed in workplaces providing baby loss services
The Report’s Recommendations
The authors of the report hope that their review is a ‘catalyst for lasting change’ and that it can help to ‘transform the landscape for pre-24-week baby loss care for this and future generations’. The report has a list of 73 recommendations that it believes are crucial to achieving these aims and so improving care for people at a time when they are particularly vulnerable.
They emphasise that ‘Though the journey has been a long and arduous one, it has been a great privilege and an honour to have witnessed many excellent examples of care within the primary and secondary care settings that we visited. Conversely, we were saddened and appalled to hear about and observe some truly shocking practices that require immediate intervention.’
The report states that ‘An estimated 254,000 babies die in pregnancy or at birth each year in the UK. This means that, since this review commenced, approximately 1,270,000 babies have died, leaving millions of parents, siblings and extended family members heartbroken. While it is not possible to prevent many of these losses from occurring, we can ensure that each grieving parent receives excellent care and compassionate support, and we all have a responsibility to do this.’
It is clear from these statistics that urgent change is required to ensure that those affected by such devastating loss get the help and treatment they need.
To to read the full report and its recommendations, please see Pregnancy Loss Review on the Government website.