What miscarriage care misses

A new group wants to humanise treatment for women with early pregnancy loss.

---

While Australian medical care for the physical effects of miscarriage is second to none, it’s lacking when it comes to psychosocial care. A new lobby group is taking the issue to Canberra.

The newly formed Early Pregnancy Loss Coalition has brought together clinicians, people with lived experience, non-government organisations and researchers investigating both the social and clinical aspects of miscarriage under one umbrella.

The move follows recent successes from advocacy groups focused on endometriosis and stillbirth, which lobbied for and were able to achieve national action plans for their respective conditions.

EPLC aims to address the four key areas of care, communication, data and research.

Thanks to vague AIHW descriptors and MBS items that don’t distinguish between miscarriage, elective abortion and termination for medical reasons, there is no solid data on how many miscarriages occur each year, although it is thought to occur in about one in four pregnancies.

University of Melbourne department of general practice deputy head Professor Meredith Temple Smith told The Medical Republic that recent research has found that there’s typically very little psychosocial care for women who have experienced miscarriage.

“Frequently after having had a miscarriage, people feel confused and upset and angry and sad,” she said.

“And they don’t necessarily have a good outlet for these.”

Professor Temple Smith co-founded Miscarriage Australia, which provides resources for Australian women and families who have gone through miscarriage and is on the EPLC’s policy advisory committee.

One of the key improvements to care that EPLC is calling for is to move early pregnancy assessment services – which manage women with pain or bleeding in their first trimester – away from maternity wards.

It’s also calling for the AMA, RANZCOG and RACGP to stop using “offensive” terms like “spontaneous abortion”, “incompetent cervix” and “failed pregnancy” to help reduce stigma around miscarriage.

The unintended consequence of a system that focuses on the physical health of women post miscarriage, Professor Temple Smith said, is that mental health care falls through the gaps.

“We know that people who have had really strong support all the way through the system, who feel like they knew exactly what was happening to them, where they were going to go next, et cetera – all of those people will do so much better in recovery than people who don’t know what’s happening next and feel completely powerless,” she said.

RACGP spokesman on antenatal and postnatal care Dr Wendy Burton told TMR that some of the nuances of caring for miscarriage can get lost because it’s so common and because it can mean different things to different people.

“Sometimes these are the griefs that can’t be spoken,” she said.

“Everyone says, ‘oh you’ll be fine, just get on with it and have another baby and you’ll forget’ – some do, but some carry it with them.

“The expectations they had, the names they had chosen, the schools they were going to go to.

“Make no assumptions.”

Dr Burton said she had been reflecting on her own practice and her role as a miscarriage educator for other GPs.

The slide that she typically uses for education sessions on early pregnancy bleeding lists four questions for doctors to answer: “Is the woman haemodynamically stable?”, “Where is the baby?”, “What blood type is she?” and “Is the baby alive?”

“They are the medically necessary things, but I really need to add a fifth point: [asking that woman] ‘are you okay?’” Dr Burton said.

“After we sort out all of those important things – and they’re important to families, just like they’re important to medical people – everybody’s journey is different.”

The next step, she said, is for doctors to initiate that discussion, rather than assuming the woman will bring it up herself.

“I think we [GPs] have a role of advocacy, I think we have a role in support and being part of the support network,” Dr Burton said.

“I’m just really pleased to see [noise around] something that is so incredibly common that it suffers from being overlooked.”