Early care scheme could prevent thousands of miscarriages a year
After experiencing two heartbreaking miscarriages, Lisa Varey found herself confronting an unexpected and difficult reality.
She realized that under current NHS guidelines in England, specialist support is typically only available after three miscarriages. With one in five pregnancies ending in miscarriage, most before 14 weeks, this meant she would likely have to endure another loss before receiving targeted care.
Lisa, 34, told her husband:
"We're not waiting another year. We need to be pregnant and miscarry as soon as we possibly can."
She recalls their shared disbelief, saying:
"We looked at each other and said: 'I can't believe I'm actually saying this out loud.'"
Following her second miscarriage, Lisa was invited to participate in a pilot project at Birmingham Women and Children's Hospital. Experts believe this initiative could prevent thousands of miscarriages annually by providing earlier assessments and guidance.
Tests revealed that Lisa would benefit from taking the hormone progesterone to support her pregnancy, along with a daily aspirin to improve the likelihood of a healthy birth.
Lisa is currently pregnant and approaching the end of her second trimester. She becomes emotional when discussing the significant impact the pilot program has had on her experience.
"There's so much support for pregnant women, but it didn't always feel like there was any support for women who were no longer pregnant. We're having to go through that journey of just feeling very sad."
'You feel like your body has failed you'
Emily, 42, from Birmingham, endured two miscarriages within a year, which left her feeling as though her body had "failed" her.
Having faced challenges conceiving and undergoing multiple rounds of IVF, Emily felt hopeful when she received a positive pregnancy test. However, a subsequent scan revealed the baby was not developing as expected, a devastating outcome.
After experiencing a second miscarriage, Emily was invited to join the Birmingham pilot project.
She was prescribed aspirin and a higher dose of folic acid. Early testing provided possible explanations for her miscarriages, alleviating the "guilt and shame" she had felt.
"Knowing there were things that could make a difference. That gives you some hope to hang on to," Emily said.
Tommy's, a pregnancy charity, has highlighted that NHS care for women who have had three miscarriages can be "inconsistent and inadequate." Prior to this threshold, women are often advised simply to try again at home.
Both Lisa and Emily participated in the Birmingham study, which involved two groups of 203 women each, all of whom had previously experienced miscarriages. One group received standard NHS care, while the other was treated under a new care model.
The innovative approach began offering care after just one miscarriage, with progressively increased support following each subsequent loss. Researchers reported a slight reduction in miscarriage rates among the test group. For those who experienced additional miscarriages, the study ensured they received enhanced care and support.
One in five women in the study were found to have treatable health conditions, such as abnormal thyroid function and anaemia, which can impact pregnancy outcomes.
Although formal data on annual miscarriage numbers is lacking due to underreporting, researchers estimate that if the pilot's findings were implemented NHS-wide, approximately 10,000 miscarriages could be prevented each year.
'Unacceptable anomaly'
Within the pilot project, women who had experienced one miscarriage received a one-on-one consultation with a specialist nurse. This session addressed lifestyle changes, including reducing alcohol intake and quitting smoking, as well as the use of progesterone, a hormone that may help prevent miscarriage.
After a second miscarriage, women underwent testing for anaemia and thyroid abnormalities, both of which can affect pregnancy outcomes. They were also offered early scans to confirm the pregnancy was progressing normally.
Following a third miscarriage, the care pathway aligned with existing NHS protocols, including referral to a recurrent miscarriage clinic, additional blood tests, and pelvic ultrasound examinations.
Professor Arri Coomarasamy, head of miscarriage research at Tommy's, described the requirement to wait for three miscarriages before receiving specialist care as an "unacceptable anomaly."
"We don't do that with any other medical condition. If somebody has a heart attack, we don't say have your third heart attack and then we will see if there is anything we can do," he explained.
He also noted that the study's findings, if adopted across the NHS, could result in cost savings. The pilot suggests that expenses related to additional staff and training would be offset by the reduced number of miscarriages.
Sally, 33, who has experienced two miscarriages, expressed disappointment with the care she received and is currently hesitant to try for another child.
Residing in Gloucester, Sally does not have access to the pilot program but believes it might influence her decision if it were available.
"Putting these systems in place show women that they are thought about, that one miscarriage is enough to be thought about and to be supported," she said.
In the recent Women's Health Strategy announcement, the government indicated it is considering "wider adoption" of the pilot program across the NHS in England.
Baroness Merron, Parliamentary Under-Secretary of State at the Department of Health and Social Care, stated:
"This will be carefully considered as part of our ongoing work to make sure women get the high-quality, compassionate NHS care they deserve."
NHS Scotland has already begun improving miscarriage care by eliminating the wait until a third miscarriage and providing separate rooms in maternity units for women experiencing pregnancy loss.
Northern Ireland and Wales currently follow the same guidelines as England. Researchers involved in the Birmingham project remain "hopeful" that their model will prompt change.
Kath Abrahams, chief executive of Tommy's, emphasized the importance of the pilot in helping women understand the care they will receive.
"Knowing what's going to happen next can be incredibly comforting in a moment when you're in crisis," she said.
For those affected by miscarriage or related issues, BBC Action Line offers information and support.
