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Miscarriage Research: The Lancet

Volume 697: debated on Thursday 17 June 2021

Motion made, and Question proposed, That this House do now adjourn.—(Rebecca Harris.)

I would like to thank Mr Speaker, through you, Madam Deputy Speaker, for allowing parliamentary time on this important topic in this Adjournment debate on miscarriage. I wanted to bring to the Chamber’s attention the recent series of papers published in The Lancet entitled “Miscarriage matters” and the petition by Tommy’s on support for women after miscarriages. The petition currently has over 170,000 signatories.

I know that this topic is often one that is difficult to talk about, but I hope that by giving the Chamber an opportunity to hear some of the experiences and latest research, this debate can act as a catalyst for change for miscarriage services in the upcoming women’s health strategy. For too long, miscarriage has been a taboo, and I was disappointed that while the press release on the women’s health strategy call for evidence mentioned breaking taboos, it did not mention miscarriages directly—only pregnancy-related issues.

I am so pleased that prominent women, like Meghan Markle and Myleene Klass, have been brave enough to speak and break the taboo about their experiences. Miscarriage is little spoken about but incredibly common. One in four pregnancies is thought to end in miscarriage. The research suggests that 15% of recognised pregnancies around the world end in miscarriage—that is 23 million a year or 44 miscarriages a minute. Black mothers face a 40% higher relative risk than white mothers and the risk of miscarriages is lowest between the ages of 20 and 29, but goes up threefold by 40 and fivefold by 45. Unfortunately, I think that this commonality and the well-known challenges in women’s health have meant that services are not always set up in the best interests of women. Miscarriages are often a symptom of an underlying health condition. They should not just be seen as a fact of life, and I am concerned that this attitude speaks to wider gendered inequalities in our society.

I shared my own experience in a Westminster Hall debate last year and I have been overwhelmed by families contacting me to share their experiences. I have heard from women who have never told anyone but their partners that they have experienced a miscarriage and women who have experienced this 30 years ago still carrying the hurt, and now, some are seeing their children going through exactly the same issues. Although I spoke of my loss to highlight the impact of the pandemic, what is clear to me is that, covid or not, there are some huge holes—sometimes voids—in the care provided. Some people are lucky enough to have access to fantastic services and early pregnancy units. Others attend their GPs and others end up at A&E. Unfortunately, some attitudes seem to be very, very prevalent both in society and in some health services.

May I just say how moved I was—the hon. Lady knows this—by her contribution in Westminster Hall on that day? It moved me to tears. I congratulate her on securing this debate. We should change the way we handle support for miscarriages as a result of that debate. Does she not agree that the threshold of three miscarriages in a row for NHS investigation must change, as every miscarriage is devastating and the estimation of an acceptable level of loss is abhorrent?

I absolutely agree and I will come on to the issue of how care is provided later in the debate.

There seems to be a general lack of understanding that while miscarriage is common it is also incredibly traumatic and can lead to mental health problems. The Lancet research series highlights that anxiety, depression and even suicide are strongly associated with going through a miscarriage. Partners are also likely to be affected and previous reports have highlighted links with post-traumatic stress disorder. Despite that, the loss associated with miscarriage can often be minimised with phrases such as, “It’s okay, you can just try again,” or “It just wasn’t meant to be this time.” After my miscarriage, I got into a cycle of blaming myself and obsessing over what went wrong—if I ate the wrong thing, lifted something too heavy and so many other ridiculous thoughts. I have had to have counselling to deal with my trauma, but it was not offered. It was something that I had to seek out myself.

The same cycle has been described back to me again and again and again by people who have experienced miscarriages. My brave constituent Lauren, who has allowed me to share her story today, has sadly suffered three miscarriages. She has never ever been offered any mental health support through the miscarriage pathway. In fact, even after she requested it, her miscarriages were not even recorded on her medical notes, leaving her to explain to five different healthcare professionals about her three miscarriages. On one occasion, a member of staff asked her when she had had her first child. That is clearly incredibly distressing, and why I support calls for better data collection and patient recording of miscarriages.

Women have also told me about suffering three, four and five miscarriages. The reasons found for them were underlying health conditions, such as blood clotting disorders, autoimmune diseases and thyroid disease. Since my miscarriage, I ended up in hospital again and was diagnosed with diabetes, an issue that may have been picked up if testing had been carried out at the time of my miscarriage. The information I have received since my diagnosis of diabetes about pregnancy has been very informative and helpful, and a really stark contrast to those who have to get information about miscarriage.

There are some excellent examples and many, many committed staff who often share the frustrations about the system, which has a hard cut-off of 24 weeks for some support services. We have seen a huge number of organisations stepping forward to fill the gaps in support and advice: Tommy’s, Sands, the Miscarriage Association and, locally in Sheffield, the Sheffield Maternity Cooperative. I spoke with Phoebe from the Cooperative, an experienced midwife who herself has gone through a miscarriage. She works with individuals and families across the city to provide timely, appropriate and sensitive care, after her own experiences were, unfortunately, the exact opposite of that.

So what shall we do? I hope today the Minister will respond to the key findings of The Lancet series and to these key asks. The first is that the three-miscarriages rule has to end. The large number of people who signed the Tommy’s petition shows the strength of feeling on that. We would not expect someone to go through three heart attacks before we tried to find out what was wrong and treat them, so why do we expect women to go through three—in some cases preventable—losses before they are offered the answers and treatments they need? Instead, the research recommends a graded support system where people get information and support after their first miscarriage—we should not phrase it like that, though—tests after the second, and consultant-led care after the third.

The second key ask is 24/7 care and support being available. That care should be standardised to avoid a postcode lottery or the patchy provision currently available, and it should include follow-up mental health support to help to reduce mental illness post miscarriage.

Finally, we need to acknowledge that miscarriage matters and start collecting data on miscarriage, stillbirth and pre-term rates. I was shocked to find that no central data existed on the statistics and these estimates are based on very many different sources. We must break the taboo on miscarriage. I know from personal experience, and from many people who have contacted me, that we could do so, so much better. Will the Minister today commit to take forward these proposals and take a stand for women, individuals and families the system is failing? And will she meet me and campaigners to discuss this issue further?

First, I pay tribute to the hon. Member for Sheffield, Hallam (Olivia Blake) for how brave she is. She moves everybody to tears when she talks about her story, because it is personally so touching. I responded to her debate the first time in Westminster Hall. So she has not elaborated on her own situation in the way she did then, but she is so incredibly brave to do what she does and to champion women who have suffered from miscarriages. I also want to say that I worked closely with her mother, Judith, at the beginning of the covid outbreak and her mother must be very proud of her. Her mother is a formidable lady, I have the hugest respect for her and I am sure she is incredibly proud of the hon. Lady today.

I thank everybody who has shown a particular interest in this subject, both in the Chamber and in the Westminster Hall debates that have been held. I also thank Tommy’s, in Coventry—for those who might think I am talking about a hospital over the bridge—a charity that does incredible work to support families through their pregnancy journey, including those who sadly miscarry, with funding research centres and specialist clinics to help us understand why pregnancy sometimes goes wrong and how we can prevent complications and loss, and to provide specialist care for those women who need it. Tommy’s petition to improve miscarriage care has drawn a huge amount of support, and I am glad this deeply important issue has the attention it deserves.

The three papers published in The Lancet provide an important insight into the prevalence, effects and costs of miscarriage, which is the most common complication of pregnancy, experienced by an estimated one in five women. We know that miscarriage can significantly impact the emotional and psychological wellbeing of women and their families. It can be extremely isolating for women and their partners, with long-term complications.

Women who have suffered miscarriage are 3.8 times more likely to die by suicide, and it takes only one miscarriage to increase the likelihood of a suicide for a woman. Such difficult experiences should not be faced alone, which is why as part of the NHS long-term plan we are improving the access to and quality of perinatal mental healthcare for mothers and their partners affected by their maternity experience, including miscarriage.

Mental health services around England are being expanded to include new mental health hubs for new, expectant or bereaved mothers. The hubs will offer treatment to about 6,000 women in the first year for a range of mental health issues, from post-traumatic stress disorder after miscarrying or giving birth, to a fear of childbirth. The new hubs will also provide specialist training for midwives and other maternity staff, as well as reproductive health and bereavement services.

The series in The Lancet highlights the unacceptable inequalities in women’s chances of having a miscarriage; for example, black women have a 40% increased relative risk of miscarriage compared with white women. It also provides evidence of the importance of maintaining a healthy lifestyle before conception and during pregnancy for all women, to reduce the risk of miscarriage. Women who smoke in the first trimester are 1.2 times more likely to have a miscarriage than non-smokers. Women with a low body mass index, under 18.5, are 1.6 times more likely to miscarry and those with a BMI of 30 are 1.9 times more likely to do so. This is the information that we know.

The NHS is open for all, and no woman should feel that they cannot seek help. The earlier women come forward during their pregnancy, the easier it is for the NHS to make sure that they receive the right support to reduce the risks. A pregnancy lasts about 40 weeks, but a lifetime approach is needed to address some of the reasons why some women are at more risk than others. Tackling health inequalities and levelling up society is a priority.

While there is still more to do, good progress has been made to improve maternity safety and achieve our national maternity safety ambition. Since 2010, the stillbirth rate has fallen by 25%. Some 98,000 women now receive care from the same midwife team throughout their maternity journey—so-called continuity of care—which is up from 10,000 women in March 2019, and this was throughout covid as well. This helps to reduce baby loss, pre-term births, hospital admissions and the need for intervention during labour, and to improve women’s experiences. It is so important that the voices of women, including those who have suffered miscarriages, are heard. That is why I pay tribute to the hon. Lady, because here in this place she champions those voices.

In March, I announced that the Government are embarking on the first women’s health strategy for England—something that I was absolutely committed to start and finish when I first became a Minister in the Department for Health. This strategy is first and foremost about listening to women’s voices. The call for evidence recently closed, and we have seen an incredible response. Over 112,000 women from across the country came forward to share their experiences in the online survey. The call for evidence specifically asked about women’s experiences with fertility, pregnancy and baby loss, which is such an important area of women’s health. We are analysing responses closely to make sure that the strategy reflects what women identify as their priorities, and we will consider the recommendations made in the Lancet series as part of this work.

I am looking forward to visiting Tommy’s National Centre for Miscarriage Research in Coventry myself in the coming months. Its research into the causes of miscarriage and search for solutions and treatment are incredibly valuable. I look forward to meeting the authors of the Lancet papers and talking to some of the patients to hear about their experiences of miscarriage and miscarriage care. I would like to extend an offer to meet the hon. Lady so that we can discuss this issue further too. Every miscarriage is a tragedy and it is only right that parents are supported through difficult times.

The hon. Lady asked particularly about the recommendations that were made, so I will go through them and what I am doing about each one. Recommendation 1 was to

“ensure that designated miscarriage services are available 24/7 to all, taking into account local conditions and resources.”

I am including recommendation 1 in the women’s health strategy as part of the work that we are doing specifically about those issues.

Recommendation 2 says:

“Treatment and care must be standardised and equitable. Appropriate care must be given to everyone after 1, 2 and 3 miscarriages in line with a ‘graded model’ of care.”

I am not putting that into the women’s health strategy because, as a Minister and not an obstetrician or a gynaecologist, I do not decide what the guidelines or the recommendations are on miscarriage. We are politicians, so we look to the Royal College of Obstetricians and Gynaecologists, which is reviewing the guidelines regarding recurrent miscarriages and is expected to publish that review later this year. I am sure that it will include the findings of the Lancet papers. I hope that the recommendations will also be taken into account in the review of the guidelines.

Recommendation 3 is:

“To acknowledge that miscarriage matters to parents and take steps to record every miscarriage in England.”

The story of the hon. Lady’s friend was disturbing, and recording and data are so important, so I am putting that recommendation into the women’s health strategy to be part of our review.

On the women’s health strategy, the 112,000 responses was a huge number and it will take some time to get all those responses together and group them into the areas in which people have responded, and then in each of those areas take forward our policy recommendations. So I have asked for both those recommendations to go into the section on miscarriages, paternity, baby loss and pregnancy. I hope that the hon. Lady is happy with that. It is incredibly important that we get it right, and to get it right we need the recommendations to be fully evaluated. I look forward to going to Tommy’s so that I can talk to people further about this.

The national bereavement care pathway was developed with this in mind, to improve bereavement care and reduce variation in the care that families receive after miscarriage. I believe that 63% of England’s trusts are now fully signed up and all those that remain have formally expressed an interest in the project that Tommy’s has run. The hon. Lady is absolutely right in what she says about the response. I am really impressed with the 112,000 women who have taken the time to respond to our women’s health strategy, and I believe that Tommy’s must be equally impressed with the response that it has had from women. Women are really standing up and making their voices heard, because projects such as these are giving them the opportunity to do so.

Finally, I would like to take this opportunity to urge those women who have suffered a miscarriage: help the NHS to help you. Please do not suffer in silence. Please reach out and seek support, and the first placej to do that is with your GP or in the hospital where you receive care.

I would like to thank the Minister for the sensitive way in which she has responded to the great courage that the hon. Member for Sheffield, Hallam (Olivia Blake) has shown in bringing this subject to the Chamber. Most of us have never dared to raise these matters here because we know the reaction that we would previously have got, but now we have made a difference, and the hon. Lady and the Minister have made a big difference today in treating this matter with the seriousness it deserves here in this Chamber.

Question put and agreed to.

House adjourned.