According to the Miscarriage Association (2021) more than one in five pregnancies end in miscarriage, probably around a quarter of a million in the UK each year, and although most miscarriages occur in the first 3 months of pregnancy, they can happen up to week 24, with pregnancy loss from 24 weeks known as stillbirth.
On 13 May 2021, Angela Crawley (2021) MP tabled an Early Day Motion calling on the UK Government to introduce paid miscarriage leave. Crawley noted that while 2 weeks parental bereavement leave and pay are provided after stillbirth in the UK, no such support exists for anyone who has experienced a miscarriage before 24 weeks of pregnancy. The motion was unsuccessful.
Citing the motion, Hodson (2021) makes several important points. First, in March 2021, the New Zealand Government introduced 3 days of bereavement leave for women and their partners following miscarriage. Second, women who miscarry before 24 weeks are entitled to sick leave with the additional protections afforded by the Equalities Act, but half of the women who miscarry are not aware of their employment rights. Third, and perhaps most importantly, ‘the cliffedge at 24 weeks is a stark injustice demanding remedy.’ Yet while Hodson (2021) correctly identifies an injustice to be remedied, he also acknowledges that the motion raises questions such as, how many days should be included? Why exclude termination of pregnancy? What about women who cannot tell their employer they are trying to start a family?
Hodson's ‘stark injustice’ could arguably be viewed as adding insult to the injury of a miscarriage, but it is a perspective that is tempered by Porter (2015), who considers it right ‘to say that it simply is not a cause for grief for every woman/couple who experiences miscarriage. However, it seems equally right to say that for some, miscarriage appears to be just this sort of event: it appears to be the death of a being that they love and judge to be of value.’
The absence of UK government support for provision of paid miscarriage leave is unfair, but in what practical ways can healthcare provision be improved? Smith et al (2020) undertook semi-structured in-depth narrative interviews with 38 parents from two parent support organisations and four NHS Trusts in England to investigate their healthcare experiences following the death of a baby either before, during or shortly after birth between 20+0 and 23+6 weeks of gestation. A key finding was the importance of the language used to refer to the death of their baby: ‘parents who were told they were “losing a baby” rather than “having a miscarriage” were more prepared for the realities of labour, the birth experience and for making decisions around seeing and holding their baby’. Appropriate terminology, it seemed, helped to validate parental loss, and the authors highlight the importance of a combination of compassionate bereavement care together with an ability to use terminology that reflects parental language preferences.
Johnson and Langford (2015) examined the effects of a secondary bereavement intervention on grieving in 40 women who experienced complete spontaneous miscarriages in the first or second trimester (8–20 weeks gestation) in the USA. The intervention protocol included prompt identification and labelling of the participant's room and chart, acknowledging their loss; provision of chaplain or related services; honouring requests like baptism or prayer; offering memorial flower seeds for planting at home; and participation in a naming ceremony. The authors concluded: ‘a bereavement intervention administered immediately after the miscarriage promotes women's ability to cope with early pregnancy loss.’ One of many significant observations made by Johnson and Langford (2015) is that women who miscarry before 20 weeks gestation report that the healthcare they typically receive is primarily focused on blood loss, infection prevention and haemodynamic support.
Meanwhile, to determine why miscarriages and stillbirths occur, a team from the Great Ormond Street Hospital for Children (2021) reported that it had developed a non-invasive imaging technique for postmortem imaging of miscarried or stillborn babies. At a time when traditional postmortem protocols seem too traumatic for parents this approach could help provide answers for bereaved parents.