To ask the Minister of Health to detail any support that is provided to mothers and families who have experienced a miscarriage, broken down by Health and Social Care Trust.

Belfast HSCT Trust

Women are cared for within different departments depending on their gestation and their clinical condition on presenting at the hospital. These include the:

Maternity Assessment Unit (MAU)

Early Pregnancy Unit (EPU)

Delivery suite

Some women will be seen in the MAU, which provides care to women who require assessment and or additional care at various gestations as appropriate. Some women may need to remain in the MAU until their physical condition is stabilised prior to transfer to theatre and or onto a different department.

Women are also supported through miscarriage in the Early Pregnancy Unit. Specially trained midwives who offer transvaginal ultrasound and bereavement support are available in the unit Monday – Friday 08:00-16:00. In addition to this, the service has two Consultant Obstetricians and a Speciality Doctor who provide cover three mornings weekly. The midwives provide counselling in relation to the options for the management of miscarriage and provide care for medical management both as an outpatient or an inpatient option. Surgical management of miscarriage is also offered. Women who chose this option will be cared for in the ward setting of EPU where they are transferred to theatre for the procedure and returned to the ward to receive post-operative care from the midwives within EPU. For women who chose medical management of miscarriage they will remain under the care of EPU for a number of weeks until the miscarriage is fully resolved. This can involve additional visits to the unit or virtual appointments over the phone.

All midwives, doctors and maternity support workers provide bereavement care. They are mindful of the need to provide sensitive and compassionate care, which meets the needs of individual families. Some women will need to return to the EPU for ongoing care and they are cared for in a small private area with private toilet facilities. The EPU has been recently refurbished while working in partnership with the Snowdrop staff.

Women are provided with supporting documentation from the BHSCT / Miscarriage Association / Cradle and also informed of the bereavement support available from the childbirth and loss midwives. Women experiencing recurrent pregnancy loss are also referred to the recurrent pregnancy loss clinic.

It is recognised that families who experience miscarriage are vulnerable to mental health difficulties and trauma symptoms alongside their grief. If required those families can be referred to the Maternity Psychological Service, embedded within the Royal Maternity Jubilee Hospital. Referrals for women, and birth partners/fathers are accepted and they are offered individual or couples-based sessions, depending on the clinical need. There is a longstanding high demand for psychological input into Maternity services and the Service is actively exploring opportunities to improve access for psychological interventions and reduce waiting times for bereaved families.

South Eastern HSC Trust

South Eastern Trust provide Early Pregnancy Service 7 days a week for women with early pregnancy issues. Women who experience miscarriage can access support from the bereavement team who cover gynaecology, maternity and neonatal.

Northern HSC Trust

The Northern Trust is committed to delivering high quality, compassionate care to women and their families following loss at any stage during pregnancy. Women and families experiencing miscarriage or a stillbirth have the support of the multidisciplinary team, the Trust Bereavement coordinator, the Bereavement Support Midwife, specialist midwives and specialist nurses who work collaboratively. The service provides support and guidance to all parents who experience pregnancy loss at any stage of pregnancy, miscarriage, stillbirth, early neonatal death, termination for medical reasons, and pregnancy after loss.

In the clinical setting bereaved parents are cared for in their recently opened bereavement room. ‘The Willow Suite’ is a dedicated space for parents and families following the loss of a baby after 20 weeks providing an appropriately safe and sensitive environment, which upholds privacy and dignity whilst giving the opportunity to grieve and spend time with their precious baby whilst in hospital. On occasions there may be more than one bereaved family, therefore staff will use judgement as to their placement. Prior to 20 weeks, those experiencing loss are cared for in a private room on the gynaecology ward. In both clinical settings and supported by the multidisciplinary team parents receive:

Compassionate and empathetic care;

Clear and sensitive communication;

Guidance to make informed choices and decisions;

Emotional support;

Opportunities for memory making with provision of memory boxes, additional resources & bereavement photography;

Provision of cuddle cot whilst in hospital or for use at home – a specialised cooling cot giving parents the opportunity to spend as much time as needed with their baby both in hospital or at home in the time before burial or cremation;

Individualised care planning;

Assessment of mental health and onward referral if necessary;

Opportunities for remembrance and reflection;

Support of specialist bereavement support midwife and signposting to other specialist services as required - outlined below.

The Bereavement Support Midwife works alongside multidisciplinary professionals providing training, support, guidance for staff in the clinical setting and supporting women and their families following miscarriage or stillbirth in the weeks and months after discharge as needed. The Bereavement Support Midwife also offers a listening service following loss at any stage of pregnancy, miscarriage, stillbirth, neonatal death, termination for medical reasons, or in a new pregnancy after loss.

The Listening service is a 1:1 session (or sessions as required) with the Bereavement Support Midwife. This is a supportive session, which is individualised, led by the individual and offers signposting or referral to other services as required. The location, length of time and frequency of appointments are tailored to the parent’s needs. The parent also has access to the Bereavement Support Midwife via text, phone or email outside of these appointments. In addition to the listening service, if other specialist service are required for example therapeutic counselling or psychological support, the individual may be referred via a number of pathways;

Referral to Mental Health Practitioner at GP practice;

Referral to GP;

Referral to community mental health team or psychological therapies;

Referral to Trust Perinatal Mental Health Midwife;

Referral for support at the Extra support/Birth Trauma Clinic or debrief clinic; and,

Referral to Social Complexities midwife.

Signposting to local and national charitable organisations for further support, befriending services, counselling services is also an option for families when psychological therapy is not required. Following Recurrent Pregnancy Loss, the trust offers referral to a specialist clinic. The clinic provides strong continuity of care for women and their partner. A small multidisciplinary team specialising in early pregnancy and recurrent miscarriage lead this clinic. The purpose of each appointment is to provide specialist support, undertake investigations, and provide treatments with an overall aim of reducing anxiety and improving mental and physical well-being prior to any future pregnancy. The Bereavement Support Midwife provides a supportive role alongside this clinic by providing a listening service, extra time, emotional support and guidance when needed.

Recognising the importance of remembrance for all bereaved families, the Trust organise remembrance events for all those who have experienced the loss of a baby or child. These events are in the form of a snowdrop walk event for all the family once a year, interdenominational remembrance services in both areas of the trust, and the opportunity for parents to have their baby’s name entered into the books of remembrance. Events are also held throughout baby loss awareness week to raise awareness and give staff and service user’s opportunities to remember and reflect.

The Trust have recently established and opened their own dedicated Garden of Remembrance where families can come to remember and reflect. This space also hosts bereavement remembrance events throughout the year. Many parents have expressed their sincere appreciation for these services and events and have found comfort in remembering their baby or child in this way.

A service user group, ‘The Butterfly Group’, is available for bereaved parents, NHSCT staff and members of public. The group meet quarterly with the aim of improving services and bereavement care.

Southern HSC Trust

The Southern Trust provide an information leaflet and details for local support groups that women who experience miscarriage can attend. The information leaflet will also provide answers to some questions that women may have in relation to miscarriage and the process following this.

Local Charities such as ‘4Louis’ and ‘Cradel’ provide memory boxes which are provided to women by the Gynaecological Nurses.

Western HSC Trust

Women who experience miscarriage and attend hospital are offered a visit by a midwife to provide additional support. Parents are also offered additional support by the Pregnancy and Loss Midwife for the Trust if their loss has occurred after 20 weeks. Women are also provided with details of support organisations that they wish to avail of at this time or at a later date.