Early care scheme could prevent thousands of miscarriages a year

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After going through two devastating miscarriages, Lisa Varey could not believe what she was thinking.

She knew she would have to miscarry again before she could get the help she needed. Only when you have had three miscarriages do you normally qualify for specialist NHS help in England. One in five pregnancies end in miscarriage, most before 14 weeks.

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 says they looked at each other, and said: "I can't believe I'm actually saying this out loud."

After her second miscarriage, Lisa was invited on to a pilot project at Birmingham Women and Children's Hospital, which experts believe will prevent thousands of miscarriages every year by offering earlier checks and advice.

Tests showed she would benefit from taking the hormone progesterone to help maintain her pregnancy and a regular aspirin tablet to increase the chances of a healthy birth.

Lisa is now pregnant and in the last weeks of her second trimester. She breaks down in tears as she speaks about how much difference the project's help has made.

"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, suffered two miscarriages in one year and it left her feeling like her body had "failed" her.

She had struggled to get pregnant and was undergoing rounds of IVF - so when she got a positive test, she says she felt "this is it". Then a scan showed the baby was not growing as it should, which she says was devastating.

She went on to have a second miscarriage, before she was invited to join the Birmingham project.

She was put on aspirin and a higher dose of folic acid. She says being offered early tests gave her possible reasons for the miscarriage, which took away "the guilt and shame that you feel".

"Knowing there were things that could make a difference. That gives you some hope to hang on to," Emily says.

Tommy's, the pregnancy charity, says NHS care offered to women who have suffered three miscarriages can be "inconsistent and inadequate". Before then, women are often told to simply go home and to try again.

Both Lisa and Emily were part of the Birmingham study, which compared two groups of 203 women who had previously suffered miscarriages. One group was treated under standard NHS care, while the other was treated with a different model of care.

The new model started after just one miscarriage, and gave the women progressively more care after each baby loss. Researchers say it found a small reduction in the miscarriage rate among its test group. Where women did go on to have more miscarriages, researchers say they received better care and support.

One in five women in the study had treatable health issues, such as abnormal thyroid function and anaemia, which could affect their chances of a healthy birth.

And while no formal data is collected on the number of miscarriages that happen every year - with many going unreported - they estimate the pilot project could prevent around 10,000 miscarriages a year, if its findings were implemented across the NHS.

'Unacceptable anomaly'

As part of the project, women who had suffered one miscarriage were given a one-to-one consultation with a specialist nurse to discuss lifestyle changes - including reducing alcohol consumption and giving up smoking - and using the hormone progesterone, which can help prevent miscarriage.

After a second miscarriage, women were tested for anaemia and abnormal thyroid function, which can affect pregnancy outcomes. They were also offered early scans to reassure them the pregnancy was advancing normally.

Following a third miscarriage, the pathway joins up with what the NHS currently offers - including a referral to a recurrent miscarriage clinic, further blood tests and a pelvic ultrasound.

Professor Arri Coomarasamy, head of miscarriage research at Tommy's, says the three miscarriage wait is 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 says.

He says the findings of the study, if rolled out across the NHS, could also save the NHS money. The pilot suggests the extra costs of staff and training are outweighed by the money saved having fewer women miscarry.

Sally, who is 33, has had two miscarriages and feels let down by the care she was given. She says she's not ready to try for another baby because of her experience.

Living in Gloucester, she doesn't have access to the pilot project but says if she did, she might change her mind.

"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 says.

In the Women's Health Strategy announcement last week, the government said it was considering "wider adoption" across the NHS in England.

Baroness Merron, Parliamentary Under-Secretary of State at the Department of Health and Social Care said: "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 is already making improvements in miscarriage care, including not waiting until a third miscarriage and providing separate rooms in maternity units for women who are going through pregnancy loss.

Northern Ireland and Wales currently follow the same guidelines as England. Researchers on the Birmingham team say they are "hopeful" their model will bring about change.

Kath Abrahams, chief executive of Tommy's, says the pilot would give women an understanding of the care they would be offered.

"Knowing what's going to happen next can be incredibly comforting in a moment when you're in crisis," she says.

If you have been affected by any of these issues, go to BBC Action Line for information and support.