Pregnancy Loss Review and Government response supports Tommy’s miscarriage care model in overhaul of NHS system

At present, women and birthing people in the UK must have 3 miscarriages before they qualify for care or pre-conception advice that could prevent the loss of another baby. Mental health or bereavement support is patchy.  

In 2021 researchers from our Tommy’s National Centre for Miscarriage Research proposed a new system, based on research evidence and consensus amongst key experts on what needs to change.  

More than 250,000 people signed our Miscarriage Matters petition in support of this new model.

As Director of the Tommy’s National Centre for Miscarriage Research Prof Arri Coomarasamy OBE says: 

“There is no scientific logic behind waiting until a woman has had 3 miscarriages to provide care. We don’t wait for someone to have 3 heart attacks to take them seriously.”

Because of our campaign for change, the ‘Graded Model of Care’ - which is currently being trialled by the Tommy’s team led by Prof Coomarasamy at Birmingham Women’s Hospital – has now been recommended as a key proposal in the Pregnancy Loss Review.

The review recommends that NHS England should work with the Royal Colleges to develop standard primary and secondary care clinical guidelines for miscarriage to include the Tommy’s Graded Model. This is designed to make sure families can access standardised, best practice care when they experience miscarriage. It also recommends the Royal College of Gynaecologists and Obstetricians update their Green Top Guidelines for recurrent miscarriage to bring these into alignment.  

We are delighted to see that the Government specifically mention their support for the work of Tommy’s National Centre for Miscarriage Research, and their commitment to evaluate the results of our Graded Model of care pilot and assess the potential for implementation on a national scale.  

Under the Graded Model of Care:

• Women and birthing people would be seen by a healthcare professional after a first miscarriage, screened for mental health, and provided with guidance and information to reduce the risk of future miscarriage.  
• After 2 miscarriages they would have an appointment in a nurse or midwife-led clinic in an Early Pregnancy Unit and have access to further tests, including blood count and thyroid function, referred for specialist care if there is a need, and have access to early reassurance scans in future pregnancies.  
• Following a third miscarriage they would have a consultant-led appointment at a recurrent miscarriage clinic, and further advanced tests and treatments.  

Clear pathways and consistent care access

Currently, access to miscarriage care can vary depending on where you live. It shouldn’t be a postcode lottery. Since 2021, we have been calling for consistent miscarriage care to be available in every area of the country 24/7, including access to dedicated Early Pregnancy Units.  

We are pleased to see 24/7 access to compassionate, consistent care wherever you are based has been included in the Review’s recommendations and the Government’s pledge to map and evaluate current provision to develop new care pathways for women and birthing people.

We also support the Government's commitment to the Pregnancy Loss Review recommendation that women and their families must be provided with better information on where to go and what care they should expect to receive if they are experiencing pregnancy complications which may result in miscarriage.

Kath Abrahams, Tommy’s Chief Executive, said:  

“We’re delighted to be one step closer to introducing a system of compassionate, flexible, care for all. For too long we’ve had a postcode lottery of care depending on where you live, as well as a system which fails to recognise the serious mental health impact of miscarriage on women, birthing people and partners.  

“It is simply not acceptable that people must wait for a third devastating and traumatic miscarriage until they qualify for any sort of support and care which may find answers and treatments which might help them bring home a baby.

“We’re pleased to see the Pregnancy Loss Review also recommends that guidelines must be flexible to accommodate and prioritise different factors such as older maternal age, infertility, recurrent loss, and other medical conditions. Ensuring everybody receives equitable care does not mean ‘everybody receives the same care’ - it means creating a system that understands individuals’ needs and the care that’s right for them.”

Professor Arri Coomarasamy, Director of the Tommy’s National Centre for Miscarriage Research and Professor of Gynaecology and Reproductive Medicine at the University of Birmingham, said:  

“The new care guidelines we’ve created and implemented in a pilot study at Birmingham Women’s Hospital show how we can practically provide best practice care which is backed by the latest research – we'll be evaluating its success at the end of this year.  

“It’s an extremely welcome development to see our care model recommended in the Pregnancy Loss Review and the potential of our work recognised by Government. But change for the hundreds of thousands of people impacted by miscarriage in the UK each year will only come with the Government's continued support and with increased investment to ensure specialist nursing staff and resources are available.”  

Tommy’s Ambassador Myleene Klass says:   

"Miscarriage is a life altering, heartbreaking event. The ripple effect on the family is far reaching. For so long, countless people have been silently attempting to cope or deal with what is effectively the final taboo in women’s healthcare. If the recommendations made in this review become policy, the impact it would make now and for future generations will be enormous.  

“I want to know that my own children will never have to endure the frustrations, fear and unnecessary cruelty that I and so many women and their families have encountered. I’m extremely proud to be working with Tommy’s and MP Olivia Blake to campaign for change. When that change comes it will be a profound relief and a realisation to the four little voices I never got to hear but who pushed me to never give up."  

Olivia Blake, Labour MP for Sheffield Hallam says:

"I am overjoyed by today’s announcement. For too long, miscarriage has been dismissed as “a fact of life”, something to be swept under the carpet, dismissed, and ignored. And too many grieving couples have been told to simply go home and "try again." 

Today’s long over-due announcement will make an unimaginable difference to women in my constituency, and so many others across the country. I am so grateful to everyone who joined the campaign. Without you, this would not have been possible."

Counting and recording miscarriages

Today’s announcements mention challenges around data collection for pregnancy and baby loss before 24 weeks, but disappointingly do not prioritise changes which will make sure this can happen.

Data is vital to understand the scale of miscarriage, so it is no longer a hidden issue. We welcome the Pregnancy Loss Review’s attempts to use extant data sources to try and develop a picture of the scale of the problem, but this further reinforces the critical need for investment in finding a solution.

Robert Wilson, Head of the Sands & Tommy’s Joint Policy Unit says:

"The Pregnancy Loss Review highlights a number of areas for improvement, to ensure anyone experiencing pregnancy loss before 24 weeks gets the care and support they need. The UK Government must now make clear how they will respond to these recommendations in a way that will result in action, including the funding and resources needed to implement them.  

"We highlighted in our own progress report that the lack of systematic counting and reporting of miscarriages conceals the full picture of pregnancy loss across the UK. The Scottish Government has already made specific commitments on this, and we want to see the UK Government and NHS working to follow their lead as a matter of urgency.  

"Technical challenges in recording pre-24-week losses must not be an excuse for inaction by the government. Without a robust mechanism for recording miscarriages, we cannot fully understand the scale of the problem, set ambitions for reducing rates, or know the impact of preventative interventions.

"As an immediate first step, there is a role for the NHS to standardise and bring together existing records of miscarriage from across the key healthcare settings where pregnant women present. This should include losses before 12-weeks where women are in contact with health services.”

The Pregnancy Loss Review was co-chaired by Zoe Clark-Coates, Founder and CEO of The Mariposa Trust and Samantha Collinge, Lead Bereavement Midwife - George Eliot Hospital NHS Trust.

During their review work, they visited Tommy’s National Centre for Miscarriage Research to see first-hand the cutting edge care and support being offered in our centre of excellence, and to find out more about our Miscarriage Matters recommendations to improve care for all.  

The Review was commissioned by the DHSC to consider options to improve NHS gynaecology and maternity care practices for parents who lose a baby before 24 weeks of pregnancy.

The review team worked with partners – including Tommy’s - and with families who have shared their experiences to make recommendations that should be taken forward by the Government.

[Photo above: The team at Tommy's National Centre for Miscarriage Research in Birmingham, Tommy's Chief Executive Kath Abrahams, and representatives from the University of Birmingham and Birmingham Women's Hospital during a recent meeting with the Minister Maria Caulfield, Olivia Blake MP, and Ambassador Myleene Klass]