Steps forward in developing a new miscarriage care model

With the generous support of a £244,687 grant from the Peter Sowerby Foundation, the Tommy’s National Centre for Miscarriage Research team at the University of Birmingham and Birmingham Women’s Hospital will be turning their research on new, improved, care pathways into usable guidelines for hospital commissioners. 

After introducing and testing the Tommy’s recommended model of miscarriage care in Birmingham, it will be rolled out for testing at 7 more hospital sites in England and Scotland, with the aim of then changing the miscarriage care system across the whole of the UK.    

What does miscarriage care currently look like? 

We believe that the current UK system is not good enough and more than 250,000 people who signed our petition calling for the transformation of miscarriage care agree. 

At present, women and birthing people must lose 3 pregnancies in a row through miscarriage before they qualify for psychological support, preventative care or pre-conceptual advice that could prevent the loss of another baby. 

It can also be difficult to find appropriate care when a person is experiencing a miscarriage. While Early Pregnancy Units (EPUs) exist to manage early pregnancy emergencies, most have limited opening hours and for many people in the UK, they can be too far away to get to when time is critical. With miscarriage services so regionally inconsistent, the system means that women from disadvantaged backgrounds often have worse access to care.  

Mental health support is missing 

There is little support for mental health needs after miscarriage. Tommy’s researchers have found that 18% of women meet the criteria for post-traumatic stress disorder (PTSD) 9 months after they have a miscarriage. We also know that women who have had a miscarriage are nearly 4 times more likely to die by suicide than those who have not. 

Yet when Tommy’s researcher Dr Rosinder Kaur – part of our Birmingham team - surveyed Early Pregnancy Units (EPUs) earlier this year she found that just 7% carried out psychological screening of women and birthing people after miscarriage. 

Our solution – the Graded Model of Care 

In 2021, the Tommy’s National Centre for Miscarriage Research, published a proposed Graded Model of Care in medical journal The Lancet, based on an exploration of the current system and consensus between key experts on what needs to change. 

The model proposes that women and birthing people are seen by a healthcare professional after their first miscarriage, screened for mental health, and provided with guidance and information to address health needs.  

After 2 miscarriages they would have an appointment in a nurse or midwife-led clinic in an EPU and have access to further tests, including blood count and thyroid function, referred for specialist care if tests show it’s needed, and have access to early reassurance scans. 

Following a third miscarriage they would have a consultant-led appointment at a recurrent miscarriage clinic, further advanced tests and treatment including genetic testing and further screening and care for mental health issues. 

We want all women to have care personalised to their medical risks and to receive the best quality, most appropriate support, wherever they live, rather than the current ‘postcode lottery’ of good or poor care. 

How will the new funding help? 

With funding from the Peter Sowerby Foundation our researchers will develop clear guidance and support for NHS Trusts to provide the graded model of miscarriage care. They’ll start by surveying both patients and staff to identify barriers to introducing the graded model of care.

The model will be trialled and refined at Birmingham Women’s Hospital before being tested in another 7 areas across the UK.  

Given the findings of Dr Rosinder Kaur's EPU survey, the team will work in partnership with the Tommy’s Miscarriage Research team at Imperial College London to prioritise the development of a new psychological screening and support tool for women who have experienced a miscarriage. This will be a crucial part of the new model. 

The aim is to ensure that NHS hospitals have the tools and guidance they need to provide appropriate care to every family after every miscarriage. 

The Peter Sowerby Foundation was established in 2011 to direct the personal wealth of Dr Peter Sowerby as grants to organisations that meet the charitable objectives of Dr Peter Sowerby and his late wife, Ann. Visit the Peter Sowerby Foundation website to find out more.