*Currently this page is still under development but I wanted to put some information out there as the topic is so important so have chosen to publish while still in draft form with the plan to keep improving it
Miscarriage affects around 1 in 4 pregnancies, perhaps more as some are lost before they are detected by the woman.
Many women don’t talk about it, but suffer silently
There is a gap in NHS service provision for women affected by miscarriage and baby loss. Perinatal mental health provision is patchy and offered to pregnant women and those in the postnatal period. More general mental health provision has been indicated by a research report below to not be specialist enough for the needs of parents affected by miscarriage and baby loss.
Practical Coping Tips
When I had a second trimester miscarriage after two first trimester miscarriages, I was unprepared practically speaking for how different – and how physically and emotionally traumatic – it would be. The NHS response was to diagnose the miscarriage by scan and accept my decision to wait for the inevitable to happen at home. I didn’t have any kind of follow up after the scan, or after the inevitable happened a month later – or when the bleeding stopped a month after that. The leaflet I got from the NHS was inadequate in terms of either practical or emotional coping tips. The best advice I found was on Mumsnet so I’m sharing that link here:
Emotional Coping (where ACT comes in)
Acceptance and Commitment Therapy can be adapted to be of use to anyone at any life cycle stage aiming to cope with psychological distress occuring in the context of trying to live a meaningful life. I am grateful to have had professional training and experience using the approach prior to experiencing miscarriage. It was particularly valuable for me personally in the period when I was grieving but also after experiencing miscarriages when I was pregnant and anxious not to lose another pregnancy.
There are several key concepts in ACT which when used flexibly can help anyone who is willing to try the approach to cope with what they need to in order to move forward in a direction they value. In a context of trying to conceive again after miscarriage and coping with pregnancy after miscarriage what was particularly key to me was Values work. I was willing to tolerate the anxiety of possible further pain and loss in order to pursue the possibility of holding a healthy baby in my arms one day. Mindfulness during pregnancy was very valuable to me in order to stay grounded in the present moment rather than following my thoughts to the future where further loss might await or to the past where memories of loss were still raw – in the present I could feel safe and have some respite. Defusion was helpful to me in getting some space from difficult thoughts and feeling that otherwise would have trapped me in unhelpful behaviours such as not talking about miscarriage. Self as context was invaluable for me in allowing some perspective from the broader areas of my life that mattered, and the perspective that miscarriage was one painful chapter in a much longer life coloured with the broad range of emotions common to everyone else – including both joy and pain.
For a more general overview of ACT have a look at my more general “Introducing ACT” page following the link below. If you would find it helpful to read more about how I found ACT helpful personally in the context of coping with miscarriage, trying to conceive after miscarriage and pregnancy after miscarriage I’ve written about that in my Blog, particularly in my earlier posts as that is what originally motivated me to write.
Gaps in Specialist Mental Health Care For Women Who Miscarry
The National Care Bereavement Pathway in Scotland is supported by the Scottish Government and is clinical governance support for health professionals to ensure quality of care in the immediate aftermath of pregnancy loss
If you haven’t already, consider reading “The Out of Sight, Out of Mind” report – https://babyloss-awareness.org/wp-content/uploads/2019/10/BLAW2019_Report_CountryBriefings_Scotland.pdf
60% of parents affected by miscarriage or baby loss who were asked said they felt they needed specialist mental health support but couldn’t access it on the NHS (Sands Survey 2019, sample size 1007)
86% of Scottish Health Boards said they do not commission talking therapies specifically for parents affected by baby loss (Baby loss awareness alliance, October 2019)
The “Delivering Effective Services: Needs Assessment and Recommendations for Specialist and Universal Perinatal Mental Health Services” March 2019 Report advises NHS staff to ensure parents who are affected by baby loss have support in place prior to discharge from hospital and advises signposting to third party organisations for bereavement and mental health support – although few of these can actually offer counselling, never mind tailored psychological therapies to parents affected by baby loss.
Baby Loss Awareness are calling for:
A Government led review of current service provision
Quality standards and national guidance on perinatal mental health provision
Mandatory training for involved health professionals in identifying potential mental illness in parents affected by baby loss
Adequate resource allocation by commisioners
Clear referral pathways to specialist mental health services for parents affected by baby loss
Miscarriage Awareness Raising
“We are calling on Governments across the UK to take action to ensure that all parents who experience pregnancy or baby loss and need specialist psychological support can access it, at a time and place that is right for them, free of charge, wherever they live.
Thousands of parents experience pregnancy or baby loss every year, many will go on to experience psychiatric illness that requires specialist support, triggered by intense grief and the trauma of their experience.
Our research shows that too often this support is unavailable, inaccessible or inappropriate. Bereaved parents are falling through the gaps between policy and funding, regularly overlooked altogether.”
Quote from babyloss-awareness.org
Find out about and join campaigns such as the planned “wave of light” during Miscarriage Awareness Week 2020 which falls on 9-15th October to spread awareness of baby loss
Write to your MP and/or MSP to ensure they are aware of the above and ask them to raise it in their parliament and ask for an update regarding what is being done to address this.
What shocks me regarding the above is that as Clinical Psychologists, my professional group are trained to deliver bespoke assessment, formulation, treatment and evaluation to individuals across the age range experiences a wide range of psychological distress in relation to a wide range of contextual stressors, the trauma of baby loss being relevant here, and as such within Clinical Psychology there is a skilled workforce able to assist should more perinatal services be commissioned across the UK, but those skills are currently under-utilised in the baby loss arena.
There are also a wealth of mental health self-help resources out there, and my focus here is the ACT approach as that is what was helpful to me when I experienced miscarriages. I am aware that self-help is no substitute for 1:1 tailored psychological intervention with a trained empathic professional, but increasing awareness of what is available from the psychology world which could be of benefit to parents affected by baby loss may be of some value to parents and those caring for them until the situation improves, and perhaps by illuminating the links I can help in some small way.
Support Organisations that may be helpful to look up
Provides lots of information for women on different types and stages of miscarriage as well as learning materials for healthcare workers supporting women and resources for employees affected by miscarriage and their employers. Includes information about practical and emotional coping. There is also information about how Coronavirus is affecting services at Early Pregnancy Units, and support groups – some noted to be meeting on Zoom.
Stillbirth and Neonatal Death charity. Provides specialist bereavement counselling and support for anyone affected by baby loss.
#miscarriage #babyloss #babylossawarenessweek #mental health service gaps #ACT