Miscarriage Research: The Lancet

Part of the debate – in the House of Commons at 5:10 pm on 17th June 2021.

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Photo of Nadine Dorries Nadine Dorries Minister of State (Department of Health and Social Care) 5:10 pm, 17th June 2021

First, I pay tribute to Olivia Blake for how brave she is. She moves everybody to tears when she talks about her story, because it is personally so touching. I responded to her debate the first time in Westminster Hall. So she has not elaborated on her own situation in the way she did then, but she is so incredibly brave to do what she does and to champion women who have suffered from miscarriages. I also want to say that I worked closely with her mother, Judith, at the beginning of the covid outbreak and her mother must be very proud of her. Her mother is a formidable lady, I have the hugest respect for her and I am sure she is incredibly proud of the hon. Lady today.

I thank everybody who has shown a particular interest in this subject, both in the Chamber and in the Westminster Hall debates that have been held. I also thank Tommy’s, in Coventry—for those who might think I am talking about a hospital over the bridge—a charity that does incredible work to support families through their pregnancy journey, including those who sadly miscarry, with funding research centres and specialist clinics to help us understand why pregnancy sometimes goes wrong and how we can prevent complications and loss, and to provide specialist care for those women who need it. Tommy’s petition to improve miscarriage care has drawn a huge amount of support, and I am glad this deeply important issue has the attention it deserves.

The three papers published in The Lancet provide an important insight into the prevalence, effects and costs of miscarriage, which is the most common complication of pregnancy, experienced by an estimated one in five women. We know that miscarriage can significantly impact the emotional and psychological wellbeing of women and their families. It can be extremely isolating for women and their partners, with long-term complications.

Women who have suffered miscarriage are 3.8 times more likely to die by suicide, and it takes only one miscarriage to increase the likelihood of a suicide for a woman. Such difficult experiences should not be faced alone, which is why as part of the NHS long-term plan we are improving the access to and quality of perinatal mental healthcare for mothers and their partners affected by their maternity experience, including miscarriage.

Mental health services around England are being expanded to include new mental health hubs for new, expectant or bereaved mothers. The hubs will offer treatment to about 6,000 women in the first year for a range of mental health issues, from post-traumatic stress disorder after miscarrying or giving birth, to a fear of childbirth. The new hubs will also provide specialist training for midwives and other maternity staff, as well as reproductive health and bereavement services.

The series in The Lancet highlights the unacceptable inequalities in women’s chances of having a miscarriage; for example, black women have a 40% increased relative risk of miscarriage compared with white women. It also provides evidence of the importance of maintaining a healthy lifestyle before conception and during pregnancy for all women, to reduce the risk of miscarriage. Women who smoke in the first trimester are 1.2 times more likely to have a miscarriage than non-smokers. Women with a low body mass index, under 18.5, are 1.6 times more likely to miscarry and those with a BMI of 30 are 1.9 times more likely to do so. This is the information that we know.

The NHS is open for all, and no woman should feel that they cannot seek help. The earlier women come forward during their pregnancy, the easier it is for the NHS to make sure that they receive the right support to reduce the risks. A pregnancy lasts about 40 weeks, but a lifetime approach is needed to address some of the reasons why some women are at more risk than others. Tackling health inequalities and levelling up society is a priority.

While there is still more to do, good progress has been made to improve maternity safety and achieve our national maternity safety ambition. Since 2010, the stillbirth rate has fallen by 25%. Some 98,000 women now receive care from the same midwife team throughout their maternity journey—so-called continuity of care—which is up from 10,000 women in March 2019, and this was throughout covid as well. This helps to reduce baby loss, pre-term births, hospital admissions and the need for intervention during labour, and to improve women’s experiences. It is so important that the voices of women, including those who have suffered miscarriages, are heard. That is why I pay tribute to the hon. Lady, because here in this place she champions those voices.

In March, I announced that the Government are embarking on the first women’s health strategy for England—something that I was absolutely committed to start and finish when I first became a Minister in the Department for Health. This strategy is first and foremost about listening to women’s voices. The call for evidence recently closed, and we have seen an incredible response. Over 112,000 women from across the country came forward to share their experiences in the online survey. The call for evidence specifically asked about women’s experiences with fertility, pregnancy and baby loss, which is such an important area of women’s health. We are analysing responses closely to make sure that the strategy reflects what women identify as their priorities, and we will consider the recommendations made in the Lancet series as part of this work.

I am looking forward to visiting Tommy’s National Centre for Miscarriage Research in Coventry myself in the coming months. Its research into the causes of miscarriage and search for solutions and treatment are incredibly valuable. I look forward to meeting the authors of the Lancet papers and talking to some of the patients to hear about their experiences of miscarriage and miscarriage care. I would like to extend an offer to meet the hon. Lady so that we can discuss this issue further too. Every miscarriage is a tragedy and it is only right that parents are supported through difficult times.

The hon. Lady asked particularly about the recommendations that were made, so I will go through them and what I am doing about each one. Recommendation 1 was to

“ensure that designated miscarriage services are available 24/7 to all, taking into account local conditions and resources.”

I am including recommendation 1 in the women’s health strategy as part of the work that we are doing specifically about those issues.

Recommendation 2 says:

“Treatment and care must be standardised and equitable. Appropriate care must be given to everyone after 1, 2 and 3 miscarriages in line with a ‘graded model’ of care.”

I am not putting that into the women’s health strategy because, as a Minister and not an obstetrician or a gynaecologist, I do not decide what the guidelines or the recommendations are on miscarriage. We are politicians, so we look to the Royal College of Obstetricians and Gynaecologists, which is reviewing the guidelines regarding recurrent miscarriages and is expected to publish that review later this year. I am sure that it will include the findings of the Lancet papers. I hope that the recommendations will also be taken into account in the review of the guidelines.

Recommendation 3 is:

“To acknowledge that miscarriage matters to parents and take steps to record every miscarriage in England.”

The story of the hon. Lady’s friend was disturbing, and recording and data are so important, so I am putting that recommendation into the women’s health strategy to be part of our review.

On the women’s health strategy, the 112,000 responses was a huge number and it will take some time to get all those responses together and group them into the areas in which people have responded, and then in each of those areas take forward our policy recommendations. So I have asked for both those recommendations to go into the section on miscarriages, paternity, baby loss and pregnancy. I hope that the hon. Lady is happy with that. It is incredibly important that we get it right, and to get it right we need the recommendations to be fully evaluated. I look forward to going to Tommy’s so that I can talk to people further about this.

The national bereavement care pathway was developed with this in mind, to improve bereavement care and reduce variation in the care that families receive after miscarriage. I believe that 63% of England’s trusts are now fully signed up and all those that remain have formally expressed an interest in the project that Tommy’s has run. The hon. Lady is absolutely right in what she says about the response. I am really impressed with the 112,000 women who have taken the time to respond to our women’s health strategy, and I believe that Tommy’s must be equally impressed with the response that it has had from women. Women are really standing up and making their voices heard, because projects such as these are giving them the opportunity to do so.

Finally, I would like to take this opportunity to urge those women who have suffered a miscarriage: help the NHS to help you. Please do not suffer in silence. Please reach out and seek support, and the first placej to do that is with your GP or in the hospital where you receive care.