Report on registration of pregnancy loss

Civil Partnerships, Marriages and Deaths (Registration Etc.) Bill – in a Public Bill Committee at 3:30 pm on 18 July 2018.

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Question proposed, That the clause stand part of the Bill.

Photo of Virendra Sharma Virendra Sharma Labour, Ealing, Southall

With this it will be convenient to discuss amendment 14, in the title, line 3, leave out

“about the registration of stillborn deaths” and insert

“for a report on the registration of pregnancy loss”.

This amendment adjusts the long title so as better to reflect the contents of Clause 3.

Photo of Tim Loughton Tim Loughton Conservative, East Worthing and Shoreham

We come to the subject of pregnancy loss. On Second Reading, many Committee members spoke with extraordinary passion and eloquence about stillbirth. I am sure that no one will object to me singling out the hon. Member for Washington and Sunderland West. I said at the time that Labour MPs often reduce Government Members to tears, but in that case she did so for the right reasons. That was a highly emotional part of the debate, in which we heard some really brave personal testimonies. The work that hon. Members have done—including the work of my hon. Friend the Member for Colchester and others through the all-party group on baby loss—has rightly raised the profile of this subject. The Government have done a lot as a result, but there is much more to do.

The Second Reading debate gave extra oxygen to the cause and generated great publicity. Celebrities such as Kym Marsh of “Coronation Street” should be applauded for lending their voices to the cause. The previous Health Secretary was greatly moved by that debate and, as a result, set up a working party. I will come back to that, but let me turn first to the guts of what the clause does and why it is necessary.

The Births and Deaths Registration Act 1953 provides for the registration of stillborn babies after 24 weeks’ gestation, which is considered to be the clinical age of viability. Parents of babies who are stillborn after 24 weeks’ gestation receive a medical certificate certifying the stillbirth and, upon registration, can register the baby’s name and receive a certificate of registration of stillbirth. When a pregnancy loss occurs before 24 weeks’ gestation, the hospital may, if the parents want it to, enter the baby’s name in a local book of remembrance or issue a local certificate to commemorate the pregnancy loss. That does not happen universally, and of course it does not carry any weight officially. Crucially, for many, that understandably just does not go far enough.

That was the case with my constituent Hayley Petts, who instigated my bringing the issue forward several years ago via a ten-minute rule Bill. I and many other hon. Members made it clear that we believe there should be official acknowledgement of pregnancy losses before 24 weeks’ gestation, which would otherwise be classified as stillbirths. It is only a simple matter of chronology that prevents them from being registered and, crucially, recognised by the state. We should therefore explore whether parents should be given the opportunity or the right to register such a loss. Clause 3 would require the Government to prepare a report on whether the law should be changed—and, if so, how—to require or permit the registration of pregnancy losses that cannot be registered as stillbirths under the 1953 Act.

Many parents who have faced the tragedy of losing a baby before the 24 weeks gestation threshold want a recognition that their baby actually existed. We heard cases of mothers who had been through long, painful labours, knowing in many cases that they will give birth to a child who is not alive. They held the child in their arms, had photos, took footprints and had formal funerals, yet in the eyes of the state the child never existed. At a particularly vulnerable time in those parents’ lives, to be effectively told, “Your child did not exist,” exacerbates the hurt and injury that has already been caused.

The Department of Health and Social Care has begun considering the issue and has commissioned a review to be carried out on behalf of the Secretary of State. The review will also look at how the NHS can improve the support it gives to families who have experienced pregnancy loss prior to 24 weeks’ gestation. The most important thing the Department of Health and Social Care can do—and it is doing this—is ensure that we prevent pregnancy loss in the first place. The figures for this country remain worryingly high, but they are coming down. A comprehensive package of measures has been announced, and that is to be welcomed. I am a member of the advisory panel, as are the hon. Member for Washington and Sunderland West and my constituent, Hayley Petts. I look forward to progressing the important work that will help bereaved parents get the rightful recognition of their loss. That is why this clause is so important.

There is a problem with the work that is going on. The hon. Member for Washington and Sunderland West and I were able to attend only the third meeting, because the officials who set up the working group were so urgent about their business that they forgot that we were supposed to be on it. I am afraid that the focus is not sufficiently on stillbirths. Virtually all the women on the working group attached to the main group who have had personal experiences have had miscarriages, rather than stillbirths. In fact, my constituent is the only one who actually had what would unofficially be termed a stillbirth—before 24 weeks. I have some reservations about where that group is going, but my Bill commits only to set up a review to come up with suggestions on how the law can be changed. In many respects, its terminology has already been achieved, and it is now for the Department of Health and Social Care to progress the findings.

I am very clear that we need to do something specifically for women who have given birth but it happens to be before 24 weeks. We probably need to do more for the many more women who have had pregnancy loss through miscarriage, at whatever stage. I know that other measures are being looked at—there is a separate private Member’s Bill in the House of Lords—but I am focusing on the experiences of women who have given birth to children who, alas, are not alive when they are born. That is a different experience. Having a baby loss at any stage is hugely traumatic. I am not in any way trying to undermine the tragedy of everybody’s loss. The problem here is that, simply because of the way the law is figured and the chronology, which is part of the law, many children who would otherwise have been registered and acknowledged do not exist in the eyes of the state. That cannot be right, so I urge hon. Members to support this clause.

Amendment 14 seeks to amend the long title of the Bill. It would provide for

“a report on the registration of pregnancy loss”.

I would prefer to include the term “stillbirth” rather than “pregnancy loss”, but the term “stillbirth” cannot, as the law stands, be applied to births before the 24-week threshold. I urge hon. Members to support clause 3 and amendment 14.

Photo of Sharon Hodgson Sharon Hodgson Shadow Minister (Public Health) 3:45, 18 July 2018

It is a pleasure to serve under your chairmanship, Mr Sharma. I am happy to be able to respond on this issue again and support the private Member’s Bill promoted by the hon. Member for East Worthing and Shoreham and his efforts to secure this change.

How we feel about the issue will be born out of our own lived experiences for those of us who have lived experiences of baby loss and, in this case, pre-24-weeks baby loss. Those who were present at Second Reading or who have followed the Bill’s progress will know what my lived experience is, as I relived it on the Floor of the House, with lots of tears along the way. That was a very painful experience for me, and I do not intend to relive it again today, for which I am sure everyone will be grateful. However, for the benefit of the Committee and those who may not know, I will just briefly say that I had a stillborn baby girl at 23 and a half weeks. We called her Lucy, and she would have been 20 years old on 19 May this year. We had a naming ceremony for her in a room in the hospital—it was not a bereavement suite, because this was 20 years ago—and that was because of the thoughtfulness of the hospital chaplain, who went on to arrange Lucy’s burial with the Co-op funeral service, which did not charge anything. I know that my hon. Friend the Member for Swansea East has campaigned for burial fees and funeral costs to be waived in such cases, and the Government have committed to that, which is great, so things do move on—things are getting better—and that is what we are hoping to see here today.

As some hon. Members will know from the Second Reading debate, Lucy was buried in the same grave as my nana and grandad. When we got the deeds back, that was the start of me realising that Lucy formally did not exist, because I was horrified to see that it was my name on the deeds for the burial plot. I realised that that was because, legally, Lucy did not exist; it was a bit of me that was in the plot. I still cannot quite come to terms with that. I hope that it does not confuse whoever is burying someone in that plot next; will they think, “Oh, is Sharon Hodgson in here?” Hopefully I will not be.

I am not sure whether what we are proposing with this Bill would change any of what I have described, but I hope that it would change the feeling that I had nothing other than Lucy’s grave and a couple of photos to prove that she had existed. Also, I do not think that the Bill would change the fact that she is recorded in my medical notes as a miscarriage. Even while I was holding her in my arms—she was a fully formed baby—she was classed as a miscarriage, because she had not taken a breath. If she had, she would have been rushed to the special care baby unit at the Royal Victoria Infirmary, and, because it is one of the best in the country, she probably would indeed have celebrated her 20th birthday earlier this year.

The Bill will not change the miscarriage-recording fact, because we are not discussing viability, as we know where that would lead, and none of us wants to go down that path or open up the abortion debate with this Bill. However, I hope that the Bill will ensure that sensitivity about language and the use of language when the worst happens— especially in the pre-24-weeks period, for all the reasons that I have explained—is improved.

On the subject of what we hope that the Bill will do, I note that the review that the Bill instigated and which the hon. Member for East Worthing and Shoreham spoke about is still under way and has not yet reported. I also share his concern that we have managed to take part in only one of the three sessions so far, so lots of debate would already have happened in the review without the hon. Gentleman or me attending.

I have read through the policy statement from the Miscarriage Association that it probably has submitted to the review, and evidence submitted by the all-party parliamentary group on baby loss. I am proud to be one of vice-chairs of that group. Both groups make the case that any registration or certificate given should be on a voluntary not mandatory basis. I refer to page 4 of the all-party group’s evidence to the review, which states that there were 2,586 respondents to the survey that the Miscarriage Association carried out, and 93% of those responded said they had had experience of pregnancy loss themselves.

It will become clear where I am going with this: the overwhelming majority—74%—were in favour of permitting voluntary registration for pre-24 week loss, miscarriage, ectopic or molar pregnancy at any gestation, and 23% said that they felt that that option should be for only a certain gestation, the cut-off points varying from four to 23 weeks. Just under half of the 23%— 11% of all respondents—suggested that that cut-off point should be 12 weeks. In summary, among the respondents there is overwhelming majority support for allowing registration for pre-24 week pregnancy loss. Some form of registration for pre-24 weeks is agreed, and it seems to be agreed from those respondents that it should be voluntary.

The hon. Gentleman’s constituent, Hayley, who first approached him about the issue with her twins, feels that it should not be a matter of voluntary or mandatory—I agree, because I do not like “mandatory”; I prefer “automatic”—for late-term miscarriage or very early stillbirths, whatever they are called. If it happened at over 24 weeks, it would not be, “You must have a death certificate”, it would just happen. I would not necessarily have liked to have been asked at that stage whether I wanted to have some sort of certificate of registration. It was bad enough that this awful trauma had just happened, without being asked to make a decision that I probably was not in a strong enough position to make. I understand that the Government say that people would have 42 days to make that decision, but I come back to it being automatic at a certain stage.

I have looked at the survey questions in detail—I am not an expert on surveys or questionnaires, although I am pulling apart my clinical commissioning group questionnaire at the moment—and I think it is a fair set of questions. But by the rules of mathematics, it will have been weighted to receive more responses from people who may have suffered, or are connected to someone who had had, a miscarriage from conception to pre-20 weeks, rather than those from 20 weeks to pre-24 weeks. Among the 2,586 people, the latter group will have been smaller than the nought to 20 weeks group. Of the survey respondents, 93% had suffered a pregnancy loss, but I do not think they were asked when that pregnancy loss was. I hazard that if a further survey were done that separated those two groups we might be able to see a difference in the answers. That is something the review should do when it is trying to form an opinion about whether it should be automatic—I will not use the term “mandatory”, because people automatically get a birth certificate or a death certificate after 24 weeks—rather than voluntary.

The all-party group report looked at some really good examples from around the world, which I hope the review will look at. The ones that stand out are Queensland, Australia, which registers post-20 weeks and families can apply for an early pregnancy loss recognition certificate. If that cannot all be done under the Bill, the bit about registration from 20 weeks could be, and we could look at having a voluntary scheme for earlier losses. British Columbia, Canada does a similar thing and registers from 20 weeks, but families can apply for a still-birth certificate of remembrance. Similarly, the USA registers from 20 weeks, and France registers at the gestational age of 22 weeks.

Queensland, Australia seems to be the one that ticks both boxes, as far as I am concerned. A survey of 2,500 people is not huge in a country with a population of 70 million, but people who have been affected by baby loss before 24 weeks are a very important sector of that population. Again, it would be interesting to see how that separated out among the two groups I identified, and how they would have felt if they had been given some of those examples.

The review still has a long way to go, and I hope we have more chances to engage with it. Perhaps it will seek further thoughts from people who have suffered the post-20 weeks experience. I hope that that does not stand in the way of the Bill progressing on to the statute book, but that something can stay in the Bill and make it through. I would give that my full support—we will support whatever we can get into the Bill in that regard—because it would be a positive step forward. Again, I thank the hon. Member for East Worthing and Shoreham for introducing the Bill.

Photo of Victoria Atkins Victoria Atkins The Parliamentary Under-Secretary of State for the Home Department, Minister for Women 4:00, 18 July 2018

I apologise for my voice, Mr Sharma; I am suffering from end-of-term lurgy. I hope hon. Members can hear me. I thank my hon. Friend the Member for East Worthing and Shoreham again for this part of his Bill, and I emphasise that the Government are committed to ensuring that the NHS provides the safest and highest quality care. That is particularly true for maternity services.

Sadly, some pregnancies will end in the death of a much-loved and wanted baby. Although the care considerations for still births and pre-24 weeks pregnancy losses may be similar, in practice, local factors may have an impact on the support parents receive, depending on the gestation stage of the loss. Registration and certification can be an important part of acknowledging a pregnancy loss, and that is why the Government fully support the need to look into the issue more closely.

Pregnancy loss is more common than people realise, and I thank all hon. Friends and hon. Members who have spoken in this place about their experiences, and who have educated those of us who have not had to endure the agony of losing a baby. I am bound to thank the hon. Member for Washington and Sunderland West for her contribution to the wider debate and in Committee, and my hon. Friend the Member for Colchester, who has done so much work on the issue across the House. That is why the Government have already committed to looking at whether the legislation should be changed to allow for the registration and certification of pregnancy losses before 24 weeks gestation.

We support the requirement in this clause that a report is prepared before we consider any changes, because of the obvious sensitivities involved. In conducting this review, the Government are engaging closely with health practitioners, registrars and charities. Most importantly, the review is speaking to parents who have lost a baby before 24 weeks, to learn about their experiences and how to ensure that they receive the best care and support possible when such a tragedy takes place.

I am delighted that my hon. Friend the Member for East Worthing and Shoreham and the hon. Member for Washington and Sunderland West are on that panel. If I may say, the hon. Member for Washington and Sunderland West has demonstrated the considerable weight of experience and the value that she will contribute to that panel. I know that hon. Members were not invited to the first meeting. I understand that it had already taken place before the Secretary of State insisted that both hon. Members sit on the panel. I know that the officials sitting behind me will ensure that future sessions of the panel are communicated properly to both hon. Members, so that they are able to contribute, as they clearly should. The work of the panel will inform the report that the clause requires the Secretary of State to prepare and publish.

Photo of Tim Loughton Tim Loughton Conservative, East Worthing and Shoreham

I am grateful for the great support from the hon. Member for Washington and Sunderland West. She shares my reservations about the way the committee is going. But with the comments we have made, and the support of the Minister and the new Health Minister, I think we will achieve a satisfactory conclusion in due course.

The hon. Lady also mentioned her daughter Lucy. It was mentioned on Second Reading that if this becomes law, it should be known as Lucy’s law. There was great agreement on that at the time. This affects too many women, and fathers too. It would cost nothing to put it right. A little effort would prevent an awful lot more angst for parents who have already been through this traumatic situation.

The clause only commits to having a report at this stage, but there is an expectation that the Government will want to turn that report into legislative change—into action—to complement the good work that is going on to prevent anybody from being in the iniquitous position of realising that their child is not officially recognised by the state, by substantially reducing the number of stillbirths and miscarriages.

Question put and agreed to.

Clause 3 accordingly ordered to stand part of the Bill.

Clause 4