‘Clinical aspects of miscarriage are just the start of the emotional journey’ – says Chesterfield hospital wellbeing midwife

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As a part of our You’re Not Alone campaign we spoke to staff at the Women’s health Unit at Royal Chesterfield Hospital.

Chesterfield Royal Hospital NHS Foundation Trust offers comprehensive miscarriage support - from physical management to mental health support.

The Early Pregnancy Assessment Unit (EPAU), within the Women’s health Unit (WHU) is part of the Family Care Division at the hospital, which offers help and support for those who might be experiencing problems in early pregnancy.

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One of the important recent changes is that now any pregnant woman can self-refer to the unit if they experience any pain or bleeding during early pregnancy – which can be quicker and easier than going through the traditional GP referral route.

As a part of You’re not alone campaign we spoke to staff at the Early Pregnancy Assessment Unit and Maternity Wellbeing Support Team at Royal Chesterfield Hospital.As a part of You’re not alone campaign we spoke to staff at the Early Pregnancy Assessment Unit and Maternity Wellbeing Support Team at Royal Chesterfield Hospital.
As a part of You’re not alone campaign we spoke to staff at the Early Pregnancy Assessment Unit and Maternity Wellbeing Support Team at Royal Chesterfield Hospital.

After the referral, WHU staff discuss the symptoms and medical history with the patient before they are booked in for a scan or other appropriate investigations. The scans are available every day between Monday to Friday, but the time slots and availability vary. If the scan is inconclusive, investigations and a follow up scan will be arranged where appropriate.

Patients are seen by the nurse prior to and after the scan, and any repeat scans or investigations are booked. Written supporting information is also given.

If the scan confirms a miscarriage, the nurse will explain some of the options for the treatment and provide written information.

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EPAU Sister Anne Kayley- Burgess, said: “At this point, we don’t expect anyone to make a decision straight away. They’ve just been given unexpected news and that’s just really not the right moment to make these decisions”.

Sister Anne Kayley- Burgess works at The Early Pregnancy Assessment Unit (EPAU), within the Women’s health Unit (WHU) - which offers help and support for those who might be experiencing problems in early pregnancy.Sister Anne Kayley- Burgess works at The Early Pregnancy Assessment Unit (EPAU), within the Women’s health Unit (WHU) - which offers help and support for those who might be experiencing problems in early pregnancy.
Sister Anne Kayley- Burgess works at The Early Pregnancy Assessment Unit (EPAU), within the Women’s health Unit (WHU) - which offers help and support for those who might be experiencing problems in early pregnancy.

“Patients can then go home and consider which option would best suit them. Then they would call the ward with their decision, or I would call them back if we’ve not heard from them within a couple of days. We can then make all the relevant arrangements.”

The patients have three main options of treatment to choose. In the first instance patients can decide to let things happen naturally at home. The second option is medical treatment where they are offered medication that can be taken either in the hospital or at home. The third option is surgical treatment which can be done either under general or local anaesthesia.

Anne said: “This is an emotionally difficult time. Sometimes the treatment is a lot to deal with. All patients will be offered an initial follow-up call with the opportunity for further ongoing support if needed.

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“Some of our patients are suspected of having an ectopic pregnancy. Some of these patients will be seen on the WHU via EPAU, while some may go through the Emergency Department and possibly theatre and then to a ward.

Julie Clark, Maternity Wellbeing Lead Midwife at Chesterfield Royal Hospital, has experience with birth trauma and bereavement support.Julie Clark, Maternity Wellbeing Lead Midwife at Chesterfield Royal Hospital, has experience with birth trauma and bereavement support.
Julie Clark, Maternity Wellbeing Lead Midwife at Chesterfield Royal Hospital, has experience with birth trauma and bereavement support.

"Not all ectopic pregnancies require surgery, again as with a miscarriage, expectant, medical or surgical options will be provided depending on an individual basis and the patient’s suitability for that treatment.”

As part of her new role, Anne is able to check if patients have been admitted to a ward overnight with an ectopic pregnancy and see them to ensure that they have the relevant information and contact details for support.

For patients who have attended EPAU and have suffered three or more miscarriages, tests can be carried out to investigate potential underlying causes in the recurrent miscarriage clinic.

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This is a new service development which has been well received by patients. This also helps to support the patient’s mental health and wellbeing.

Many improvements are being made with regards to supporting early pregnancy loss and closer links now exist with improved referral pathways to the Maternity Wellbeing Support Team.

Julie Clark, Maternity Wellbeing Lead Midwife at Chesterfield Royal Hospital, who has experience with birth trauma and bereavement support, said: “Historically there have been national issues with access to mental health support after miscarriage. Our trust and senior leadership team at Chesterfield Royal Hospital have looked closely into gynaecology services and invested a lot of time and effort to address this issue.

"It feels like a real privilege to be part of the team which has now grown and developed to consist of five midwives and a maternity support worker. We have close links and referral pathways to a group of psychologists who belong to the Maternity Mental Health service.”

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Originally, the isolated birth trauma midwife role was in place, however, the development of a team approach has been established which allows the team to give seven-day cover as required within the national three-year delivery plan for maternity and neonatal services.

Julie said: “All patients are now given a calling card with details for our team if they wish to contact us. We find that sometimes people don’t wish to be referred at first though seek support later as the emotional response after losing a baby can feel very different on day one, day 10, a month or a year down the line.

“The clinical aspects of miscarriage are just the start of the emotional journey for the person affected. It is difficult to talk about the impacts of miscarriage in a generic way.

“Some people might not need much support while others, the impact may be absolutely devastating. There may be additional complexities for an individual which compounds the grief reaction for example previous pregnancy losses or traumatic experiences.”

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The maternity well-being team offers support both for childbearing people and their partners who can attend regular sessions where they can discuss their feelings at the time.

Julie said: “We’re providing a listening ear a safe space to talk. Many people find that they can’t be very open and honest particularly with partners or families, as they often fear upsetting loved ones further. It makes it a lot easier to speak to us in a nice safe place where they can freely express their thoughts and emotions.

“We’re monitoring their grieving process, which can be an absolutely awful yet natural journey. We notice that some patients have a complex grief reaction or show signs of more serious conditions such as Post Traumatic Stress Disorder (PTSD). When we recognise this, we can refer the patients to other organisations to receive specialist support.”

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