Miscarriage Care and Facilities in Scotland: Scoping Report National Overview

Staff guidance, skills and training

Written clinical guidance

There is written clinical guidance for clinical staff on the appropriate treatment and care for miscarriage at all gestations at 38 of the 44 sites, across 12 Health Boards. In NHS Grampian, written clinical guidance is not available at Peterhead Community Hospital, Fraserburgh Hospital, Jubilee Hospital and Inverurie Health and Care Hub, however women who present here are directed to Aberdeen Maternity Hospital where the guidance is available. In NHS Shetland, clinical guidance is only available for first trimester losses with all women experiencing a loss in the second trimester transferred out of the Health Board area to NHS Grampian where guidance is available in the two sites that treat women for miscarriage. In NHS Western Isles, Uist and Barra Hospital has guidance for first trimester losses only although this site transfers women to Western Isles Hospital for treatment. (Table 25).

*NHS Shetland only provide first trimester care with second trimester care referred to NHS Grampian

Staff skills and training

The Lancet series stated that 'miscarriage care should ideally be given by clinical nurse specialists and doctors with specialist training in early pregnancy care, in the setting of early pregnancy units, which appear to be effective and cost-effective' and 'specific focus on training for clinical nurse specialists and doctors to provide comprehensive miscarriage care within the setting of dedicated early pregnancy units'. The Lancet series also states that medical consultant model might not represent an optimal use of finite health-care resources^[14].

The training and skills mix of staff providing miscarriage care varies across Health Boards. Often specialist training is centralised within one or two units within a Health Board area. Some Health Boards operate a medical approach to miscarriage care with consultant led provision and doctors trained to provide comprehensive miscarriage care with fewer Health Boards with nurses or midwives with additional specialist training.

There are staff with additional specialist training to deal with all baby losses from early pregnancy to stillbirth in 13 of the 14 Health Boards in Scotland, in NHS Highland there are plans to implement this in the next 2 years.

Midwives/nurses with additional specialist training to provide comprehensive miscarriage care are available in 11 of the 14 Health Board areas in Scotland. NHS Orkney and NHS Shetland plan to implement this in the next two year and NHS Tayside plans to implement this in one site in the next 2 years.

Midwives/nurses with additional specialist training for recurrent miscarriage care are available in seven of the 14 Health Boards. NHS Borders, NHS Dumfries and Galloway and NHS Forth Valley have no plans to implement this in the future, although NHS Borders stated that if a midwife/nurse showed an interest in training for recurrent miscarriage care it could be provided. NHS Dumfries and Galloway and NHS Borders both indicated that they do not have midwives/nurses with additional specialist training for recurrent miscarriage care due to the small size of the service they provide. NHS Forth Valley reported that although several nurses have a special interest in this training, there are barriers to providing tailored miscarriage services due to a lack of a lead nurse for the EPU. NHS Tayside and NHS Western Isles plan to have midwives/nurses with additional specialist training for recurrent miscarriage care in the next 3 years or longer and NHS Orkney and NHS Shetland can access this in NHS Grampian.

Specialised medical staff are trained specifically for recurrent miscarriage care are available in 12 of the 14 Health Board areas. NHS Shetland refer women to NHS Grampian to access this. NHS Dumfries and Galloway do not have medical staff that are trained specifically for recurrent miscarriage care and do not plan to implement this due to the small size of the service they provide.

Almost all Health Boards have doctors that are trained to provide comprehensive miscarriage care. NHS Shetland refer women to NHS Grampian to access this (Table 26).