Miscarriage Care and Facilities in Scotland: Scoping Report NHS Borders

Dedicated facilities

Unexpected pregnancy complications at any gestation

The Scottish Government has committed to the provision of dedicated facilities for women experiencing unexpected pregnancy complications through the Programme for Government 2021-22^[6]. All sites were asked if they currently provide dedicated facilities for women experiencing unexpected pregnancy complications at any gestation and sites with an EPU were also asked to indicate if they currently provide dedicated facilities for women experiencing unexpected pregnancy complications at any gestation within the EPU.

With NHS Borders, Borders General Hospital indicated that they currently provide dedicated facilities for women experiencing unexpected pregnancy complications at any gestation both within and out with the EPU (Table 12). They also indicated that there are no dedicated rooms available for women that are miscarrying, however, there is one bereavement room with en-suite facilities which is situated on the labour ward.

Separate room/area/ward for women experiencing miscarriage

All sites were asked if they provide a separate room, area, or ward away from the labour ward for women that are miscarrying. They were also asked if they provide a separate room, area, ward, or unit with dedicated services to admit women who are miscarrying. The number of separate rooms reported to be available for women who are experiencing miscarriage ranged between 1 and 12 rooms in Scotland.

In NHS Borders, Borders General Hospital reported that there is an EPU, located within the pregnancy assessment unit, this means that, women experiencing a miscarriage may be in the same area as women with a continuing pregnancy. NHS Borders are unable to provide a separate area away from the labour ward for women who are miscarrying due to a lack of space. However, within the labour ward there is a bereavement room which is separated by double doors from the main labour ward area. This is not soundproof and women experiencing miscarriage can hear women in labour and babies crying which can cause distress to women and their partners and the staff caring for them. The bereavement room attached to the labour ward may be used for other pregnancy complications or loss including termination of pregnancy due to fetal anomaly (TOPFA) and molar pregnancies or still birth. Women experiencing ectopic pregnancies are treated on the surgical ward. The facilities that are provided are set out in Table 12 above.

Scanning facilities

Scans are often performed to confirm a miscarriage has occurred, for the scoping exercise all sites were asked if a separate area was available to carry out complication or investigative scans for women with continuing pregnancy.

Overall 7 out of the 14 Health Boards reported having a separate area to carry out complication/investigative scans separated from women with a continuing pregnancy, either within or outwith the EPU.

When asked about areas where complication or investigative scans are carried out in NHS Borders, scans are conducted in the EPU at Borders General Hospital during opening hours. If a woman presents with a suspected miscarriage out of hours at A&E and a scan is required and the patient is stable, they will be scanned during opening hours at the EPU. Scans are also undertaken within the Maternity Unit 24 hours a day, seven days a week at Borders General Hospital and in the Obstetrics and Gynaecology Department. When a woman presents out of hours and is not stable, an investigative scan would take place within A&E or the maternity unit by the on call obstetrics and gynaecology team who have a portable ultrasound machine. As the EPU is also the PAU where women in the third trimester may be attending, and due to lack of space, scans are carried out in the same area as other expectant mothers.