Official Report 1069KB pdf
The next item of business is a debate on motion S6M-16353, in the name of Jenni Minto, on improving miscarriage care.
On a point of order, Deputy Presiding Officer. It has just been drawn to my attention that, although the motion says that the Parliament
“welcomes the publication of the Delivery Framework for Miscarriage Care in Scotland and the Progesterone Pathway”,
members did not have the opportunity to see those publications until twenty-five past three. They were sent to certain members—business managers and so on—but not to the speakers in the debate. It is very difficult to comment on a framework and a pathway when we do not have clear information in front of us from the Government. I want to make you aware of that, and I seek your advice on the matter.
Thank you, Ms Hamilton. It is generally accepted that as much notice as possible should be given to members, although I appreciate that there will be occasions when that is more difficult than it is on others. I am not aware of the circumstances to which you have referred, Ms Hamilton, but we will look into them. If a more detailed response is required, we will come back to you.
I call the minister.
15:30
During my time as the Minister for Public Health and Women’s Health—and, indeed, during my life—I have heard many devastating stories from people who have been affected by miscarriage and baby loss. The charity Tommy’s has said that one in two adults have experienced or know someone who has experienced miscarriage or baby loss, so I know that many people in the chamber and those who are watching us today will have been affected by such issues. I extend my heartfelt condolences to all those who have experienced miscarriage or baby loss. I know that the pain does not go away. However, I hope that, by speaking out about miscarriage and stillbirth, we can help to break the associated stigma and ensure that women and families feel empowered to find their voice and access the right care and support for them.
I am pleased to bring forward a debate on this very important topic. I hope that it serves as an opportunity to reflect on progress that has been made and to discuss the next steps for improving miscarriage care in Scotland.
Today, we became the first country in the United Kingdom to publish a Government delivery framework for miscarriage care, alongside a new progesterone pathway, since the publication of The Lancet report, which was a pivotal moment in the campaign for better miscarriage care. Those documents will make a real difference in ensuring that those who experience miscarriage receive a good standard of care and support wherever they live in Scotland.
Key to that is ensuring that women do not have to wait until they have had a third miscarriage before receiving tailored support, that they can access care in dedicated early pregnancy units or services and that separate spaces are provided in hospitals for those who experience pregnancy or baby loss, whether a miscarriage or a stillbirth. We also remain resolute in our commitment to expand access to progesterone for women who need it.
We have made progress on all those commitments, but we believe that the delivery framework will be key to driving progress and to focusing on areas in which improvement is still required.
I did not want to interrupt the minister while she was explaining those important documents. The delivery framework is 54 pages long and the national progesterone pathway is 13 pages long. Was there any reason why the Government could not have shared those documents with members in advance of the debate? An hour is not enough time for us to scrutinise them. Clearly, the Government was aware of them on Tuesday, when it lodged its motion for the debate. No one has tried to amend the motion, because this will be a consensual debate, but it would have helped us to have a good debate if Opposition members had had the same insight as the Government.
I understand where Douglas Ross is coming from. What is important is that this is the start of a process. I will go on to talk more about the framework and its importance to Scotland. I am offering to have a meeting, at some point after the debate, with members who are interested in learning more about the issue. I thank him for his intervention, which allowed me to say that.
Although the framework focuses on miscarriage care in the first trimester, I want to take a moment to acknowledge the women and families who go through baby loss and stillbirth at later stages. It is vital that they receive excellent care and support at such an incredibly difficult time, and I know that improvements continue to be made by NHS boards and through the stillbirth national bereavement care pathway.
In developing the framework, we carried out a scoping exercise across all NHS boards into the availability of services for miscarriage and unexpected pregnancy complications. Although the “Miscarriage Care and Facilities in Scotland: Scoping Report National Overview” sets out that all NHS boards have
“dedicated facilities for women experiencing unexpected pregnancy complications”
and
“services available for women experiencing miscarriage”,
there is variation in how those services are delivered.
For example, 10 boards have a dedicated early pregnancy unit, with the rest delivering early pregnancy services through existing services. Eleven boards have a separate room, ward or area away from the labour ward for women experiencing miscarriage. Boards without a separate space are aware that that must be addressed as a priority and are working on providing that space.
Although elements of the graded approach to miscarriage, as recommended by The Lancet’s report, can be accessed in 13 out of 14 boards, none consistently deliver all elements, in particular after the first or second miscarriage.
We will approach the debate in good faith, because we have not yet read the framework. However, on the point about the territorial boards that have yet to make progress, can the minister give a timeline for when that work will be completed?
I recognise the very important work that Monica Lennon has done in women’s health and for her constituents. I cannot give a timeframe just now, but my team of officials is working closely with NHS boards to ensure that those separate spaces are created as soon as possible. In some cases, it might be down to the financing of the building of the hospital, or there might be issues with trying to find a specific space. There are a number of reasons, but we are working closely with health boards.
In developing the framework, an expert miscarriage group and a writing group were established, and I am deeply grateful to everyone who has been involved. The expert group was co-chaired by Colin Duncan, a professor of reproductive medicine and science at the University of Edinburgh, and Professor Justine Craig, Scotland’s chief midwifery officer, and it had wide representation from across the NHS, the royal colleges and third sector organisations.
The expert group has set out timescales for delivery of the framework and its 34 deliverables and actions. I acknowledge that this is a difficult time for boards and that there will be some challenges to implementation, which is why I am pleased to announce £1.5 million of funding for boards in the next financial year to support that very important work.
Kath Abrahams, the chief executive officer of Tommy’s national centre for miscarriage research, has today described the framework as
“a real milestone on the path to excellent care for women and families in Scotland”.
As well as Tommy’s, the organisations Held In Our Hearts, the Stillbirth and Neonatal Death Charity and the Miscarriage Association have been at the heart of the work, and I thank them for their crucial input.
Thankfully, for most women, a first miscarriage is also their last, but that does not mean that it is not a devastating experience that is full of questions that often just cannot be answered, such as “Why did it happen to me?”, “Did I do something wrong?” and “Can I help to prevent it from happening again?”
Although there are often no answers, we can provide women with as much information as possible. I am aware that the documents that have been published today are dense and are aimed specifically at senior management and health professionals involved in miscarriage care. However, I know from speaking to women and partners who have experienced miscarriage that there is a real need to provide more clear and accessible information to those who are going through the experience.
Will the minister take an intervention on that point?
I would like to make some progress.
That is why we have been working with the charity Tommy’s and a group of professionals and third sector organisations to develop patient leaflets. There are three leaflets, which are entitled “I think I’m having a miscarriage”, “After a miscarriage” and “Miscarriage: dads and partners”. All three leaflets are available digitally from today and will link to the newly published, vastly expanded and improved NHS Inform miscarriage pages. We also have a leaflet on reducing the risk of stillbirth, a copy of which is given to every pregnant woman in Scotland.
Following the publication of the framework, we will work closely with Tommy’s and Held In Our Hearts to develop a patients charter that sets out clearly the care and support to which women are entitled and how they can access it. I will ensure that people with lived experience and health professionals are involved in the development of the charter.
To ensure that all women and their partners receive the support and care that they need, we must have a more accurate picture of the number of miscarriages in Scotland. We commissioned Public Health Scotland to collect that data, initially concentrating on establishing data collection for miscarriages in which women present to early pregnancy units and services. I am pleased to announce that a data set has been agreed and that Public Health Scotland is now testing it in boards.
We know that miscarriage can be devastating for partners, who often feel a great sense of helplessness. We also know that many dads and partners believe that they need to put their feelings to one side to support their partner. That is just one example of why tackling stigma is so important. We need to break the silence that too often goes alongside miscarriage and stillbirth to ensure that everyone who needs support receives it. I am pleased that we in the Parliament are playing our part in speaking out today.
One of my first engagements as a minister was to the Sands and Scottish Government national bereavement care pathway conference. The powerful speeches and atmosphere of that event will stay with me always. There was a real warmth in the room, which might seem to be a strange thing to say, but it was clear that everyone there, no matter their personal circumstances, wanted to support others and share experiences to improve things for others.
We continue to work closely with Sands. As well as funding and supporting the development of the national bereavement care pathway programme, we continue to fund Sands to support boards with implementation of all five pathways for pregnancy and baby loss. Last year, I attended a round-table meeting that was hosted by Held In Our Hearts and Bob Doris to hear about the innovative hospital-to-home project. I then had the privilege of visiting its premises to chat again with its chief executive, Nicola Welsh, staff members and bereaved parents, and I was pleased to confirm £60,000 of funding for the project for this year and the next. We have also launched a memorial book of pregnancy and baby loss prior to 24 weeks, because we know that, for many people, recognition of their loss provides some comfort and validation during an incredibly painful time.
I have said many times previously how immensely proud I am to hold the position of Minister for Public Health and Women’s Health. Today, as I open this important debate, is no exception. I hope that, in coming together today and speaking openly about miscarriage in our national Parliament, we can help to break down the stigma, send a message to people that they are not alone and, importantly, drive improvement for those who access miscarriage care.
I move,
That the Parliament recognises the devastating impact that miscarriage and stillbirth can have on women and their families, and extends its condolences to all those who have been affected; acknowledges the importance of good stillbirth care and that improvements continue to be made by NHS boards and through the stillbirth national bereavement care pathway; notes that, although miscarriage care in Scotland is generally considered to be of high quality, there is still more to do to standardise and end the variation in the care and support delivered across Scotland; welcomes efforts from NHS boards to further improve miscarriage care following recommendations in The Lancet series, Miscarriage Matters, and Royal College of Obstetricians and Gynaecologists and NICE guidelines around the use of progesterone; thanks hardworking NHS staff and all those who have contributed to the progress to date for their care and professionalism when caring for women experiencing miscarriage; welcomes the publication of the Delivery Framework for Miscarriage Care in Scotland and the Progesterone Pathway as key steps in implementing a graded model of care that will ensure that women receive tailored support from their first miscarriage; supports the provision of dedicated facilities for women experiencing unexpected pregnancy complications, miscarriage or still birth, and believes that it is vital that everyone in society, including employers, works together to break the stigma surrounding miscarriage and stillbirth to ensure that women and their families can access the information, care and support that is right for them.
15:42
I remind members that I have a daughter who is a midwife in the Scottish NHS.
I am grateful to have the opportunity to open the debate on behalf of the Scottish Conservatives. Miscarriage or stillbirth has such a profound and traumatic impact, predominantly and rightly on the mother. However, as the minister has recognised, there is also trauma for those around the mother who support her through that time.
I say that because I have been in that situation myself. Even though it was more than 30 years ago, the strength of those emotions took me by surprise when they surfaced, knowing that I was going to give a speech and remembering what my wife had to go through that night.
For many, it is a big surprise to learn how many people go through a similar experience. One in four women lose a pregnancy, along with their families and friends. When that happens to you, you think that you are the only one going through the trauma. That is why, as the minister said, in such debates, it is so important to get the message out that there is help to be sought. I was therefore glad that the minister mentioned the organisation Sands, which does incredible work, and there are many others that work along those lines.
Many members will know of my constituent Fraser Morton, whose partner gave birth to Lucas, who was initially diagnosed as stillborn. As a result of a campaign that included a BBC documentary and an investigation by Healthcare Improvement Scotland, he got that diagnosis changed to death during birth and managed to get his son registered on a birth certificate. Not many people know that many stillborn children do not get the opportunity to have a birth certificate. We need to consider that, because it seems to me that that is an important anchor for the people whom I have met previously.
That was one of the first constituency cases that I was involved in, and I have remained in contact with Fraser and his partner ever since. As an outcome of the investigation, they managed to highlight that Crosshouse hospital was 24 neonatal staff short. He and his wife, June, have campaigned and raised money for others who are suffering a similar loss. In my view, they are two very special human beings.
Women in Scotland struggle to access mental health support after a miscarriage. Across all health board areas, there does not appear to be a clear process, in every site that provides miscarriage care, for routine assessment or for referral to support services for mental health bereavement or counselling support. Screening for mental health issues is not provided by all health boards.
In 2020, Imperial College London found that miscarriage and ectopic pregnancy may trigger long-term post-traumatic stress, anxiety and depression. Following the publication of that research, the Miscarriage Association gathered online responses, which echoed the research and focused on the serious and long-term impact on mental health. Many people shared personal experiences of the gap between their needs and the services and support that were available.
Key issues that were mentioned were not exclusive to Scotland, but if anyone has confided in you about their miscarriage experience, the comments will not be surprising. The issues included lack of support at the time of loss and later on; lack of recognition of pregnancy loss as a significant event, including in the language used by medical staff; women experiencing loss being seen in the same place as expectant mothers or those who have given birth; high levels of anxiety when thinking about another pregnancy and during future pregnancies; and little access to, or even mention of, counselling or other therapies—and, often, long waiting lists if they were referred to them.
When we look holistically at the impact of miscarriage, we need to recognise that the woman’s partner and family are often the first line of support for that woman. However, all too often, they also feel the loss of the pregnancy deeply. Making sure that partners and families get the right support means that they will be able to process that trauma and support the woman in their lives while she processes her own trauma. Although all that is recognised in current NHS pathways, there is a lack of bespoke support for partners—especially men—and families to help them to process their distinctly different emotions.
That brings me to healthcare professionals. Without the staff, the “Delivery Framework for Miscarriage Care in Scotland” and the progesterone pathway cannot be delivered. It is important to look after our staff, both mentally and through making sure that they are properly resourced. Proper resourcing means not only that they have the tools for the job but that they have the proper facilities, educational support and staffing to do their job effectively.
In the Scottish Government’s programme for government for 2023-24, the Scottish National Party promised to improve miscarriage care and support, including by having secure separate spaces in hospital maternity wards for women who suffer a miscarriage. However, the recent report from the Royal College of Nursing includes eye-opening accounts of the lack of privacy and dignity for patients, with nurses having been left with no choice but to discuss miscarriages with couples in hospital corridors.
Midwives are often the first line of support for women experiencing miscarriage. However, the Royal College of Midwives has said that midwives simply do not have the time or education to provide high-quality, evidence-based and compassionate miscarriage care. The RCM advocates access to high-quality, evidence-based and compassionate miscarriage care, but we need a workforce with the time and education to provide that support. Although it welcomes the work on updating the predicted absence allowance, it is currently not adequate to meet the core mandatory training needs or the gap in speciality midwives to ensure that women and families receive the care and aftercare that they need. That includes the key role of midwives in supporting perinatal mental health for women with miscarriage.
The emotional toll of miscarriage can affect a person’s mental health and their approach to future pregnancies, including their willingness to access care. It is important that women receive the right support from their very first miscarriage, for their mental and physical health, so that there is no loss of trust in medical professionals.
I know that there is a persistent and serious issue in the delivery of healthcare, let alone miscarriage support, in rural areas. My colleague Douglas Ross will touch on that in more detail. However, I note the travel time to access maternity services and mental health services; access to transport to get there; the fact that telehealth might not always be the most appropriate way to deliver care; the shortage of mental health professionals in rural health wards; and the fact that stigma around mental health can be more pronounced in rural communities, increasing the isolation that women and their families feel after miscarriage.
The debate is very welcome, and I thank the Scottish Government for providing time for it. I think that all members understand the suffering and trauma of miscarriage and stillbirth, but the evidence is clear that we are still falling well short of where we need to be. I look forward to getting the opportunity to read through the document that has been produced by the Scottish Government.
15:50
I am pleased to open the debate on behalf of Scottish Labour to discuss an issue that touches the lives of many families across Scotland. It is vital that we look at what more can be done to improve miscarriage and stillbirth care, so that the next generation does not suffer the same dismissal that perhaps many women have suffered before.
I thank the minister and her officials for the collective way in which they formed the motion. We all want to support and progress the issue to ensure that the care that women receive only improves over the coming years.
At this stage, I welcome the framework, but I am sure that the minister will expect there to be scrutiny from members on how actions are delivered. It is fair to say that some elements of care are delayed, and we need to treat the situation with some urgency.
Let me, like other members, acknowledge the deep emotional toll that miscarriage and stillbirth take on individuals and their families. It is a grief that is often unspoken, and it is crucial that we recognise the profound impact that it has on the many women and families who, sadly, require access to such services.
Although I hope that stigma around miscarriage has reduced, let us not forget that it persists. To address that, we in the Parliament must do our part to talk about it, as the minister and Brian Whittle said, and to work out a way to rectify and improve the care pathway for women who have to travel it. Therefore, I thank all the members who will speak in the debate or who have stayed in the chamber to listen.
I express my gratitude to all NHS staff. We know that the kindness and expertise of staff is at the heart of our NHS. I am sure that, like me, other members from across the chamber hear from patients time and again about the care that they receive in the NHS. In the brief look that I have had at the document, I see actions around supporting staff, which is extremely welcome.
My party welcomes the recommendations from The Lancet’s miscarriage matters series and supports the staff who continue to work on improving miscarriage care across Scotland following those publications. We welcome the progesterone pathway and, of course, support the graded model of care.
We must ensure that the “Delivery Framework for Miscarriage Care in Scotland” can be fully implemented across all NHS health boards to improve the pathway for women. I have seen the goals in the framework. However, we know from the scoping exercise that not all NHS boards routinely or equitably—even across individual boards—provide the same service for patients, which is an important point. Perhaps in the minister’s closing speech we could get an idea of how that might be monitored, so that we can progress it. We should keep a tight look at the framework as we go forward.
Every case of miscarriage or stillbirth is a devastating tragedy for the parents and the wider family. We know that people face many unfair and avoidable inequalities when attempting to access health services, due to financial or geographic differences, which can significantly impact on pregnancy and infant mortality. Inequalities are a barrier for many families, and it is our responsibility to ensure that services recognise that and have firm policies in place to ensure that all services are provided with that in mind. I will look at the framework in that regard. We know that people from our poorest communities access services less readily or much later than more affluent families. Addressing that must be part of any Government strategy.
Disparities due to geography remain far too prevalent; I do not think that it is unfair of me to say that. We talk in the chamber about the journeys that patients have to make, and I am sure that members recognise that issue. In Scotland, we have pockets of extreme rurality. We must seek to workforce plan and have the skills available to attend women, rather than the other way round. I will look at the framework to see how we ensure that that is embedded in what we do.
I am very aware of the time but, like Brian Whittle, I want to touch on the devastating psychological impact of miscarriage for women and the wider family. Psychological services should be available to ensure that people have care right through afterwards. People will perhaps have seen the Engender briefing, which highlighted that such services were not available during the Covid period, which really affected people. There was definitely a link with women not having their family support around them at that time. Should there be any time in the future when we need to think about how we provide services, it is absolutely clear that women require that support.
I wanted to touch on the space that women have, although I do not have a lot of time left. My colleague Monica Lennon has done so much work on that, and she will possibly touch on it. I again thank everybody for coming along and speaking in the debate.
15:55
I begin, as others have done, by acknowledging the deep and often unspoken grief that miscarriage and stillbirth bring to women and their families. I thank midwives and their teams across Scotland.
Despite it being a relatively common experience, miscarriage can be profoundly isolating, especially for those without the support that they need. The emotional, physical and psychological toll can be immense yet, too often, those affected suffer in silence. There is a reluctance from many to talk about their loss, especially when that loss is early. I am sure that many members have spoken to family and friends who have had a throwaway comment such as, “At least it was early,” which definitely prevents people from being truly able to speak about their loss.
Good miscarriage care goes beyond medical treatment. It requires compassion, clear information and a shift in societal attitudes to ensure that no one faces the experience alone. I welcome the opportunity to discuss what Scotland is doing well and what we must do better to improve care and support for those affected. I thank the minister for securing the debate.
Scotland has taken important steps in improving miscarriage care, recognising that compassionate support is just as vital as clinical treatment. The national bereavement care pathway has provided much-needed guidance to healthcare professionals, helping to ensure that those experiencing pregnancy loss receive sensitive and appropriate care. That initiative has encouraged a more standardised approach in reducing disparities in how miscarriage care is delivered across the country. The pathways have been developed together with several pregnancy and baby-loss charities, royal colleges, a wide range of healthcare experts and an advisory group of women and men who have experienced loss.
The funding by the Scottish Government is vital, and it is delivered in partnership with Sands. The important role that Sands plays in supporting families affected by miscarriage and baby loss cannot be overstated. In my Central Scotland region, its local support groups cover the Forth Valley and Lanarkshire health boards and provide a safe and understanding space for bereaved parents to share their experiences and to receive comfort from those who truly understand their grief. Those groups, which are run by dedicated volunteers, offer peer support meetings, remembrance events and advice to help families to navigate the tricky situations that they are in. The presence of such compassionate support networks is invaluable in ensuring that no one feels alone in their grief.
Although it is undoubtable that progress has been and continues to be made, there is still much work to do. Too many women report feeling dismissed or unsupported when experiencing miscarriage, particularly in early pregnancy. We must do more to ensure that healthcare professionals receive adequate training to provide informed care. Access to miscarriage support remains inconsistent across Scotland. In some areas, women are left waiting for treatment or are forced to navigate a fragmented system. Steps have been taken to mitigate that, but we must double down on efforts to ensure that every woman, regardless of where she lives, can access timely and comprehensive care.
As has been mentioned, the psychological impact cannot be overstated. Although some support services exist, many women and families struggle to find the counselling and mental health support that they need. We must strengthen links between miscarriage care and mental health services. Without accurate and comprehensive data, it is difficult to identify gaps in care. I acknowledge what the minister has already said on that. We must continue to listen to those with lived experience and to ensure that their experiences shape improvements.
Although we have made significant strides in supporting those affected by miscarriage and stillbirth, the effort is far from over. It is imperative that we continue to work collectively with healthcare providers, policy makers, employers and society at large to break the stigma surrounding pregnancy loss. It is only by ensuring access to consistent, compassionate and high-quality care that we can provide solace to those families who grieve.
15:59
I am grateful for the opportunity to take part in this afternoon’s debate on behalf of Scottish Liberal Democrats, and I am grateful, too, for the time that the Parliament has been given to discuss the important topic of miscarriage care. I associate myself with the condolences extended by the minister and in the motion, which we will support.
In June 2021, I lodged an amendment to a motion on women’s health—which was not selected for debate—that raised the question of the provision of dedicated facilities for perinatal loss. Former Shetland resident Louise Caldwell, who, I think, is in Parliament this afternoon, has bravely campaigned on the issue after her miscarriage experience, when she was required to deliver on a labour ward. As I indicated in 2021, it is difficult to imagine how hard it must be to be met with newborn baby photos on walls, thank you cards, baby cries and proud partners. Official guidance says that separate facilities should be provided, but women’s experience shows that recognition of the issue does not always translate into reality.
Since that time, there has been improvement, which is due in no small part to Louise’s campaign. Last November in Shetland, the northern star bereavement suite at the Gilbert Bain hospital marked its first anniversary. The suite is designed for parents who have suffered an early pregnancy loss, such as miscarriage or ectopic pregnancy. It was co-designed with the NHS team in Shetland and the baby loss charity Sands. I pay tribute to all who were involved in making that facility a reality. Feedback from patients has reportedly been very positive, despite the circumstances in which people use the service, and families have found comfort in placing their baby’s name on the memorial wall.
Shetland Sands also played a key part in developing a private space in Shetland’s Sumburgh airport for women who require to travel to Aberdeen on commercial flights when there are complications with their pregnancy. I do not think that people understand how difficult it must be for someone from a small community, who is travelling and is in the departure lounge—
I thank Beatrice Wishart for mentioning the facility at the Gilbert Bain hospital, which I was able to see when I was in Shetland last year. I heard directly from people that it is important not only for patients but for staff that that separate space is available to ensure that mothers and families are treated with dignity and compassion at the most difficult time in all our lives.
I think that it is absolutely true that the facility is important for staff, too.
I was talking about the situation of women who have to travel to Aberdeen and how difficult it is, as members of a small community, to have other people come up and ask whether they are going on holiday or whatever. Therefore, the private space at Sumburgh airport is important, and I pay tribute to Highlands and Islands Airports Ltd, which engaged with the request that such a space be provided. Nothing can take away the mix of emotions that are present, but anything that helps to blunt the sharp edges is worth while.
We should also consider what could be done for inhabitants of the far north of Scotland, for whom there is a lot of travel involved in accessing women’s healthcare.
Across the UK, the national bereavement care pathway is implemented with varying degrees of success, although Scotland is considered to be ahead of the rest of the UK when it comes to the provision of care in that area. We do not have to look far for a model of mental health support that is considered to be excellent. NHS Tayside’s mental health package for those who have experienced baby loss includes self-referral, open-ended care and support for both parents.
To help to improve services, we need to have a better understanding of the number of miscarriages, and work is well under way to establish routine miscarriage data collection in the maternity setting, while separate work is under way to secure access to data that is held in primary care for national analysis. The Sands charity has called for annual reporting on miscarriage rates, once we have a better understanding of the number of miscarriages, to enable the Government to monitor whether rates are decreasing or increasing. That will help with the introduction an outcome-based target to reduce the miscarriage rate.
I take comfort in the knowledge that, in Shetland right now, there is a memorial wall that reflects the unforgotten in a suite named after the constant shining light in the night sky of the northern star, which is well famed for its guidance.
16:04
Today’s debate concerns the very difficult topics of miscarriage, stillbirth and pregnancy loss. I know that this Scottish Government is committed to reducing stigma, breaking the silence and normalising conversations about pregnancy loss, which can, in small part, be realised by having debates such as this one today.
Although it is hard to get exact figures, as the minister touched on already, it is believed that anything from 8 to 24 per cent of pregnancies end in miscarriage. In the spirit of being open and breaking down the silence, and as I think I have said in the chamber before, my partner and I have experienced several miscarriages. We have three lovely children but have also had miscarriages at various points in that journey. The uncertainty around the figures stems from many miscarriages going unreported, with some women even being unaware that they were pregnant in the first place.
Whatever the true figures may be, each pregnancy loss has a devastating impact on those who suffer a miscarriage, as well as on their wider family and friends. That traumatic experience requires improved and supportive care that is conducted with dignity and respect.
I appreciate the tone of today’s motion, which I think is highlighted by the fact that there are no amendments. I also acknowledge that there has been progress on the issue, but there is, of course, still much to be done. Taking forward the findings of The Lancet’s report by supporting the development of individualised care plans after a woman’s first miscarriage, ensuring that health boards and women’s services have dedicated facilities for women who are experiencing unexpected pregnancy complications and even committing to introducing three days of paid leave for families who suffer miscarriages and stillbirths are all steps in the right direction.
Although I commend the work of the Scottish Government, I must also highlight the incredible work done outwith the public sector by charities such as Baby Loss Retreat, whose chief executive officer and founder is a constituent of mine. Baby Loss Retreat was founded in February 2018 by Julie and Bryan Morrison, who lost their daughter Erin in 2003. What began as a charity that offered bereaved parents a retreat free of charge has now grown into an organisation that also provides counselling, trauma therapy and music therapy for siblings affected by loss. It utilises bereavement counsellors and holds regular support groups for those who avail themselves of its services and I know that other members representing central Scotland are very much aware of that work. The charity’s co-founder, Bryan Morrison, also does a lot of work with men who experience baby loss, a subject that has been touched on by a couple of speakers. He does fantastic work and I encourage everyone here to watch some of the videos that he has made.
As I said, I am aware of the significant progress that the Government has made on the issue, but there are still areas that need urgent attention. I spoke to Julie Morrison of Baby Loss Retreat ahead of the debate and she stressed the need for improved services in early miscarriage units. She made me aware of a case that I have been given permission to share, which I will do in Julie’s own words, as I think that will be more apt to the situation:
“I had to deal with a parent 2 weeks ago who had experienced a miscarriage. She was sent to A & E due to early miscarriage unit being closed over the weekend depending on what area you live in.
She went to A & E bleeding and scared that she was losing her baby. She arrived in A & E and had to wait 8 hours for a gynaecologist to come and see her. For him to tell her she may be experiencing a miscarriage to go home and go back to the early miscarriage unit on the Wednesday to confirm if the baby’s heart had stopped or if she’d had a miscarriage.
She messaged me scared as the bleeding was getting heavier and she was told to wait until Wednesday when the unit would be opened. She eventually had to pay for a private scan to confirm that she was actually having twins and that one twin had died.”
That is a tragic set of circumstances and my condolences go to the family, but I think it is important to raise that. Baby Loss Retreat asked me to raise a question here in this debate: why are parents who are experiencing a miscarriage being sent to accident and emergency when we have functioning early miscarriage units for anyone who is experiencing a loss at an early stage in their pregnancy? If people who are experiencing pregnancy loss could be diverted away from the traumatic experience of attending A and E, that would have the double benefit of lessening the pressures on A and E as well.
I am heartened by the steps outlined by the Scottish Government today as it looks to improve miscarriage care. We must let people know that they are not alone and that conversations such as those that we are having today are necessary to normalise discussion of pregnancy loss. The work outlined by the Scottish Government is complemented by the excellent charities and third sector organisations that have done so much for bereaved parents throughout Scotland. Nevertheless, we must continue to increase healthcare funding so that those who need it most are treated with dignity and respect. In particular, we must invest in early miscarriage units so that there is constant support when that is needed.
16:09
I was a member of the Health, Social Care and Sport Committee in 2022, when it took evidence on its inquiry into perinatal mental health, so I welcome the chance to speak in this debate. I was grateful at the time that the inquiry addressed the impact of baby loss, which is often a taboo subject, as we have heard, and is not spoken about until it affects us personally or those who are closest to us. Miscarriage and stillbirth have a devastating impact on women and their families. It is an important issue, and I extend my condolences to all those who have been impacted.
As we have heard, miscarriage care in Scotland still faces serious challenges. Women in Scotland are struggling to access mental health support post-miscarriage. Across all health boards, there appears to be no clear process that provides miscarriage care, routine assessment and referral to mental health and bereavement support services or counselling.
In 2023, the Scottish Government published “Miscarriage Care and Facilities in Scotland: Scoping Report National Overview”, which evaluated miscarriage services across Scotland. That report acknowledged that not all health boards had a separate room for women who are miscarrying and that four health boards lacked dedicated early pregnancy units, forcing women to seek care in general emergency departments where specialised miscarriage support may not be available. Furthermore, the report said that the training and skills of healthcare staff who provided miscarriage care varied across health boards and that specialist training was often centralised in one or two units within a health board.
As we know, sadly, under the SNP, workforce planning always takes a back seat. I ask members to consider these words from a midwife who responded to a survey from the Royal College of Midwives:
“I cannot remember the last time we had safe staffing within our unit. On a daily basis, we are struggling to provide a decent standard of care to our women and their families.”
Staff shortages are impacting not just on recruitment and retention, but on training, which is too often failing to take place because of staff shortages.
The inconsistencies across the different health boards in Scotland need to be fixed. The delivery framework, which was embargoed until this debate started, references 34 key actions that are needed and classifies them as N, meaning now, for things that need to be addressed within six months; S, meaning short term, for things that need to be implemented within 12 to 15 months; or M, meaning medium term, for things that need to be implemented within 15 to 24 months.
Eighteen of the actions are classified as needing to be looked at within six months, and they range from bereavement care to what needs to happen when women have had three miscarriages. I draw members’ attention to action 27, which says:
“Where 3D ultrasound is not available, 2D ultrasound should be offered after a 3rd miscarriage. Where any abnormality is suspected, further imaging with 3D ultrasound, at a different site or with an agreement with another NHS Board, or MRI should be offered.”
I really hope that there will be resources for the 18 things that are needed immediately, because we will never make the change that is needed if there is not money to fix things.
The 10 actions that are classified as M, or medium-term requirements, include out-of-hours access to support, which previous speakers have discussed. The actions that are required within 15 to 24 months also include a series of steps with regard to what happens when a woman has a second miscarriage. Again, resources must follow those actions. I hope that the minister will provide us with a dashboard that shows progress at health board level so that we can see how each board is stepping up to the mark and delivering on the new framework.
I am glad that we now have the progesterone pathway. However, it is nothing new, and I do not understand why it has not been made available to us until today. It was in National Institute for Health and Care Excellence guidance that was published in 2019 and revised in 2023, which recommended offering
“vaginal micronised progesterone 400 mg twice daily to women with an intrauterine pregnancy confirmed by a scan, if they have vaginal bleeding and have previously had a miscarriage.”
There is nothing new in what you have presented to us this afternoon, minister. I do not understand why we could not have had sight of the framework earlier so that we could have really discussed it and celebrated something on which we might look forward to making Scotland the best in class.
I remind members to always speak through the chair.
16:14
I thought that that was a very disappointing tone in Sue Webber’s contribution.
Today, we are debating an emotive and heartbreaking issue, which is sadly very common.
Will the member take an intervention?
No, I have just started.
The loss of a baby at any stage is tragic. It is a traumatic experience that can have a profound impact on families—going from the elation of being pregnant and the happiness that comes from planning to welcome another life into the world and to enhance your family, to suffering devastating heartache and disappointment.
Miscarriage is the loss of a pregnancy before viability, which is currently defined as 23 weeks and six days’ gestation. It may occur spontaneously or as a missed miscarriage, which may require medical or surgical management. It affects around 8 to 24 per cent of pregnancies, although it is difficult to obtain an accurate figure, because it can often occur before a woman knows that she is pregnant.
Throughout it all, the Scottish Government expects all women who are receiving maternity care to be treated with dignity and respect. We have made clear progress on maternity care in the past five years, and we are committed to progressing that further. In 2023, we launched a memorial book and certificate for those who have experienced pregnancy or baby loss prior to 24 weeks.
Many hospitals already have separate spaces for women who suffer pregnancy or baby loss, and the Scottish Government will ensure that all major hospitals and NHS boards with maternity units do. It is a simple but humane and necessary measure to ease the pain of baby loss.
As has been mentioned by other speakers, breaking the silence and reducing the stigma and isolation associated with pregnancy loss and baby death are of the utmost importance. For too long—and certainly for my generation—it was an unspoken trauma, almost secretively guarded by families as they attempted to cope with their grief. People were often told by doctors, “At least it proves that you can get pregnant. Try again and everything will be fine.” Although that might be true, it gives no comfort to grieving parents at the time of such a tragic loss.
The Scottish Government believes that, by delivering good-quality, supportive and compassionate miscarriage and bereavement care, we can break the stigma and begin normalising conversations about miscarriage and stillbirth. Our Government-funded national bereavement care pathway for pregnancy and baby loss and accompanying care standards are clear that women and families who experience pregnancy or baby loss should be treated compassionately and that difficult news should be delivered in a quiet, private space.
We fully support taking forward the findings of the report by The Lancet and supporting the development of individualised care plans after a woman’s first miscarriage. That also includes ensuring that women’s services and health boards have dedicated facilities for women who are experiencing unexpected pregnancy complications. The SNP is also committed to emulating New Zealand, where families who experience miscarriage or stillbirth are entitled to three days of paid leave, by delivering that within the public sector.
As we have heard, the “Delivery Framework for Miscarriage Care in Scotland” ensures that work is improved and updated and that it will standardise and bring an end to the variation in the care and support that is delivered across Scotland for women and families who experience miscarriage and pregnancy loss. The framework will outline a plan for the introduction of a graded model of miscarriage care in Scotland. It has been developed by an expert short-life working group, which included representation from health professionals and third sector organisations.
In conclusion, there is an abundance of support organisations out there, such as Sands. Miscarriage matters, and I hope that grieving families will take comfort from knowing that they can get help to get through it.
I call Monica Lennon, who will have up to five minutes, given how Labour has sought to allocate its speaking time today.
16:18
I welcome the opportunity to speak in this important debate and am therefore grateful to the minister for bringing the motion to the Parliament. I associate myself with her remarks about sympathy for all those who have been affected and our collective efforts to smash the stigma. It is good to see the Cabinet Secretary for Health and Social Care in the chamber, and I hope that that gives an indication of how important the issue is to the Government.
We all recognise that, for generations, miscarriage, stillbirth, baby loss and women’s health have not been high on the agenda for policy makers or Governments anywhere. The issues that we are debating today are certainly not unique to Scotland, but we all have a responsibility to right that injustice. That is why today’s debate is so important.
I am fortunate that I do not have the lived experience that many people have shared today, and I am grateful to hear from colleagues about their own experiences. As an MSP, I rely on my constituents to tell me about their experiences. It is a great privilege when they feel that they can open up and trust me with their trauma and loss.
Beatrice Wishart made an excellent contribution, and I am glad that she was able to take part. I know that she is claiming Louise Caldwell as a Shetlander, which she was briefly. I thank Beatrice Wishart for her genuine support and compassion for Louise Caldwell, who is one of my constituents in Central Scotland. Louise and her husband Craig are from East Kilbride and are in the public gallery and, true to form, I can see that they are sitting at the very back of it. Louise is incredibly modest about her campaigning work. I often use the word “changemaker” to describe Louise—I know that she will be blushing at that, but it is thoroughly deserved. I will come on to speak about the award that she received form the Sunday Mail.
Louise does not want to be in that position. She is a campaigner because she has the lived experience. She knows what it is to have experienced miscarriage and to have to find yourself in the general labour ward of your local maternity hospital in a nightmare situation. The balloons, cards, elated parents and newborn babies are in juxtaposition with the mothers, partners, dads and other family members who are in utter shock, disbelief and so much pain. When Louise came to me for help, of course, I was going to listen and do whatever I could.
It has been a privilege to help Louise to have a platform in the Scottish Parliament. Louise attended a meeting of the cross-party group on women’s health to share her experience, and I am glad that she was able to do that. This is the first time that Louise and Craig have ever been to the Scottish Parliament. I hope that their attendance reinforces the importance of opening up the Parliament to the people of Scotland. Rather than the Parliament just being a place where members come to talk among ourselves, it should be a place where people can feel seen and heard, can influence our policies and where investment goes, and can make change happen.
Louise Caldwell was crowned the Sunday Mail’s community champion in 2022, which is no mean feat and is a national recognition. Whether members represent Shetland, Central Scotland, the Borders or anywhere in between, the issues that we are debating affect every corner of Scotland. At the time, the Sunday Mail’s editor said:
“Extraordinary people rarely think they have done anything out of the ordinary. The courage, dedication and sheer determination of these unsung heroes make them Scotland’s champions.”
That was said in direct reference to Louise Caldwell.
I know that I am running out of time, but I will mention a couple of other things. I am really grateful that the Government included recognition of stillbirth. I know that Tess White is not in the chamber, but she and I, along with other campaigners, visited Bute house in the summer to talk about the impact of stillbirth and to campaign for the placental growth factor test, which helps to identify the risk of pre-eclampsia. I was with my good friend Lynsey Hamilton and her husband Bradley, who were there because of the loss of their baby, Carys. The outcome of that meeting shows that we can be a listening Parliament and that we can have a listening Government. We rely on the courage of the changemakers, such as Louise Caldwell and Lynsey Hamilton, to put pressure on us to ensure that we step up.
I asked the minister for an update on dedicated baby loss facilities. There is more work to do. Scottish Labour is entirely committed to playing our part to ensure that the words that we share in the Parliament turn into action.
16:24
I took part in a similar debate on miscarriage in October 2020 that was led by Shona Robison. I said at the time that my wife Janet and I had had four miscarriages over the years, but that we were absolutely blessed to have our son Cameron in our lives who, at that time, was four years old. Now, we are also incredibly lucky to have a beautiful young daughter Isla, who is three. Cameron is now nine.
My short contribution to the debate, for which I have drawn in part from our family experience, is tempered by the reality that, despite the heartache and trauma that we went through, two beautiful and joyous children are now our lived reality. Others go through the pain and heartache of recurrent miscarriage and may never be as fortunate as we have been.
Today’s debate must ask the question: have matters related to miscarriage improved since 2020? I am pleased that there has clearly been progress, but we need to take a step back and comprehend what that means in practice. For instance, a key recommendation that has been made over the years is to have dedicated facilities for women who are experiencing unexpected pregnancy complications. It is positive that that is happening increasingly in NHS boards across Scotland, with most providing early pregnancy units. However, although that is incredibly welcome, such facilities are often co-located with or in close proximity to maternity units. Although I understand the reasons for that, the emotional impact of it can be quite profound.
Imagine heading to an early pregnancy clinic and expecting not to find a heartbeat, anticipating that yet another pregnancy will not progress. You are not excited. You never get excited about a pregnancy when you have faced recurrent miscarriage; you are anxious the entire time. You are using the same shared space as mums-to-be who are almost full term, or family members of new mums who are excited to see a new baby in what is one of the happiest moments of a family’s life. They should be happy and excited, and they should share that joy with anyone and in any way that they so wish. However, the impact on those on the way to have the most devastating news passed to them—that yet again they will not see the birth of a child that they so desperately want, or that they will have to undergo a related clinical procedure—can be profoundly traumatic. The thoughts that people have at that time are not always rational, but they are very real. We have to think more not just about dedicated facilities but about the geography and co-location of those facilities.
I want to talk about the emotional support that is available to mums and families. Again, I can see that there has been progress, such as that in NHS Greater Glasgow and Clyde, which has bereavement midwives and strong referral processes to valued partners. Indeed, Glasgow midwife Caroline Judge won the prestigious Mariposa award for the quality of service that she offers. However, I suspect that what often happens across Scotland—or in some parts of Scotland—is that information is made available through signposting or a soft referral process at a time when mum and dad are numb, not receptive, or unable to engage with such support. I have no idea what support me and Janet were offered; that time was a chaotic blur. That is why I have been championing Held in our Hearts’ hospital to home model, which trains people, often those with lived experience, to reach out to families in their homes, and not just at the point of crisis but later, when that chaotic blur has died down and when mums might most need that support and be most receptive to it. I will engage further with Dr Mary Ross-Davie, who is leading miscarriage care in NHS Greater Glasgow and Clyde, to see how it is getting on with the support that I believe is needed.
I have a tiny amount of time left. If I had more time, I would have said more about graded miscarriage support, links to assisted conception services and the lack of reliable information that is out there—for example, do natural killer cells cause miscarriages? Discuss, please. When you are a victim of recurrent miscarriage, you go through the internet forensically to work out why. No one knows why, and we need more research.
16:28
This has been a good, constructive and important debate. I want to echo the way in which the minister and other speakers opened their speeches and send my condolences and sympathies to every family who has gone through a miscarriage, and give my thanks to people like Louise and Craig Caldwell who, in moments of adversity, deal with their own trauma but want to improve things for others, too. It is great that Louise and Craig are able to join us in the gallery.
My health board area, NHS Grampian, took part in the national bereavement care pathway pilot, and a lot of work is being done at our local hospital, Dr Gray’s, which I will talk about in a moment. Fulton MacGregor was right to say that it is difficult to get precise numbers on this, but I remember reading a document a couple of years ago that said that NHS Grampian believes that each year it helps 15 to 20 women who are going through a stillbirth, 50 to 60 women who are experiencing loss after 13 weeks but before 24 weeks, and approximately 1,000 women who are going through a miscarriage. Given that we are talking about a rural area that is not as densely populated as other health board areas in this country, it means that a significant number of women and families are experiencing this on an annual basis. As we are seeing those numbers every year, it is right that we take time in our Parliament to discuss such important issues.
Gillian Mackay, and others, were right to talk about stigma. Ms Mackay made the point that some people say, “At least it happened early.” That is partly the fault of men; I know that men do not speak about their own health very much, and certainly not about their wife’s or partner’s health. Sometimes they think that such comments can be helpful, but, because we have not broken down the stigma, they have not shared their experience with others, and they just add to the pain and suffering of their loved ones when they are simply trying to help.
Brian Whittle suggested that I would mention rural healthcare, and I will do so, because the issue affects women in every part of the country, as well as their families. I will not rehearse the comments that have been made about the late notice that we got of the report—it means that I have not read all 53 pages—but after doing a search of the document, I note that rural and island services are mentioned in only one paragraph in those 53 pages. That paragraph states:
“The model of care within rural and island services will be different”.
However, we all know that.
I hope that, in the meeting that the minister has offered to the Parliament, there will be a discussion about this. After all, she represents rural and island communities in her constituency; the cabinet secretary has talked repeatedly about his own experience in Orkney; and I am thinking, too, of their fellow minister, Maree Todd. They all represent rural and island areas. We will need to tease out how the report’s recommendations will affect people across Scotland; it might contain 34 recommendations or key actions, but rural and island services are not mentioned in any of them. We know that we will have to do something slightly different, as Beatrice Wishart said in her excellent speech. The circumstances in our island communities are very different from those in our urban communities, and we have to recognise that.
It is right that, every time, we focus on the women and families who are affected by the issue, but, as members have done and will continue to do, we should also praise the staff for the incredible work that they do in such difficult circumstances.
I read a comment from Marcia Dean, who was a bereavement midwife at Dr Gray’s hospital a couple of years ago. She said:
“I’ll always remember one mum saying ‘you’re the midwife no-one wants to meet but I’m really glad I did.’”
That shows that in their darkest moments—the immediate moment of a miscarriage or stillbirth—a mum-to-be and a family are getting support and care from specialist midwives, care that can continue for months and years. It is therefore right that we recognise the incredible work of our NHS staff in that respect.
16:32
I welcome that the Scottish Government has brought forward this important debate. After all, many people in the Parliament or watching at home will have experienced the loss of a baby.
In Scotland, we pride ourselves on being a contemporary and open-minded society, but, for many, discussing the topic of loss can still feel somewhat off limits. We can still feel inhibited in being open about how we feel and the true impact of a miscarriage.
For those trying to comfort the bereaved, the words for expressing sympathy often do not come easy. If we are being honest, the fact is that, at the end of the day, no words can help. However, the sentiment can make all the difference, so we must reach out. If we cannot find the words, we can just hold their hand—or them. Just letting folk know that we care and are thinking about them can help a little.
This is a bittersweet debate because, although the data tells us that miscarriage is a relatively common occurrence, the loss of a baby, at no matter what stage of pregnancy, is traumatic and can have a profound impact on parents and families. There is a lot for parents to process as they grieve the often unexplained and unexpected loss of their precious baby. At the same time, they are honouring their baby, seeking and providing support, and setting out on what might well be a long journey of healing.
There is absolutely no doubt that there have been significant improvements in miscarriage care in Scotland, and I welcome the Scottish Government’s commitment to ensuring that everyone affected by pregnancy loss before 24 weeks gets the high-quality care and support that they need. I also welcome that the Scottish Government has mandated the national bereavement care pathway, which has meant that all health boards are currently working on implementing the standards and pathways associated with it. The positive impact is beginning to show for both bereaved parents and healthcare staff, with 82 per cent of healthcare professionals agreeing that it has helped raise the profile of effective bereavement care. Although that is positive, there is work still to be done.
I thank Sands and everyone else who has taken the trouble to get in touch with us before the debate. In its briefing, Sands said that it has heard of significant delays of up to three days between women being seen in A and E for a suspected miscarriage and being referred to early pregnancy assessment services. Health boards must consider what work they can do to reduce such delays and to offer more direct access to early pregnancy assessment services. I would be interested to hear from the minister in her closing speech whether an assessment has been made of the adequacy of access to early pregnancy assessment services for all those who need it, and what improvements can be made.
I take the opportunity to thank the Scottish Government for launching a memorial book and certificate in 2023, for all those who experience pregnancy or baby loss prior to 24 weeks. To those who have not suffered a loss, it probably does not have a significant meaning; to those who have, it means the world. The loss of their loved one, no matter how young, matters and is not forgotten.
I finish by expressing my sympathies to all those who have gone through such a tragic loss.
I must advise the chamber that we have used up the additional time in hand that we had earlier, and I now ask members to keep to their speaking times.
16:37
Today’s debate has highlighted the progress that we have made in Scotland, but it also underscores the urgent need to continue to improve miscarriage care. We have heard powerful contributions from colleagues, and I thank those who have shared their personal testimony. It has been hugely powerful, and I have a massive amount of respect for those who have done so. I, like Monica Lennon, have not experienced this horror—and I sincerely hope that we never do—but I thank the campaigners who have been mentioned for the change that they have made.
One of the gaps that we need to address is how employers, in particular, treat miscarriage. We should be making that support consistent for everyone. Some employers might provide sick leave or bereavement leave, but very few provide dedicated miscarriage leave that accurately reflects the physical and psychological trauma that women are going through. Some employers are doing the right thing, but it is not a guarantee. We should be pushing for standardised miscarriage leave, based on what women need to recover properly.
I add my voice to Brian Whittle’s ask with regard to ensuring that stillborn babies have the opportunity to have a birth certificate. It is hugely important for some in their grief journey that there is an official acknowledgement that their baby was here. We have recognised that through the memorial book of pregnancy and baby loss, and I think that that is another logical step.
Bob Doris’s speech was hugely powerful, and his reflections on the chaos around miscarriage and the ability of families to take in information were really insightful. It is important to ensure that, as with other forms of bereavement, people can get support when they are ready, not just in the immediate aftermath of loss.
Psychological support for recurrent miscarriage is a must, both at the time of those miscarriages and for those who become pregnant again. The anxiety experienced in pregnancy is quite something. I originally wrote “in early pregnancy”, but miscarriage covers up to 24 weeks, which for some will be more than halfway through their pregnancy. The anxiety does not go away beyond 12 weeks, and I would welcome some detail from the Government on how we ensure that those with recurrent losses are supported properly.
I welcome the early scan provision in the framework, along with other enhanced physical measures. However, we need to make sure that mum stays well, with appropriate mental wellbeing support. Providing early contact with a scan before 12 weeks means that those invaluable relationships between patients and midwives can be built. Beyond eight weeks, many women around Scotland will have access to their notes through the Badger Notes app. For those who have not seen the app, I can say that it provides women with the ability to see their blood test results, alongside other resources that are relevant to pregnancy.
I apologise if this is indeed in the framework—I have not managed to fully make my way through it yet—but I wonder whether the Government has given any consideration to what the app can do to support those who have had recurrent miscarriages or who are going through a miscarriage. Moreover, the app lists all of a user’s previous pregnancies, and I would be grateful if the minister could tell me whether she has considered giving those with a history of previous miscarriages the ability to ask for those pregnancies not to appear in it.
Those reflections reinforce the importance of ensuring that every woman and every family affected by pregnancy loss receives compassionate and high-quality care. The “Delivery Framework for Miscarriage Care in Scotland” represents a crucial opportunity to establish consistent, dignified and compassionate care for all. However, it will only be effective if we continue to push for real, tangible change to ensure that improved data collection, expanded specialist services and stronger psychological support become a reality, not just an ambition.
We must also continue to listen to the voices of those with lived experience, because their insights should shape our policies and the delivery of our services. This sort of work across Government, our healthcare system and support organisations will continue to make a real difference to the lives of so many.
16:41
I thank everyone in the chamber for their contribution to this crucial debate. I believe that we can have constructive debates to push for change where we are in agreement. It is important to acknowledge, as Sue Webber did, where we need to push further. We all understand that things can be delayed, but it is our responsibility as the Opposition to highlight those areas.
Some really important cross-party work has been spoken about. Monica Lennon mentioned her work with Tess White on the placental growth factor test for stillbirth. That work was thoroughly worth while, and I thank them for doing it. It shows how the Parliament can work best with Government.
Jackie Dunbar spoke about being there for people. An important part of what we are discussing is that people need support from family and friends, and we have a responsibility to ensure that that support is part of the framework.
I am keen to mention Brian Whittle, Fulton MacGregor and Bob Doris, who each made a point about breaking down stigma, and I thank them for sharing their stories. I think that everybody in the chamber appreciated that.
Douglas Ross made a suggestion about the meeting that the minister has offered. An important part of the minister’s speech was to say that we can work together, but we need to have space in the Parliament to do that. Douglas Ross and I are keen that the minister moves forward with that suggestion.
I will allow Monica Lennon and Beatrice Wishart to decide among themselves whose constituency Louise Caldwell is a part of. Louise’s contribution cannot be overstated, and her efforts show that campaigning by people in their communities can have a real effect on us in the Scottish Parliament. Campaigning can move mountains; it can make such a difference to people. There is no denying the crucial work that is being done to have spaces for people who experience pregnancy loss so that they can recover and have the care and support that they so desperately need.
An important point was raised about funding for tailored support and training so that we can get tangible outcomes for people. I am sure that the minister understands that we will be looking for that in the framework as we go through it, now that it has been produced.
We all agree on the important point of the graded model of care, which provides a comprehensive pathway. As we go through the document, we will be able to pull out those individual bits.
We know from the scoping exercise national overview report that there are inconsistencies across health boards. I have had only a brief look at the documents, so I hope that that will be addressed in a way that ensures that we can identify outcomes.
Gillian Mackay spoke very well in her opening speech about the organisations that we know do such great work with the NHS. The one that springs to mind is Sands, which operates in her area.
In conclusion, we all need to work together on this issue. I thank the Scottish Government for bringing the debate to the chamber, and I hope that we can move forward in a way that ensures that people get the best outcomes in this area of care.
16:45
Today’s debate has been valuable, although I give the Government another rap over the knuckles for not delivering the framework for members to read prior to the debate, because that should have happened. However, I think that the Government has taken that on board, and it is probably a lesson to learn in the context of such emotive debates.
I thank Louise Caldwell for her continuing campaigning and petitioning—she has won an award for her work, as Monica Lennon said—and the rest of the people in the gallery. I also thank the men in the chamber, as I thought that they—Fulton MacGregor, Brian Whittle, Bob Doris and Douglas Ross—delivered really good speeches today. It is important that we remember that men are partners in the whole process.
Bob Doris’s speech in particular was very good. For the first time ever, I have felt confident today, 15 years later, to talk about a 12-week miscarriage that I experienced. I received incredible care at the Borders general hospital—the BGH, as we call it in the Borders. It did not have separate rooms, but the gynaecologist and the nursing staff were very caring and compassionate, and I had access to a quiet room, although it was in an area where there were heavily pregnant women.
Like Bob Doris, I was caught up in the chaos of the news; the staff did the best that they could, but I did not really understand what was going on around me. What has not been mentioned today is the whole process—you have to take on board a lot of information about what will happen next and the surgical procedure.
Beyond that, many members have talked knowledgeably about the aftermath of everything. I remember specifically not telling anybody other than my very close family. They then all decided that I should go to a family wedding. I felt different, with the hormones and the emotions, and coping with the changes and the recovery from the surgical procedure, and I just did not want to talk about it.
I thought that it was so clever of Gillian Mackay, Rona Mackay, Douglas Ross, Sue Webber and others to talk about the taboo and the stigma. I was not able to talk about it—I was not ready, and I probably have not been ready to do so until this day. When I was offered the opportunity to speak about miscarriage, I thought, “Yes, I’m ready now”. That is 15 years later, so one can imagine how raw it feels for so many other people.
Brian Whittle, Carol Mochan and other members talked about the mental health aspects, and support and training for the workforce of health professionals. That is so important. Members also talked about ensuring that services are accessible everywhere, including in rural areas. I know that the minister is from a rural area, so she gets those rural issues. It should not be a postcode lottery.
As I said, I did not feel as though I was being discriminated against because I did not have a separate space, because my mind—my head space—did not register it. Looking back, however, I think that that is important, particularly for women who have multiple miscarriages and who have trouble conceiving; it must be so retraumatising to go back through that.
The framework that we are looking at is important in enabling us to understand where those separate spaces are not offered, and to gather the data that will allow the Scottish Government to deliver on its promises. However, I want to be frank with the minister that the timeframe—as my colleague Sue Webber said—will be quite challenging for the Scottish Government. There are reasons why NHS boards do not offer separate spaces, mental health support and workforce support, but I suppose that our ambition is for everyone to have access to deal with grieving and loss in those private spaces.
Brian Whittle talked about miscarriage being not just a medical event but a long-term emotional and psychological event. It is important that, as Jean Turner, executive director of the Scotland Patients Association stressed, we recognise that psychological support can be as much a priority as physical care for women who are experiencing miscarriage.
When I was considering what to cover in my speech, one of the things that I wanted to highlight was rural access. As many members know, I live and work in, and represent people from, a rural area. More than 90 per cent of women in Caithness are forced to make a 210-mile round trip to Inverness to access maternity services, and women in Dumfries and Galloway have to travel 70 miles because maternity services are centralised. As other members have said, I have not had time to read the report, but I hope that it will address the issues that women are having while travelling for care.
Finally, I want to summarise a number of areas that I believe are really important with regard to this issue. They are: consistent provision; separate spaces; better mental health and bereavement support; improved access to treatment in every region; and better data collection.
I call Jenni Minto to wind up on behalf of the Scottish Government. If the minister could take us up to 5 o’clock, that would be grand.
16:51
The debate this afternoon has again highlighted how vital it is to prioritise the healthcare needs of women. I thank every member who has shared their personal miscarriage or stillbirth story this afternoon and those who have shared their constituents’ journeys. I have spoken to Monica Lennon about this previously. It is an absolute privilege to listen to her constituents and to understand how she can make a difference.
Speaking personally, one of my constituents came to me and described the situation that she ended up in, having to travel to a hospital where she was in the same space as women who were about to give birth, and the impact that that had on her and her partner. That has stuck with me and has been my leading light, as Louise Caldwell has been for Monica Lennon and Beatrice Wishart.
It is a privilege to hear such stories and to know that we can try to make a difference. I hope and believe that the work that we have been doing to improve miscarriage support in Scotland will move in that direction. I therefore thank everyone in the chamber for the tone of the debate and for raising their points.
Brian Whittle and others raised mental health. I touched on the meetings that I have had with Held in Our Hearts and the help at home that it provides here in Lothian and in NHS Highland. That organisation recognises and understands that women and families need support at the appropriate time. The women whom I met who had received that support were clear that the personal phone call that they got from Held in Our Hearts staff or volunteers had helped their mental health and wellbeing and—if “coming to terms” is not quite the right phrase to use—their ability to find a path through their baby loss. That is why I was pleased to be able to agree funding for Held in Our Hearts in the current financial year and in the following year.
Bob Doris and Fulton MacGregor both referred to Shona Robison’s debate in the Parliament a couple of years ago. When I read the Official Report of that debate, I was struck by the frequent use of the word “stigma”. I agree with Rachael Hamilton that the men in the chamber today have shown their compassion and understanding of the situation. The fact that they have been able to talk about the situations that they have personally experienced or that they recognise from their constituents is incredibly important. I thank them very much for doing so.
Douglas Ross gave us the quote:
“you’re the midwife no-one wants to meet but I’m really glad I did.”
I am fairly sure that I heard that story when I was at Dr Gray’s hospital. It shows the compassion that we need from all our healthcare staff. I hope that the framework that we have released today gives health boards the structure to ensure that there is support for their staff.
I agree that the antidote to stigma is compassion, love and care. A trauma-informed approach does not happen by chance. I have had a look at the framework and I am pleased that trauma-informed support is mentioned throughout it.
How can the minister reassure the Parliament that there will be investment in training and education, not just for the workforce in our maternity wards but for those working in primary care, and to ensure that, as others have mentioned, we reach workplaces, homes and communities?
I was about to move on to that. As I said earlier, I am delighted to announce that the Scottish Government has agreed £1.5 million of funding to support miscarriage care. I would like to go further than that—I am still arguing to go further—but I am so pleased that I have got that £1.5 million to allocate as appropriate.
We will ask NHS boards to assess what their services are delivering now and how we can progress that support. Very close work is happening between my officials and NHS boards on that. It is one of the conversations that we may have at a future meeting with officials and, I hope, with Professor Justine Craig, our chief midwifery officer.
Bob Doris raised a point about research. The Scottish Government works very closely with Tommy’s, which is a leader in miscarriage research. We meet regularly for discussions including on on-going research and clinical trials. The chief scientist in the Scottish Government also works to support and increase the level of high-quality research in Scotland. Those are other ways in which we are looking at improving knowledge across Scotland and, perhaps, finding some solutions.
One thing that strikes me, which was not discussed much during the debate, is that, after miscarriage, and especially after ectopic pregnancy, there can be a significant impact on fertility. Is there a way in which we can make sure that the physical impact on fertility of both of those can be linked to in vitro fertilisation? How do we make those part of the process?
That is quite a wide-ranging question. I recognise exactly the point that he makes about fertility and ectopic pregnancy. There is a pathway and a framework for that—I am very happy to get more information and come back to the member on that.
I am so pleased that Beatrice Wishart talked about the northern star ward at NHS Shetland’s Gilbert Bain hospital. It is a star. I hope that other health boards can see that, review it and work towards matching that standard.
I am grateful to everyone for their input to this important debate. I am also grateful for the hard work that the chairs of the working groups have undertaken, for their leadership and for the time that they have given to ensure that the framework for miscarriage care in Scotland and the progesterone pathway are as strong as they can be. They will make a difference to the lives of women who go through miscarriage or threatened miscarriage in future.
I am deeply grateful to the professionals who take care of women and their families every day in Scotland following a miscarriage. That includes the professionals who break bad news, the staff who take care of women following a confirmed miscarriage and the third sector organisations that look after women and their families. I also thank the people with lived experience who have fought so hard to bring about the change.
Finally, I thank everyone in the chamber for their speeches. I look forward to continuing the discussion.
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