Care Following Your Pregnancy Loss

(Intended for maternity patients/those using The Snowdrop Suite)

If you are reading this leaflet because you or someone you know is experiencing pregnancy loss, or you are expecting your pregnancy to end soon due to a termination for medical reasons (TFMR) we are truly sorry and offer our sincere condolences at this difficult time.

We hope that by reading this leaflet you gain an understanding of what to expect during the coming days. This leaflet will hopefully give you general information about what will happen following pregnancy loss.

Some of your questions will be answered by this leaflet. It is not intended to replace the discussion between you and your Doctor or Midwife, but may act as a starting point for discussion

We would recommend you access the Maternity Bereavement Service section of the Trust website, using the link below for information regarding your care and for links to further support services, websites and charitable organisations:

If after reading this leaflet you have any concerns or require further explanations, please discuss this with a member of the healthcare team who is caring for you.

The Specialist Bereavement Midwife is available Mon to Fri during office hours (excluding bank holidays) and is contactable via switchboard: 01642 617617 ask for Bereavement Midwife on extension 46187 or via email.

Email: [email protected]

If the Bereavement Midwife is unavailable you can contact a Midwife on Delivery Suite at any time on 01642 382818.

What will happen next?

At the Antenatal Day Assessment Unit

You will be welcomed into a counselling room by a member of staff, usually a Midwife. The midwife will ask for your consent to perform an antenatal assessment on you, this involves checking your observations (blood pressure, pulse, temperature), personal details, documenting any allergies or medications you take. They will also discuss any concerns or questions you may have.

It is at this time that the Bereavement Midwife would aim to meet you if they are available.

The Midwife may ask to perform some blood tests on you. The reason for taking these blood tests should be explained to you, inform the midwife if you are unclear about anything.

If you are Rhesus negative, you may be offered an Anti-D injection.

The Midwife or Doctor will then discuss taking mifepristone with you.

Receiving the news of your pregnancy loss or antenatal diagnosis can be a devastating and shocking time. If you feel that you require some time at home or away from the hospital to talk with your friends and family please inform staff in the Antenatal Day Assessment Unit of this and they will advise of a suitable time to return to discuss the next steps of care.

What is Mifepristone?

Mifepristone is a tablet which acts by blocking the effects of progesterone, a hormone which is needed for a pregnancy to continue. It makes the uterus (womb) sensitive to contractions and helps soften the cervix (neck of the womb). The mifepristone tablets can be swallowed with water.

It is important to inform you that mifepristone does not have a UK licence for use in pregnancy, but is a recognised and approved drug of choice for effectively managing pregnancy loss. This can be discussed fully with your Doctor or Midwife.

Possible side effects

Very common side-effects (in over 10 in 100 women):

• Uterine contractions (like labour pains)
• Cramping
• Nausea
• Vomiting
• Diarrhoea

Common side-effects (in less than 10 in 100 women):

• Heavy bleeding
• Infection following birth
• Light or moderate stomach cramps

Uncommon side-effects (in less than 1 in 100 women):

• Skin rashes
• Fall in blood pressure

Rare side-effects (less than 1 in 100 women):

• Headaches
• Malaise (feeling tired)
• Hot flushes
• Dizziness
• Chills
• Fever
• Hives
• Serious skin disorder

Options after taking mifepristone

After you have taken mifepristone you will be offered to go home with an appointment time to return to The Snowdrop Suite on Delivery Suite for ongoing labour care. This is usually 48 hours after taking mifepristone.

If you chose to go home you are welcome to return to the hospital/Snowdrop Suite prior to your planned admission date/time if you have any concerns, feel unwell, go into labour or wish for an earlier admission.

If you do not wish to go home immediately following mifepristone, we may be able to accommodate an immediate admission to The Snowdrop Suite if capacity allows.

You should be shown the private Snowdrop Suite entrance to Delivery Suite prior to going home from the Antenatal Day Assessment Unit.

If you forget how to find it please refer to the directions on the Trust website using the link displayed at the beginning of the leaflet.

What happens after taking mifepristone?

If you are sick within two hours of taking the tablets, please telephone the Antenatal Day Assessment Unit or the Delivery Suite for advice.

You may experience some backache or mild period type pains prior to your admission to Delivery Suite. This can be helped by taking paracetamol. If the discomfort worsens or if you have any vaginal bleeding, telephone the Delivery Suite and ask to speak to a Midwife who will be able to give you advice.

What will happen on the Snowdrop Suite?

You will be welcomed by a Midwife who will be caring for you and your birth partner. You will be orientated to the ward and your room and given time to settle in.

Following your arrival, your Midwife will obtain a brief history and discuss your options for care.

When you feel ready, your Midwife will discuss the next part of the process. This is done using misoprostol tablets which may be taken orally or by placing the tablet high up in the vagina near the cervix. The Midwife will discuss the two options for administration with you.

The action of the misoprostol is to soften the cervix in preparation for labour.

The onset of labour following misoprostol varies for each person. You may go into labour in the immediate hours following the administration of misoprostol or the process may take up to 48 hours.

Very rarely women require medication in addition to misoprostol if the misoprostol is ineffective at getting you into labour. If this happens a doctor will thoroughly discuss this with you and your birthing partner.

Unfortunately, the Midwives or Doctors will not be able to tell you exactly how long the process will take.

Pain relief options are available to you, and your Midwife can discuss this with you. Ensuring your comfort during this time is important.

If complications were to arise following birth any additional procedures would be fully discussed and explained to you.

Memory making and investigations

Your Midwife will also talk to you about the birth of your baby and your wishes following the birth. You do not have to make any immediate decisions. Your Midwife and the Doctors will allow you as much time as you feel you need.

You will be given the chance, with support from the Midwife, to make memories if you wish to do so. This is a very personal decision and all your choices will be fully respected.

‘Making memories’ can include:

• Hand & foot prints or clay casts
• Photographs
• A lock of hair
• Dressing & bathing your baby
• Cuddling your baby
• Getting your baby blessed
• Spending time with your baby using a ‘cuddle cot’
• You may be able to take your baby home to spend time with them before their funeral.

Visiting is unrestricted while you are in the Snowdrop Suite, but will be guided by how you feel. The Midwives will provide you with support throughout this time and the Bereavement Midwife will also aim to see you during your admission.

You will also be supported to have discussions with regards to funeral arrangements for your baby. We appreciate that these conversations can be difficult to have, we therefore do not expect you to make any final decisions regarding your baby’s funeral straight away. The Bereavement Support Officer will aim to visit you during your stay to discuss your funeral options. The Bereavement Support officer works Mon to Fri and will support in the weeks following your discharge from hospital with respects to the funeral of your baby. They are contactable on: 01642 383286.

You may also wish to explore the possibility of having investigations and tests to try find out why your baby has died. These tests and investigations include: post-mortem examination, cytogenetic testing, swabs and blood tests. The Midwives and Doctors on Delivery Suite will have these conversations with you and provide you with further written information regarding these tests.

Our Hospital Chaplaincy service can offer both religious and non-religious support to all faiths and can also perform a ‘blessing’ ceremony for your baby if you wish. Please inform your Midwife if this is something you would like.

North Tees & Hartlepool NHS Foundation Trust offer a specialist counselling service for families that have experienced pregnancy loss or the death of a baby. A referral to our unit Counsellors can be completed during your stay in the Snowdrop Suite or following your discharge. If you initially chose to not be referred but change your mind once you are home please inform the Bereavement Midwife who will complete the referral for you. The waiting time to see one of our Counsellors varies depending on work load, you will be informed of current wait times at the time of your referral.

Contact details

If you have any concerns or questions, please do not hesitate to contact:

University Hospital of North Tees

Antenatal Day Assessment Unit

Telephone: 01642 624329

Delivery Suite

Telephone: 01642 382818

Bereavement Midwife

Telephone: 01642 317317 ask for the Bereavement Midwife on extension no. 46187

Email: [email protected]

Information used in the development of this leaflet

NHS Hull University Teaching Hospital, Information about the administration of Mifepristone (Mifegyne): Ref No. HEY-491/2018.

Comments, concerns, compliments or complaints

Patient Experience Team (PET)

We are continually trying to improve the services we provide. We want to know what we’re doing well or if there’s anything which we can improve, that’s why the Patient Experience Team (PET) is here to help. Our Patient Experience Team is here to try to resolve your concerns as quickly as possible. The office is based on the ground floor at the University Hospital of North Tees if you wish to discuss concerns in person. If you would like to contact or request a copy of our PET leaflet, please contact:

Telephone: 01642 624719

Freephone: 0800 092 0084

Opening hours: Monday to Friday, 9:30am to 4:00pm

Email: [email protected]

Out of hours

Out of hours if you wish to speak to a senior member of Trust staff, please contact the hospital switchboard who will bleep the appropriate person.

Telephone: 01642 617617

Data protection and use of patient information

The Trust has developed Data Protection policies in accordance with Data Protection Legislation (UK General Data Protection Regulations and Data Protection Act 2018) and the Freedom of Information Act 2000. All of our staff respect these policies and confidentiality is adhered to at all times. If you require further information on how we process your information please see our Privacy Notices.

Telephone: 01642 383551

Email: [email protected]

Leaflet feedback

This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Clinical Governance team, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, TS19 8PE or:

Email: [email protected]