HC Deb 05 February 1991 vol 185 cc261-6

Motion made, and Question proposed, That this House do now adjourn.—[Mr. John M. Taylor.]

10.5 pm

Mr. Hugo Summerson (Walthamstow)

I am most grateful for the opportunity to raise this very distressing subject in the House this evening. I am grateful to the Table Office for helping me with the wording of this motion. It says "women suffering miscarriages and stillbirths", and that is exactly what women do.

First, I would like to acknowledge the help that I have received in preparing for this debate from Christine Moulder, who has written a book on miscarriage, and also from the Miscarriage Association.

I want to kick off with one or two definitions. Doctors call all miscarriages "spontaneous abortions"—very different from induced abortions. "Miscarriage", in the present context, is the spontaneous loss of a foetus and stillbirth is the loss of a baby over 28 weeks.

I am very well aware that there are some unwanted pregnancies and that, with these women, a miscarriage can often come as a blessed relief. I realise that, but I do not wish to touch any further on that particular aspect tonight. So why raise this subject at all?

Miscarriage is astonishingly common. At least 30 per cent. of pregnant women experience the loss of a conceived baby before the seventh month of pregnancy. That is hundreds of thousands of babies. This is bad enough, but there is massive bitterness and anger among women who miscarry. Why is this? There are two main reasons.

First, the whole subject seems to be taboo, and where there is silence there is ignorance. I do not want to turn miscarriage into something suitable for gossip on social occasions; it is far too important a subject for that. But everyone in this country will have a friend, a relative or a wife who has miscarried and it is much better to talk about it with sympathy and understanding than to try to sweep

The second reason is the attitude of some in the medical profession. It is most certainly not my aim to take a swipe at the medical profession in general terms. But there are far too many instances of neglect, indifference and sometimes downright cruelty. I quote some comments from women who have had miscarriages on the treatment they received at the hands of the medical profession: Doctors don't care. They turn you out of hospital and don't even bother to talk to you. This is a comment from a woman who miscarried at 12 weeks: I saw the foetus and kept it in a dish for the doctor to see. He glanced at it to see that I had had a complete miscarriage than he casually flushed it down the loo. Life is absolute hell. I feel hurt, angry and completely in the dark. If anyone else says, 'Never mind, you can have another', or, 'It's natures way of telling you something was wrong with the baby', I shall scream! Another women said: Why didn't any doctor bother to tell me what to do when I had a miscarriage? Why did no one warn me I might haemorrhage? How was I to know the dangers? Yet another wrote: It happened 17 years ago, but I have never got over it. The depression lasted years and nearly broke up my marriage. All because no one talked to me about it. Finally, perhaps the most harrowing story of all: The consultant was sweet. My own doctor was superb. But the staff at the hospital were horrible. They said, 'You haven't really lost a baby. It was nothing much at this stage. Why are you making so much fuss?' I had five hours of excruciating pain, much worse than childbirth, then no one talked to me or told me a thing. I didn't know what they had done with the dead baby—thrown it in the incinerator, I suppose. Then they wheeled me down the main ward through all the happy mothers holding their new babies. A girl in the next bed was there for an abortion. She asked me, 'Are you here to get rid of yours?' If I had been able to get off the trolley, I would have dragged her out of bed and knocked her down. From all this one can only assume that there are too many members of the medical profession who see miscarriage simply as just another physical condition that needs such-and-such treatment. That is a very grave misjudgment. What a woman who has had a miscarriage has suffered is a bereavement, for which grief and mourning are entirely appropriate.

In a recent survey members of the Miscarriage Association revealed that 80 per cent. of them were left feeling angry and bitter by their experiences. Of those, no fewer than 66 per cent. thought that the medical treatment that they had had was inadequate, even poor. These women complained that they received no information, no counselling and no advice. Often after a miscarriage a woman goes home to relatives who, though well meaning, carefully avoid the subject, just at the time when she most needs to talk about it.

So what is to be done? I should like to put the following six suggestions to the Minister. The first is pre-natal care. When women first go to see their general practitioner at the start of a pregnancy they should be told about the possibility of a miscarriage, what it is and what happens. I realise very well that there will be women who at the start of a pregnancy are very happy and that they will not want to hear about even the possibility of a miscarriage. Nevertheless, I feel that they should be told about it.

My second suggestion relates to scans. Access to scans needs to be improved, especially in an emergency. That includes weekends. We all know that emergencies almost always arise at weekends, or at bank holidays or in the middle of the night. Scan operators should be allowed to tell their patients the results as soon as possible, not hours later when the information often has to be relayed through doctors and consultants back to the woman concerned.

My third suggestion concerns disposal arrangements —a very sensitive issue. The loss should be treated with respect and dignity, not just flushed down the lavatory or consigned to the incinerator with the rest of the hospital waste. This is not a waste product.

Fourthly, there is the question of follow-up care. Many women are sent away from hospital without a single word of explanation or comfort. What came across to me very strongly when I was making my preparations for this debate was that very many women would have felt much better if only someone at the hospital had perhaps held their hand, or put an arm round them and just offered some words of comfort. It does not cost anything to do that, nor does it take much time. These women should be given the opportunity to discuss what has happened with an informed and, above all, sympathetic health professional. Some women will need access to skilled counsellors, although this is rarely available. I referred, in one of my anecdotes, to one woman who said that the depression following a miscarriage lasted for 17 years. Every health authority should plan the provision of follow-up care involving both hospital services and community services. There are practical matters too on which a woman will need advice. How long can she expect her bleeding to continue after miscarriage? Should she use tampons or sanitary towels? Nobody tells her. How can she know? Not only is she left prey to depression and anxiety and, very often, a great deal of physical pain, but she does not even know the answers to such questions.

The fifth suggestion concerns statistics. Detailed miscarriage statistics according to class and region are not available. I realise the difficulties, but even an approximation would be very helpful.

The sixth, and final, suggestion relates to the Miscarriage Association. This association does excellent work. However good the health service provision, many women need the support and information that only such a support group can give. The Miscarriage Association has branches in various places all over the country. Its headquarters is in Yorkshire. It could do so much more. Its founder recounted that, at the beginning, she was on the telephone until the small hours of the morning. She said that she did not get out of her nightdress until about tea time. Her phone rang and rang and rang. She talked to desperate women who had suffered miscarriage and who wanted to talk to someone about their experiences.

I am afraid that my hon. Friend the Minister is looking slightly uncomfortable when I talk about money. I know that the Miscarriage Association, like many other organisations promoting worthy causes, has approached him. Nevertheless, I press upon him the excellent work that it does.

I hope that in dealing with this subject tonight I have done two things: first, raised public consciousness of this extremely important but much-ignored matter; secondly, drawn attention to the fact that those who have suffered miscarriage need not fear rejection at the hands of the public, or of their friends, or of their spouses, or feel that in some way they have failed.

10.18 pm
The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell)

The House will agree that my hon. Friend the Member for Walthamstow (Mr. Summerson), in raising what he has quite rightly described as a difficult subject, has done us a service. As he made clear, miscarriage is an event that occurs in the lives of many families in this country. It is not as uncommon as one might like to think. My hon. Friend, by raising the issue, has achieved his objective of increasing awareness, in this House and outside, of the problem and of encouraging the idea that a family in which there has been a miscarriage or a stillbirth should not suffer the sense of rejection or of guilt that very often typifies that event.

I should like to begin by setting the subject in context. As my hon. Friend rightly said, although it is rarely discussed, miscarriage happens much more often than public discussion would suggest. In the nature of things, it is not an event that lends itself to central statistical measurement. My hon. Friend sought better statistics, but, of his six items, that is one of the more difficult to respond to as miscarriages are not always the subject of sufficiently detailed medical intervention to allow accurate reporting.

Estimates exist on how often miscarriages happen. The best estimate is that between one in three and one in five conceptions end in miscarriage. My hon. Friend is right to say that it is far from being an unusual or uncommon occurrence.

Happily, stillbirth is much less common. Obviously, however, it is much more traumatic for the family to whom it happens. Stillbirth lends itself to statistical measurement. I am happy to say that the statistics reflect a substantial success story for the health service since its inception. In 1948, there were just over 23 stillbirths per thousand live births, but by 1989 the figure had fallen to 4.7 per thousand. That is a substantial reduction in the incidence of stillbirth, and it reflects a similar reduction in perinatal deaths in Britain.

The reduction in the incidence of stillbirth and perinatal death is an important public health objective of the health service. We have achieved substantial reductions since 1948, which has continued in the 1980s. We are not complacent about that; there is still substantial variation between and within regions, and the opportunity exists for further reduction in the incidence of that unhappy event. We have made substantial progress and are committed to seeking to continue to improve on that record.

My hon. Friend rightly stressed the need for individuals who have suffered a miscarriage or stillbirth in their family to be encouraged to talk openly about it and to understand the physiological and psychological implications of what has happened. My hon. Friend also rightly stressed that good public health education should ensure that women who suffer a miscarriage understand the physiological consequences of miscarriage. We should try to ensure that if a woman suffers a miscarriage she is aware of the danger of haemorrhaging, that she takes the necessary medical advice, and that she recognises the symptoms. That should be one of the objectives of our health education programme. I shall seek to ensure that the objective that my hon. Friend raised is achieved.

My hon. Friend is right to say that not only must we concentrate on the physiological implications but we must ensure that couples have the opportunity to understand the psychological pressures which miscarriage can cause. My hon. Friend described feelings of bitterness and anger. That is true. An individual may feel angry and bitter and, perhaps more powerfully, may feel guilty, looking back over the past three, six or nine months and saying, "What did I do which led to the conception not being brought to a successful delivery?" It is to try to provide an outlet for such questioning that proper social support should exist for women who suffer a miscarriage or stillbirth.

My hon. Friend was anxious not to take a swipe, as he put it, at insensitive health professionals. I would be much less circumspect about that. If a health professional was insensitive, I would be happy to see a swipe taken at that person, because it should be part of the training of all health professionals to remember that, although they are dealing with something that they understand and they regard as routine, the patient may not understand it and will definitely not regard it as routine. Therefore, in every instance the health professional should treat the patient with great sensitivity.

I believe that professionals in the National Health Service set themselves a standard of sensitivity which they meet. The standard of professional service offered through the NHS is very high in the great majority of cases, but my hon. Friend is right to draw attention to instances of insensitive treatment, not least in order to ensure that those who are responsible for clinical standards within the health service are aware of such instances and use them to try to ensure that they do not recur.

My hon. Friend also stressed the importance of follow-up care by ensuring that there is available not only professional health expertise but also the social support that is necessary to restore confidence and encourage the sufferer back into a full normal life. My hon. Friend mentioned the role of social workers, and hospital social workers in particular, in providing that support. They are important and play a valuable role. Hospital chaplains and the generality of social workers also play an important role, as do general practitioners. All involved in offering health and social care to the community have a role to play in ensuring that those who suffer miscarriage or stillbirth understand and are helped to work through the implications. I acknowledge the work of health professionals and of social workers in offering support.

I also pay tribute to the work done by the voluntary sector, particularly in support of sufferers. My hon. Friend mentioned the work of the Miscarriage Association, to which I will return. It is also proper to mention the work of the Stillbirth and Neonatal Death Society and of other voluntary bodies working in this sphere, notably Cruse —bereavement care—and the Partnership of Child Loss Support Groups, all of which are active and all of which receive public support through the section 64 grant programme to the voluntary sector. They are all active in providing precisely the kind of support for which my hon. Friend rightly and properly calls.

I want to refer briefly to a couple of points raised by my hon. Friend about the disposal of the results of miscarriage or of stillbirth. My hon. Friend is absolutely right to stress that sensitive handling should be regarded as a high priority. He rightly says that the remains are not waste products and must not be handled as such. They are certainly not regarded in that light by the bereaved parents. The Government are on record as accepting that we should change the definition of stillbirth so that it is brought in line with the law on abortion. We have made it clear that we are sympathetic to the proposition that a foetus that is born dead after 24 weeks should be entitled to the protection of the rules that currently operate for stillbirths after 28 weeks.

Disposal and the other handling of these tissues in hospitals are factors that should be addressed by the guidelines which the Stillbirth and Neonatal Death Society has drawn up in collaboration with professional bodies in the voluntary sector and which my hon. Friend the Minister for Health will launch on 27 February. I hope that my hon. Friend will feel that our welcome to those guidelines represents a degree of interest in the importance of setting standards for the proper and sensitive handling of these issues.

My hon. Friend referred to the work of the Miscarriage Association. He will know that the Department of Health has provided support to that body since 1986 under the terms of the section 64 scheme which provides support to voluntary bodies from the health budget. In the current financial year, the association has received a grant of £4,000 and the Department is now considering two applications from the association for the next three years. We are considering, first, the renewal of core grant towards central administrative costs and, secondly, a project funding application to make information about miscarriage accessible to any woman who has suffered a miscarriage, including those from ethnic minority groups —a target group that is of special importance in ensuring the understanding of the full physiological and psychological consequences of these events. I want to place particular importance on ensuring that we get through to ethnic minority groups as part of our target population.

My hon. Friend will appreciate that it is too early to divulge the outcome of those applications. However, they are being considered and I can assure him that they will be considered sympathetically. As I have stressed, the Department recognises and values the role of voluntary bodies in providing the support that families need when they suffer such an instance. We have supported a range of voluntary organisations in this area in the past and we intend to continue to do so. We shall consider very sympathetically the applications currently in from the Miscarriage Association.

Question put and agreed to.

Adjourned accordingly at twenty-seven minutes to Eleven o'clock.