Introducing baby loss certificates shows the conversation around miscarriage is slowly changing

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Louise Thomas

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Around one in five pregnancies end in miscarriage. But despite it being a relatively common occurrence, it still feels like a taboo subject. It’s hard for parents to work out how to grieve the loss of a child they never met, and the life they might have shared – not least because this loss is so often minimised by others, from medical staff to a well-meaning friend putting their foot in their mouth. “It wasn’t meant to be,” they might say, followed by a reminder that, “You can always try again!” Or even: “At least you know you can actually get pregnant.”

Part of what makes this grief so difficult, and perhaps why it’s so easy for some to dismiss, is that there has never been a way to acknowledge the loss formally. Babies who are stillborn after 24 weeks of pregnancy must be registered, but this hasn’t been the case for miscarriages – which are defined as occurring before the 24-week mark. But this is finally changing.

In February, the government introduced a new scheme allowing parents in England to apply for a certificate to recognise babies lost through miscarriage. Initially, the scheme was only open to people who have experienced pregnancy loss since September 2018, but today (9 October) this has been extended to all parents who have gone through this, with no backdate. It’s a free scheme, which doesn’t require medical proof – crucially, it’s not compulsory, either. There’s no right or wrong way to grieve.

The simple acknowledgement of miscarriage, and the emotional pain that comes with it, is a major step forward, and one that might have the power to stop parents in this situation from feeling ignored and overlooked – as if their grief is somehow disproportionate. “Baby loss can be a traumatic and isolating experience, both physically and emotionally,” says Georgina Sturmer, a BACP [British Association for Counselling and Psychotherapy] registered counsellor. “And this can be even harder to cope with in a society that doesn’t formally recognise the loss that we have experienced. There’s sometimes a sense that the world expects us to move on [...] and even if we do want to move on, to accept what’s happened and to process what we have been through, it remains important to mark our loss in some way.”

By creating a formal record, this new certification system sends a message that a miscarriage “is just as valid and acceptable as other forms of loss”, Sturmer says. “In order to grieve, we don’t need to forget or diminish our memory of the baby that we have lost. Our grief is valid, and it can stay with us as we grow around it.”

It has taken a long time to get to this point. The independent Pregnancy Loss Review was commissioned back in 2018, co-chaired by Zoe Clark-Coates, the founder of baby loss support charity The Mariposa Trust, and Samantha Collinge, the lead bereavement midwife at the George Eliot Hospital NHS Trust in Nuneaton. Bereaved families also gave their input. Shortly after it was published last year, the government gave the certificates the go-ahead, and 1,000 families were given the chance to trial the process.

The scheme is part of a raft of measures designed to make sure that parents are properly supported through pregnancy loss. It’s genuinely shocking that some of these policies have only just been introduced, including the recent guidelines around how to sensitively store baby loss remains. Now, A&E departments must ensure they have cold storage facilities open 24/7 so that women don’t have to place remains or pregnancy tissue in their fridges at home.

A new pilot for a “graded model” of care is also underway, allowing women to access medical support after one miscarriage. Previously, they would have had to lose three consecutive pregnancies in order to be eligible. That’s a staggering amount of pain and trauma for someone to “just get on with”. The new “graded model” comes in response to a campaign by radio presenter and former Hear’Say singer Myleene Klass and MP Olivia Blake, who both have personal experience of this issue.

Although these are important developments, there’s plenty more still to be done. Miscarriages don’t tend to be systematically recorded and they remain an under-researched subject; in 2021, medical journal The Lancet recommended that all countries should gather and report their annual miscarriage data as part of a “complete rethink of the narrative”.

Without this data, it is difficult to make progress, as miscarriage remains a “hidden problem”, as Kath Abrahams, chief executive of pregnancy loss charity Tommy’s, put it earlier this year – and therefore one that isn’t prioritised by policy makers. Plus, it makes it harder to understand why certain women suffer more miscarriages than others. (Admittedly, though, gathering comprehensive data can be difficult given that not everyone seeks medical care afterwards, and some people miscarry before they are even aware they are pregnant).

It’s not just medical provision that could do with stepping up, either. Currently, there’s no statutory right to take miscarriage leave from work. In contrast, parents are given two weeks of leave after a stillbirth and can also take their planned maternity leave. You can, of course, take sick leave, and some employers might have provision for partners, too – but how many people feel comfortable having that potentially awkward conversation with their boss?

Changing legislation is one vital step towards changing attitudes, and so is recognising the grief of miscarrying – but chipping away at stigma is a slow process.