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Ambulance crews

Caring for women and their partners experiencing pregnancy loss*

* miscarriage, ectopic or molar pregnancy

A note of caution  This film includes scenes and conversations that some viewers might find upsetting, especially if they have been through pregnancy loss themselves.  You may prefer just to use the good practice guide alone.

I was on my own at home. I couldn’t walk, I was on the floor so I had to call an ambulance.

Our good practice guide

amb1From a medical perspective, miscarriage is a common and generally minor complication of pregnancy, but for women and their partners it can be distressing, frightening and lonely.

If they have called an ambulance they may be bleeding heavily, in pain and very frightened for their baby and perhaps for themselves.

Any risk to the woman’s health – and to her life in the case of a suspected ectopic pregnancy – will always be your prime concern. But your overall approach can make a positive difference to her experience at a very difficult time.

We spoke to women and ambulance crews about what helps and what makes things harder.

Women told us that they wanted compassion, understanding and acknowledgement of
the emotional impact of miscarriage as well as good physical care.

Ambulance staff told us that they needed more information about pregnancy loss: causes, symptoms and how it is treated or managed. We highlight some key points below, and have added links to where you can find more detailed information.

The context

amb4If a woman has called an ambulance because of pregnancy problems, it is likely to be because she is experiencing unexpected severe pain and heavy bleeding and has no other way of accessing emergency care. She may have collapsed or had a fainting episode/s.

She may be in labour, anywhere from 24 weeks of pregnancy to full-term. This situation is outside the scope of this training resource, however, as we focus on pre-24 week pregnancy loss, which may be:

In miscarriage

In ectopic pregnancy

If a woman of child-bearing age presents with acute abdominal pain, ectopic pregnancy should always be considered, even if she does not know she is pregnant.

Consider how she might be feeling – be sensitive and compassionate

It’s a lot different bleeding because you’ve had an accident and bleeding because you are losing your baby.

Think about your languageamb3

Deal sensitively with pregnancy tissue and remains

During the process of miscarriage, women may pass blood clots, pregnancy tissue or a recognisable fetus or baby. This may happen at home before you arrive or during the journey to hospital.

For many, what happens to these remains is very important. Even if they appear just to be blood and tissue, they are all that remains of their baby. Try to deal with them sensitively.

If I had lost anything in the house or en route, I would like it compassionately taken to hospital with us.

Give clear information about what is happening now…

Be prepared to respond to questions. Here are some example questions and answers.

Is my baby OK?

Can you stop the bleeding?

Is there supposed to be this much pain? Is this normal?

If you can’t give clear answers, think about who might be able to, in the hospital or elsewhere. If appropriate, pass on details of the Miscarriage Association as a source of support. (We can provide you with a supply of contact cards.)

… and about next stepsae1

 Got more time?

These additional resources might be helpful.

Lecture photo

Additional information for ambulance crews.

In this short teaching video for GPs and junior doctors, Professor Tom Bourne discusses both the medical and emotional aspects of ectopic pregnancy.

Take a look at the guide to our information resources.

View other films in this series.

Consider your needs too

Working in the ambulance service can he hugely rewarding but there’s no denying that it can also be stressful, especially when you are treating people with life-threatening illness or injuries.

The extra factor in dealing with miscarriage patients is that you have an additional invisible patient, one whose life you are very unlikely to be able to save or prolong. But that may not be the woman’s perspective. Her levels of anxiety and distress may be very high and you might encounter some difficult emotions not only from her but also from anyone accompanying her.

We hope some of the following suggestions will help – for miscarriage patients and perhaps others too.

Identify the difficulties

Not being able to answer their questions is very difficult and makes me feel like I’m inadequate in my job, when in fact I’ve just not had adequate training.

These may include:

Identify your sources of support…

Your most likely source of support will be your peers:

You might also consider:

… and make use of them

It’s one thing to know where you can find support. It’s another thing to do something about it. It’s worth considering that your peers may have similar concerns and might also benefit from talking about these issues together.

And finally

Miscarriage is never easy – for the woman or couple involved or for the staff who are tasked with looking after them. You may not get it right for everyone, but patients will always remember your care, kindness and compassion.

The paramedics were wonderful.  They called my husband, asked if there was anyone else I needed contacting … and they gave me some gas and air, which I needed.

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