Coronavirus and miscarriage: your care
On this page, we share information on how the Coronavirus (COVID-19) pandemic is impacting access to hospital services for those who are pregnant or experiencing a miscarriage, ectopic pregnancy or molar pregnancy, and for those awaiting investigations. But first, a note about Covid-19 vaccination and pregnancy.
Last updated: 20 April 2021
Covid-19 vaccination and pregnancy
On 16 April 2021, the Joint Committee for Vaccination and Immunisation (JCVI) announced new advice: that pregnant women should be offered the COVID-19 vaccine at the same time as the rest of the population, based on their age and clinical risk group. They note:
“We encourage pregnant women to discuss the risks and benefits with their clinician – those at increased risk of severe outcomes from COVID-19 are encouraged to promptly take up the offer of vaccination when offered.”
In a statement from the Royal College of Obstetricians & Gynacologists (RCOG), the College President, Dr Edward Morris, said:
“We are grateful to the JCVI for taking into consideration our evidence and updating the guidance around the COVID-19 vaccine in pregnancy.
“Vaccination offers pregnant women the best protection from COVID-19, which can be serious in some women. We know pregnant women can get unwell with COVID-19; one in five pregnant women who become unwell and are admitted to hospital will have a premature birth.
“We believe it should be a woman’s choice whether to have the vaccine or not after considering the benefits and risks and would encourage pregnant women to discuss with a trusted source like their GP, obstetrician or midwife, or a healthcare professional in a vaccination centre.”
You will find more information from Public Health England here. NHS Inform Scotland has similar information, and a vaccination helpline, here. Information from Public Health Wales can be found here. And HSC Public Health Northern Ireland has information here.
We all know that the Coronavirus (COVID-19) pandemic is having a major impact on many lives and especially on access to healthcare. That is still the case now, in April 2021, even as as rates of infection and hospitalisation with the virus are reducing. That is partly due to the backlog of people awaiting hospital care for a range of conditions. As before, we are still being asked to avoid using NHS services as much as possible so that resources can be focused on the most ill and most vulnerable people.
This includes some early pregnancy and maternity services, but NHS England (and guidance from the other UK nations too) encourages pregnant women to seek advice and care if they have or suspect problems with their pregnancy.
Even so, provision has differed markedly between different hospitals and at different times and with continuing changes in the level, timing and geography of restrictions, it can be truly difficult to know what to expect.
We hope the following information helps you to understand how the current situation might affect anyone who is pregnant or experiencing (or worryied they might be experiencing) pregnancy loss.
Access to hospital services for people who are currently pregnant or experiencing a miscarriage, ectopic or molar pregnancy
National and local restrictions, and social distancing in particular, mean that many early pregnancy and gynaecology units are still limiting the service they provide:
- to minimise the risk of exposure to the virus for people coming into a hospital environment
- to reduce the risk of spread within the hospital and
- because of reduced staff numbers caused by sickness, self-isolation and because of staff being moved to different departments, such as emergency care.
Wendy and Barry describe their experience of having a miscarriage during the coronavirus pandemic, with reduced access to hospital services. And you will find other people’s stories of loss during the pandemic here.
Information from the RCOG on early pregnancy care
The Royal College of Obstetricians and Gynaecologists (RCOG) has published a guide to early pregnancy services during the coronavirus pandemic. While it focuses mainly on women and couples in the first twelve weeks of pregnancy, it is equally helpful for anyone who is not yet booked with a midwife or an antenatal clinic.
They also have regularly updated information and guidance on pregnancy and Coronavirus at www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/covid-19-virus-infection-and-pregnancy/.
Many hospitals are still having to limit the number of appointments for pregnancy scans and appointments, so women may be assessed over the phone before being advised whether or not they can be seen.
Until fairly recently, most hospitals have allowed only the woman being scanned or assessed to attend her appointment. Some allow use of a mobile or smartphone for part of the appointment so that the partner or other supporter can take part remotely but that will depend on the individual hospital’s policy. This has caused considerable upset both to women and their partners, as you can read in some of these stories.
NHS England has issued updated guidance to hospitals as of 20 April 2021 to urge further action, noting:
We are asking all trust boards to urgently complete any further action needed so that partners can accompany women to all appointments and throughout birth…
There are three actions that they require:
- Conducting full risk assessments in each part of their service to identify risks of COVID–19 transmission if support people are present.
- Making changes to layout and use of space, along with infection prevention and control measures.
- Implementing testing (including the national rollout of lateral flow testing) to test women and their support people to help reduce infection risks.
Clearly this isn’t all going to happen immediately and some hospitals will take longer than others to put these recommendations into practice. But hopefully it will mean the gradual re-introduction of partners and other supporters during pregnancy appointments and care.
Hospitals are still limiting non-emergency surgical procedures under general anaesthetic. That means that women with a missed or incomplete miscarriage or a ‘blighted ovum’ or anembryonic pregnancy are more likely to be offered natural (expectant) or medical management of miscarriage at home rather than being treated in hospital. However, some units are now offering surgical management with local anaesthetic (an MVA) and this is likely to increase.
Ectopic pregnancy assessment and management
Ectopic pregnancy is a potentially life-threatening condition, so early assessment and treatment are crucial and access to care should remain as normal. See here for more information.
Molar pregnancy diagnosis and management
With fewer women having surgical management, it may take longer for some molar pregnancies to be diagnosed, so it’s very important to contact the hospital if a pregnancy tests is still positive 3 weeks after your loss. But once molar pregnancy has been diagnosed, care and follow-up will be as normal. You’ll find more information on our molar pregnancy pages, starting here.
If you are pregnant or currently experiencing a loss
If you need urgent advice regarding your pregnancy, you are encouraged to telephone your local Early Pregnancy Assessment Unit or Emergency Gynaecology Unit, or your midwife or antenatal clinic if you are already booked with them. It’s important to be as clear as possible about your symptoms or worries to help staff to assess your needs and advise on next steps. Please be assured that if you need emergency care for severe pain, very heavy vaginal bleeding, suspected ectopic pregnancy or other acute symptoms, then you will be assessed in person and seen accordingly.
If you are not pregnant, but planning on trying for a baby
You may wonder about waiting longer than you had planned before trying to conceive, particularly while access to early pregnancy and maternity care is still somewhat reduced. But the situation is changing all the time and there is no clear guidance, so this is very much a personal decision.
If you are waiting investigations following recurrent or second trimester miscarriage
Investigations into the possible causes of recurrent miscarriage or late loss were initially suspended in most hospitals, but some centres have reintroduced these over time. This may change again depending on local and national conditions and on the availability of specialist staff, some of whom have been diverted to other areas of care during the pandemic.
Information, guidance and support
The Royal College of Obstetricians and Gynaecologists (RCOG) has general up to date information and guidance on pregnancy and Coronavirus at www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/covid-19-virus-infection-and-pregnancy/.
And of course, you can contact us at the Miscarriage Association for information and support. We don’t give medical advice but we can help you think through how best to manage at this time.
You can call us: 01924 200799 (Monday to Friday, 9 a.m. to 4 p.m.)
We know that picking up the phone and talking to someone you don’t know can sometimes be a scary experience. But we’ll do everything we can to make you feel comfortable, to listen and understand and to answer your questions to the best of our abilities.
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We talk about pregnancy loss and mental health here.