Baby Loss Awareness Week

Philippa Whitford Excerpts

Tuesday 10th October 2017 Commons Chamber

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I speak as someone who has not lost a child, but I remember what happened when I was working in Lebanon and was four months pregnant with my son. We had discussed the risks of going to Lebanon when I was pregnant and we thought I would only be there a few months; even if I was here there would be nothing that could be done, so I was not adding to the risk. But when I suddenly saw blood, all of a sudden I realised how paltry that word “miscarriage” is. I understand that we are predominantly talking about babies who have been lost later, but that term “miscarriage” sounds like “misstep”—like a bump in the road—and by four or five months, particularly once you have had that little ultrasound picture, which you thought was going to be the first of a whole lifetime of photographs, you realise you have already bonded with the bulge that means you need elasticated waistbands and is giving you heartburn or keeping you up at night, or even, a bit later, starting to kick the living daylights out of you at three in the morning. So I think it is really important, as my hon. Friend the Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) said, that we think of those who are slightly outwith this debate. That is something that we must try to bring over to medical staff as well.

I acknowledge the discussion about bereavement midwives, and we always need champions and leaders when, trying to raise awareness, but as someone who has worked in breast cancer for over 30 years, I can tell the House that having a grumpy old surgeon and then sending the lady to the breast cancer nurse, who would be nice to her, is not a solution. In fact, with all midwives, all doctors, it only takes one person to turn the knife and make that heartbreak worse.

I had a friend who had three miscarriages before she successfully had two rather wild and lively boys—something for which I am sure she gives thanks every day. On her second miscarriage, a routine scan at 16 weeks revealed that the heartbeat had stopped. They thought she would miscarry, but she did not. The period between then and when she underwent surgery meant she knew she was carrying her own dead baby. That was really difficult. At the scan that made the diagnosis, she was simply sent back out to the waiting room after a couple of minutes. She was sitting there surrounded by women with their bumps discussing their plans, while she waited for almost half an hour to be taken into a room and just given leaflets. There is no point in having one person who knows how someone should be supported: every single member of every single team, from antenatal, perinatal and right through to early paediatrics, needs to know the language, the body language, the timing and the support that someone might need.

The number one thing as a doctor is to try to reduce the number of deaths. Scotland actually had higher perinatal, stillbirth and neonatal figures. About five years ago, there was a big discussion in the profession in Scotland saying that it needed to be tackled. It was not enough simply to collect data—whether the Scottish perinatal mortality data, which go back to 1977, or, now, in MBRRACE-UK. The cases had to be looked at. Regardless of whether that is done through a fatal accident inquiry, it must be done by the clinicians. As surgeons, we carry out morbidity-mortality meetings every couple of weeks to discuss cases that have gone wrong in a very open and frank way. We learn from them. Often, we will suddenly see a pattern that makes us want to change. Since 2013 in Scotland, our perinatal figures have dropped by 34%—a third—our stillbirth rate has dropped by 26% and neonatal has dropped by over 50%. That is what can be done if every single case is discussed.

Believe me, Scottish Members here know that the geography of Scotland makes providing perinatal care really difficult and challenging. It is easy to identify the difficult case with a past history of diabetes or a huge wain and a small pelvis, but any delivery can go wrong. One challenge we face, which is not faced in so many areas in England, is how to get people off our islands and how to cover hundreds of miles, yet we have managed to bring the figures down.

It is absolutely right that, even if we drop the mortality rate further, there will be children who are lost. We must not stop trying to do that and we must support people, in particular those whose babies are born and require extra neonatal care in a special baby unit. We know they have a higher incidence of post-natal depression. We know that, naturally, mothers who lose a child will have an increased incidence of post-natal depression. If we can get all our teams to try to get it right all the way through and support them, then maybe we can tackle both problems.