I don’t want a certificate for my miscarriage

...but others will – and that’s OK

A few days after my fourth miscarriage, I found myself sitting in an anonymous seminar room, taking part in the Government’s Pregnancy Loss Review.

Someone I knew from Instagram, who’d become a friend – another Jen – was there too. I told her about the miscarriage straightaway, as I sat down, clutching my water-cooler cup of water, feeling spaced out, not really knowing how to make small talk, in the circumstances.

‘What are you even doing here?’ Jen said and I’d just shrugged.

‘Don’t know what else to do with myself, really.’ And she nodded at that. She didn’t need to say anything else – I knew she understood.

The discussion I took part in that strange, sad day – largely on autopilot – was one of the sessions that contributed to the official review, led by Zoe Clark-Coates and specialist bereavement midwife Samantha Collinge, which culminated in the recent announcement by the government that people in England who lose a pregnancy before 24 weeks will be entitled to an official certificate to commemorate their loss, if they wish. This was unveiled as part of the wider Women’s Health Strategy, which aims to tackle the gender health gap (chasm, really).

These pregnancy loss certificates will not be a legal document – they will not confer the precise same status as registering a stillbirth or neonatal death after 24 weeks. It also does not mean all miscarriages will be officially recorded and counted nationally (I’ll come back to that).

But they are something.  

Personally, as I said back in that seminar room in 2018, such a document isn’t a high priority for me. I don’t think it would help me process my loss any differently – if anything, it might make me feel worse.

But I know that many others feel differently. And I don’t need to feel the same way to want such an option to exist for them. When I raised this subject on Instagram, many replied to say such a scheme would have been a real comfort, validation. This was true, regardless of the point in gestation at which someone had lost a pregnancy. (Although many did raise the point that the blunt cut-off for when a baby’s life and death can be registered feels especially cruel when a miscarriage occurs very close to the 24-week border. Before this change was announced, if a baby dies in utero before 24 weeks, no record is made. If someone has twins, one of whom is born alive at 23 weeks, and the other dies before birth, only the twin with signs of life is legally recognised, the other is not. This is not a hypothetical scenario. This is a real situation someone who messaged me on social media found themselves in. I can barely imagine the pain of such an erasure.)

And there is all manner of nuance here. Had such a policy been in place at the time of my first miscarriage – the only pregnancy of mine where I enjoyed an unfettered confidence that I would have a baby to bring home at the end of it – perhaps I would have accepted a certificate of loss, had it been offered. Perhaps it would have been a balm, perhaps it would have helped me understand that it was OK to feel as bereft as I did, being told I would not be having a baby after all.

But when it happened again? And again? I think that proffered piece of paper would come to represent something else, something less helpful.  

So, for me, the most heartening thing in the entire strategy document was this section:

‘When a pregnancy ends before 24 weeks’ gestation, there is no formal process for parents to legally register their baby. Some bereaved parents find this to be distressing, although some parents may find it equally distressing if they were required to legally register the loss when they did not wish to do so.’

There is something quietly radical about this, I think.

Too often we are encouraged to think that there is a single ‘correct’ response to an experience. That if you believe one thing to be true, you cannot also feel or think things that contradict that (or would seem to). That because you choose one thing or think one way for yourself, you disapprove of those who choose or think differently.

But it doesn’t have to be this way.

What do you think? If you have experienced pregnancy loss, would you have wanted the option of a recognition certificate?

Things I’ve written…

A book! A whole book! It’s called Life, Almost: Miscarriage, misconceptions, and a search for answers from the brink of motherhood, and it’s being published in February next year by Transworld - but it is available to pre-order now.

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In the news…

The government unveiled its Women’s Health Strategy, last month. I’m going to focus on what it said – or didn’t say – about fertility and pregnancy loss here, but this is a very good general summary by the journalist Sarah Graham.

The good

• The introduction of pregnancy loss certificates, as discussed above. Also, in case it allays any fears, the original terms of the review (which you can read here) make it clear that any recommendations regarding registration certificates for pregnancies that end before 24 weeks should not impact current laws around abortion. ‘The review will not consider changing the existing laws on abortion’ is the exact wording. (This was my first question when I was asked to take part in one of the review’s focus groups. And I think recent events have shown us that we cannot be too careful when it comes to protecting reproductive rights).  

• There are some big wins for fertility treatment. ‘Non-clinical access criteria’ for fertility treatment will be removed. This means it will no longer be allowed for people to not qualify for IVF because one half of a couple has a child from a previous relationship, for example.

• Likewise, the rules around NHS fertility treatment for lesbian couples have been clarified. Until now, some NHS Trusts have required same-sex couples to prove their fertility status or ‘need’ for treatment. Something that – as two women – they can only really do by paying privately for a number of rounds of artificial insemination (and then going back to the NHS if it doesn’t work). But this isn’t an affordable option for everyone. Now, according to the Women’s Health Strategy, ‘the NHS treatment pathway for female same-sex couples will start with 6 cycles of artificial insemination, prior to accessing IVF services if necessary’.

• When it comes to pregnancy loss, there is a stated ambition in the strategy that ‘care pathways’ be improved, including improved support for subsequent pregnancies after a loss. Support after recurrent miscarriage, in particular, is highlighted. Partners and their need for support is acknowledged in the language, too. Gold stars all round.

• The same section of the strategy also states an ambition for every maternity service to have a bereavement specialist midwife within ten years. (Great news, albeit with a side of: how is this something we don’t already have?)

The less good

• For all its lofty ambitions and talk about needing more high-quality research into conditions that affect women, and the establishment of a new policy research unit into reproductive health, there are no firm promises of any actual extra money. Actually, there are almost no commitments to specifically fund anything. (There is one very depressing line, which rather undercuts the whole point of having a distinct strategy for women’s health: ‘We are investing record amounts in improving access to NHS services, which will benefit everyone, including women’. Forgive me, but I thought the whole point of this enterprise was that what’s been good for everyone - read: men - has not always been so great for women.)

• No commitment to actually recording national miscarriage data. This is something that researchers have been calling for a while now. The charity Tommy’s has a petition going asking for this. There are lots of reasons that having a properly recorded miscarriage rate would be helpful (and I have a section about this in my book). But essentially, if we don’t officially know the scale of the problem, it’s a lot easier to ignore.

• No commitment to adopting the ‘graded model of care’ for miscarriage that was recommended by a coalition of UK experts in research published in The Lancet in 2021. ‘Graded model of care’ sounds a bit jargon-y, I know, but it basically means that people wouldn’t have to wait until they’ve had three or more miscarriages before they are eligible for some kind of support or treatment. It would also mean that tests and treatment are standardised across the country, rather than being a bit pot-luck depending on where you live. Again, this is something the charity Tommy’s and the MP Olivia Blake have been campaigning on hard. The Government had appeared to commit to taking these key recommendations into the Women’s Health Strategy. But instead there is only a vague commitment to ‘consider’ such changes depending on the final recommendations of various reports, reviews, and guideline re-drafts. (Sidenote: It is well worth reading the full statement issued by Tommy’s on this, here).

• Nothing substantial about abortion care at all. In the whole 127-page document, there are just three lines. (It says there will be further recommendations on sexual health, including abortion, later in the year. Even so, it doesn’t feel wildly reassuring, not least in light of this news story about commitments on abortion rights being deleted from an international statement on gender equality signed by the UK).  

• Nothing about improving access to Early Pregnancy Units, which often keep woefully limited opening hours. (If you want to laugh bleakly into your computer screen, have a look at the NICE guidance on the kind of access we should have to Early Pregnancy Units. ‘Regional services should be organised so that an early pregnancy assessment service is available 7 days a week’. Um. OK then.)    

I should add, the Pregnancy Loss Review is yet to give its full recommendations (due later this year) so it may be that some of this wish-list still crystallises into real commitments. And I do so want to be an optimist, here.

But I also can’t help thinking that if the Government really wanted to make some of these changes it could have done so by now. My overriding impression of the Women’s Health Strategy is that it makes (mostly) the right noises, but the Government doesn’t actually want to put any money where its mouth is. Case in point: The strategy states it wants the NHS to be ‘the best place in the world to give birth through personalised, individualised, and high-quality care’ and yet this week we learned that, for the first time in a decade, more NHS midwives are leaving the profession than are joining. How is the Government going to square that circle? How is it going to deliver the best care in the world without actually investing in the people who do the caring?

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What I’ve read/watched/listened to…

If you follow me on social media, you might have seen that I had got a bit book-locked. I had about eight things on the go, all excellent, all things I wanted to keep reading, but I couldn’t seem to do it. Anyway, I eventually broke out of the rut with Grown Ups by Marian Keyes, which is funny, sad, then funny again. It’s also full of little true-to-life details other novelists tend to treat as unimportant, and kept me guessing right to the end. I’ve now nearly finished Hush, the debut novel by Kate Maxwell, which is a great exploration of how it feels to really want a baby – to try very hard to have one – and then to find the reality difficult.

I thought this was a really interesting piece on what the evidence actually says about drinking cranberry juice for a UTI.  

Is abortion sacred? An utterly perfect bit of writing by Jia Tolentino.

This is an important blog post about the writer’s experience of infertility and recurrent miscarriage as a deaf woman. The lack of information on infertility and miscarriage available in British Sign Language (BSL), as well as the ignorance and discrimination she faced at times is shocking.

I very much enjoyed this explainer – by a lawyer – of what the hell happened in the Wagatha Christie verdict/trial.

I can’t believe it’s taken me this long to recommend Rhiannon Lucy Cosslett’s Republic of Parenthood column. Every week, she offers a clear-eyed, nuanced take on a parenting or pregnancy-related subject. She’s particularly good at holding ground in the middle of topics that have become needlessly polarised. This, on baby sleep, is no exception.  

Other joys…

Birthday parties. A sunny trip to the zoo. The mouth-full-of-marbles way a two-year-old pronounces ‘prickles’, ‘scruffy puppy’, and ‘oh my god’ (I can only conclude this last one is something I say, too frequently). Roast chicken cooked and eaten outside. Iced coffee. No-churn thyme and honey ice cream (both from Georgina Hayden’s excellent cookbook Taverna). Dungarees. Paddling in the sea, in the rain. Being surrounded by my irrepressible extended family, even if it was at a funeral. They are the best team. Defiantly unbroken.