Written by Seetal Savla. Reviewed by Jessica Hobbis. 

Seetal Savla is a fertility patient advocate, writer and speaker. Having experienced multiple failed IVFs and losses before becoming mum to a daughter, she is passionate about sharing her story to support, educate and empower others, as well as challenging stigma - particularly within South Asian communities. Seetal is dedicated to creating space for honest, compassionate conversations around fertility, loss and hope. Through her writing and advocacy, which includes numerous articles (Times Weekend, HuffPost, Women’s Health, Metro UK), book contributions (No One Talks About This Stuff), a video diary series with Ferring Pharmaceuticals, brand campaigns (Stylist, Tommy’s, Plum & Ashby), speaking engagements (The Fertility Show, Make Birth Better) and online support groups (Fertility Network UK), she helps others feel less alone in their journeys. Follow Seetal's story and work on Instagram (@seetalsavla).

Trigger warning: sensitive content relating to pregnancy. 

This blog discusses miscarriage and pregnancy loss, and we know that can be a lot to hold. Please be gentle with yourself while reading, and take a break whenever you need to. We're always here if you need support. Your well-being matters, and that is the biggest priority. OVUM is here to create a community that is safe and accessible to all, so we recognise that we need boundaries in place to ensure everyone is comfortable when we share information and education. 

Support is available for you, and some resources include: 

• Tommy’s Charity: a charity supporting those through pregnancy and baby loss

• Mind UK: a mental health service available to adults in the UK

• Fertility Network UK Support Groups: available to those who wish to share experiences with others.  

The reality of miscarriage care in the UK

According to leading baby loss charity Tommy’s, there are approximately 250,000 miscarriages a year in the UK. Behind each one, there are traumatic stories of physical pain, emotional turmoil, mental anguish, heavy hearts, broken dreams and deep grief. Given these lifelong impacts of each loss, it would be natural to assume the NHS offers women and birthing people the care and support they need and deserve following each miscarriage. 

Unfortunately, further investigations are only routinely provided after three losses despite the risks of pregnancy complications and long-term ill-health being present from the first. Despite there being no scientific reason why someone must miscarry three times before being taken seriously. Not only does this outdated model perpetuate “institutional dismissal”, as coined by career and fertility coach Jennifer Elworthy in a LinkedIn post, but it also leaves thousands of people unsupported, worsens health inequalities, misses critical opportunities to improve preconception health and most importantly, results in babies’ lives lost.

What Tommy’s graded model proposes

To restore dignity to miscarriage care and prevent these heartbreaking losses, Tommy’s is proposing a Graded Model of Miscarriage Care. Developed by experts at the National Centre for Miscarriage Research, this three-step model is a proactive approach that could prevent around 10,075 devastating miscarriages a year. 

After the first loss, women and birthing people will be advised by a nurse or midwife on reducing possible risk factors for future pregnancies, screened to identify mental health needs and given information on progesterone supplements for future threatened miscarriage. 

The same support will be available after a second loss, plus blood tests and health referrals (if needed). Reassurance ultrasound scans will also be offered to determine issues requiring early intervention and ease the many fears and anxieties that can arise during pregnancy after loss.

After the third loss, additional support includes all the above, as well as genetic tests, further blood tests, and pelvic scans, provided in a consultant-led clinic. 

What Tommy’s pilot study in Birmingham found, and why this matters 

To understand how the model could work in practice and be rolled out across the UK, Tommy’s tested it in a pilot study at Birmingham Women’s Hospital. During this study, 203 women who had previously suffered one or more miscarriages were treated according to the graded model against a control group of 203 women who received the usual care provided by the traditional model, i.e. support after three or more losses and no follow-up support after one or two losses. 

The results are very promising. In addition to the prevention of just over 10,000 miscarriages per year, data showed that: 

• 93% of healthcare professionals involved said the graded model was easy to deliver, so its implementation would not significantly impact their current workload;

• They also reported increased satisfaction in being able to give greater support to families during a very difficult time.

• Women in the graded model group were 47% more likely to have a risk factor identified and given relevant advice to help prevent future miscarriage than women receiving usual care.

• The UK could save over £40 million in the first year of implementation, rising to at least £56 million over five years.

These findings are incredibly encouraging if you are trying to conceive. Moving from reactive to proactive care means that each miscarriage will no longer be seen as a minor, isolated event with minimal long-term consequences. Consequences such as increased anxiety, depression, post-traumatic stress disorder (PTSD) or suicidal thoughts. The profound psychological effect on partners should not be underestimated either, with many experiencing similar mental health struggles in the months and years following loss. 

Why earlier care changes are everything, my personal story.

In my personal experience, receiving adequate care and compassionate support after my first pregnancy ended early could have avoided the pain, grief and cost of five failed IVF cycles and a second miscarriage. The accumulative effect of unsuccessful fertility treatment and pregnancies was the driving factor behind my husband's and my gut-wrenching decision to donate our remaining embryos, thus marking the end of our active attempts to grow our family.  

However, since we were living in Berlin at the time of our latest loss, I was referred for extensive blood tests to reveal any underlying causes preventing a successful pregnancy. It transpired that I have Factor V Leiden, a common inherited genetic mutation that increases the risk of abnormal blood clotting, and therefore miscarriage. 

To improve my chances of carrying a future pregnancy to term, my haematologist recommended that I take daily blood-thinning injections, together with daily progesterone supplements. When I conceived spontaneously a few months after my loss, I followed his advice. Unlike during my previous pregnancies, this one was straightforward, physically speaking and resulted in the birth of a healthy daughter. While no one can prove these changes were responsible for this positive outcome, I received the care I needed and gratefully welcomed the baby I had been dreaming of for years. 

My story is one of many demonstrating how being seen and supported greatly impacts our experience of miscarriage and pregnancy after loss. Every woman and birthing person deserves this level of care and compassion after their first loss. Scotland is paving the way for change by integrating the Graded Model of Miscarriage Care into its miscarriage pathway. Having shown that it can be rolled out effectively within the NHS, Tommy’s is calling on the government to implement it nationwide, supported by ring-fenced funding, guidance and training. To champion this national rollout, you can email your local MPs to encourage them to write to Wes Streeting, the Secretary of State for Health and Social Care, to introduce the Graded Model across England and meet with Tommy’s to discuss their report and policy recommendations further. If you wish to do this, you can find a template drafted by Tommy’s here.

What you can do right now 

Until the graded model is adopted, there are several actions that you can take if you are trying to conceive to reduce the likelihood of recurrent miscarriage. Firstly, risk factors such as a low or high body mass index, smoking, alcohol and excessive caffeine intake can be modified. In terms of treatable medical conditions, anaemia and thyroid dysfunction can be easily identified by your GP and readily controlled before a future pregnancy. 

Lastly, through their special helplines manned by midwives, Miscarriage Support Tool and Wellbeing after Miscarriage programme, Tommy’s also provides comprehensive emotional support. If you prefer peer support in the form of Facebook groups or personal stories, or are looking for guidance for partners (if this is applicable to your situation), this information can be found in the Baby Loss Support section.

The three-miscarriage wait needs to end now. As clearly outlined on Tommy’s website, “This is not only a matter of science and healthcare, it’s a matter of compassion, justice and humanity.” When all is said and done, the Graded Model of Miscarriage Care has the potential to save 10,075 babies’ lives a year. In other words, that means over 10,000 families bringing their babies home instead of navigating the heartbreak of pregnancy loss.

Key Takeaways

• As it stands, most women and birthing people in the UK have to suffer three miscarriages before the NHS provides support, treatment and tests. This arbitrary rule leaves thousands of people feeling unsupported, their grief unacknowledged and opportunities to improve their situation and prevent further loss, missed.

• Leading baby loss charity Tommy’s has developed and tested a Graded Miscarriage Model of Care, which provides compassionate care and support after the first loss. One of the key findings from their pilot study showed that nationwide implementation of this model could prevent 10,075 miscarriages a year.

• If you want to support a national rollout of this new model, you can write to your MP using the Tommy's template.