The loss of a baby between 13 and 23 weeks of pregnancy, often referred to as a mid-trimester loss, can be a devastating experience for parents with major effects on their health and well-being. While the term miscarriage is often used, many people find this does not describe the distressing physical and emotional experiences of going through labour and birth knowing their baby has already died or is likely to die during or soon after birth.
The precise number of families experiencing mid-trimester loss every year in the UK is not known as babies born showing no signs of life before 24 weeks of pregnancy are not officially registered. Research has emphasised parents “deserve recognition of their loss and reassurance that an accurate record of it will add to the global knowledge required to prevent future ones”. In the UK, high quality detailed data are available on registered stillbirths (loss from 24 weeks of pregnancy) and neonatal deaths, allowing robust monitoring of trends and targeted interventions. In comparison the lack of reliable robust national data on even the number of mid-trimester losses is surprising and extremely concerning. Limited regional research suggests 5,000-8,000 families experience mid-trimester losses every year in the UK, up to three times the number of families experiencing stillbirth. Monitoring these mid-trimester losses is crucial for improving care in the future.
Many parents, charities, doctors and midwives have reported that the care parents receive following mid-trimester loss differs between hospitals. Some may be cared for in gynaecology wards while others may be cared for in a maternity unit. This may lead to differences in the quality of care parents receive such as not getting the right pain relief during labour or parents not being cared for by someone trained in bereavement care. This may have a lasting impact on parents’ experiences of trauma and loss and reinforces a “hierarchy of loss” i.e. that the experience of mid-trimester loss is lesser in some way than other losses such as stillbirth and neonatal death.
This PhD will aim to gain in-depth understanding of current policy, practice and/or experiences of care in order to identify gaps and opportunities to improve the experience, consistency and quality of care for thousands of parents and their families and raise awareness of baby loss earlier in pregnancy in the UK.
The focus of this PhD is extremely flexible depending on the expertise and interests of the student. We would welcome applicants with clinical and/or research experience who would like to take a quantitative approach, such as combining routine data or collecting survey data to contribute to a new evidence base, or alternatively would like to take a more qualitative approach collecting primary experiential data or utilising available secondary data, or a combination of these methodologies using a mixed methods approach.
Particular areas of interest may include
- Contributing to a new evidence base of mid-trimester loss in the UK, by joining together routinely collected information on maternity, general practice and hospital care or collecting primary quantitative data. This will allow the exploration of care provision across hospitals and understand geographical and socio-demographic inequalities in the provision of clinical and bereavement care.
- Understanding differences in the delivery of care for mid trimester loss across gynaecology and maternity services by drawing on the experiences of those personally affected by mid-trimester loss or the experiences of doctors, midwives and nurses providing care for families.
- Exploration of variation in practice around mid-trimester termination of pregnancy relating to fetal anomaly including the type of care received, the location of care and policies around coronial investigation.