Pregnancy Loss Review calls for improved support for parents and sonographers

SoR responds to independent DHSC review on care and support when baby loss occurs before 24 weeks gestation

Published: 14 August 2023 Sonography

In response to concerns about disparities in services across England, the Department of Health and Social Care (DHSC) has commissioned and published an independent review into pregnancy loss service provision.

Pregnancy loss is a difficult time for parents, but the service and support offered to them during this time can make a huge difference in the short and long term.

The lead authors of The Independent Pregnancy Loss Review - Care and support when baby loss occurs before 24 weeks gestation reported: “We were instructed to consider what ‘good’ compassionate care could look like, and to not only identify gaps in service provision, but also to examine why families have been failed time and time again and the reasons why staff members have not been supported in their high-pressure roles.

"This has resulted in us producing what could be considered a long list of recommendations, some of which we hope will be implemented immediately, whilst others would need to form part of a long-term strategy.”

Workload pressures

The review recognises the considerable pressures that all staff, including sonographers, are under and how there is a need to balance pressure with “demonstrating compassion and sensitivity”.

The authors also highlight concerns about the lack of sonographer regulation. Gill Harrison, Professional Officer for Ultrasound at the SoR, said: “There is emphasis on statutory professional regulation of sonographers in relation to the provision of ‘safe and compassionate’ care. This is a key inclusion that helps to keep sonographer regulation high on the national agenda”.

One recommendation is that all sonographers hold a Consortium for the Accreditation of Sonographic Education (CASE) accredited award or overseas equivalent. Gill said: “As sonography is not a statutory regulated profession, holding a CASE accredited award or equivalent is one way of trying to ensure a minimum standard of education and training has been met. Statutory or voluntary regulation can only assure that someone has completed an appropriate qualificatory award. It is still imperative that clinical skills are audited on a regular basis to ensure ongoing competency”.

Key recommendations

There are some important recommendations in the document for sonographers, including:

  • "All people groups, regardless of race, colour, age, gender, sexual orientation, or religion” should be listened to and have access to personalised care.
  • Staff should receive education relating to the need for sensitive, parent-centred care and encouraged to be ‘patient-led’ in their terminology.
  • Training in bereavement care and delivering unexpected findings and difficult news should be mandated for all staff involved in proving these services.
  • Consensus Guidelines on the Communication of Unexpected News via Ultrasound should be included within the curricula for sonography courses.
  • Training should include “education on the importance of psychological well-being and self-care for staff”. Protected time for training and compliance monitoring should be incorporated into job plans.
  • Translation services should be used when delivering unexpected news, as reflected in best practice guidance. Ideally face-to-face professional interpretors but where this is not possible video or telephone interpretation can be used.
  • Early pregnancy assessment unit (EPAU) appointment times should be appropriately funded and sufficient to provide high quality care and communication to support parents’ physical and emotional needs.
  • “Reflective supervision” and peer support are recommended to provide staff with the support they need to debrief and meet their emotional needs.
  • The need for employers to recognise and support staff who have been impacted personally by baby loss, particularly when they return to working in an environment where baby loss is common, such as EPAU settings.

The report acknowledges that investment is required to implement many of the recommendations. Gill said: "Hopefully the findings of the review will be the impetus for change".

NB The report erroneously mentions the "Society of Sonographers", which does not exist.