Experts: Women must get much more information about pain relief

Women must be better informed – and have the option of general anaesthetic – before gynaecological procedures, say experts.

Maureen Sharkey, managing counsellor for Scottish Care and Information on Miscarriage, says women have needed trauma counselling after they were not sedated for post-miscarriage procedures.

“Women are getting a local anaesthetic and that’s pretty traumatic,” she said. “Witnessing or experiencing that procedure while conscious just adds to the anxiety and grief and upset that women have been through already after having a miscarriage.

“It doesn’t make things any easier when they are awake for the procedure, can feel sensations of what’s going on, or pain. It’s horrendous – and is leading many women to have trauma counselling.

“Trauma takes a long time to recover from. It’s not just a case of losing a baby. We have to address the trauma itself, which needs long-term counselling.”

Ruth Bender-Atik, national director of The Miscarriage Association, said traditionally, surgical management of miscarriage is done under general anaesthetic but, for several years now, many hospitals also offer the option of local anaesthetic, where the women is awake and has an injection into her cervix.

Ruth says that very few women are now being offered surgical management under general anaesthetic because of restrictions on most non-urgent surgery following the coronavirus outbreak. “It’s very important to recognise that miscarriage itself can be very traumatic, from the shock of the diagnosis through to the physical experience and, of course, the loss and grief that so many women and their partners feel,” she said.

“What helps most is supportive, compassionate care, clear information that is sensitively given, and time to decide, where necessary, on next steps. One of those steps may be how to manage a missed or silent miscarriage.

“The Miscarriage Association’s long-held position is that as long as the woman is clinically stable, that she is not needing emergency care, she should be offered an informed choice of all management options that are available and appropriate.”

This issue is just one area that a new campaign, Changing Miscarriage Care, aims to change.Launched by former health secretary Shona Robison and parliamentary aide Nadia El Nakla, who have both experienced miscarriage, and backed by The Sunday Post, it is calling for best practice in care and treatment to be adopted across NHS Scotland and to help raise awareness of the physical and emotional toll of miscarriage.

Meanwhile, the Campaign Against Painful Hysteroscopy is calling for action after patients undergoing an examination of the womb suffered severe pain during the outpatient procedure.

The group has been contacted by more than 40 women in Scotland distressed by their experiences.

Information provided to the campaigners under Freedom of Information leglisation reveals not all health boards in Scotland offer all hysteroscopy patients general anaesthetic initially.

Professor Justin Clark, president of the British Society for Gynaecological Endoscopy, said under the Royal College of Gynaecologists guidance, when it comes to miscarriage, women should be offered both surgical options under general anaesthetic or medical management under local anaesthetic.

I was left in tears. I felt traumatised

Michele, from Edinburgh, said her hysteroscopy was sold to her like “a cup of tea and a biscuit”.

“The consultant told me it would be quick, easy and relatively pain free, a bit like period pain. Having had lots of gynae procedures before, I just trusted that.

“There was no paperwork at all, so I didn’t look into it. On reflection, I was probably a bit naïve.

“When I arrived to have the procedure, they said I should have received a leaflet explaining I should take two paracetamol an hour before my appointment.

“But to be honest, that wouldn’t have even touched it. It was incredibly painful, I felt as if I was going to faint or vomit. The staff had said at the start if I needed them to stop, just to say so.

“And although there were two nurses squeezing my hands, it was so excruciating I had to tell them to stop. When I came out, I was tearful.”

Michele added: “I felt totally traumatised that I hadn’t been properly informed about the procedure.

“There should have been a very frank conversation about what it involved beforehand so I could choose whether I wanted the anaesthetic or not.”