Meeting of the Parliament (Hybrid)

Meeting date: Tuesday, October 6, 2020

Official Report 888KB pdf

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Miscarriage

The final item of business today is a members’ business debate on motion S5M-22771, in the name of Shona Robison, on changing miscarriage care. I ask those members who wish to speak in the debate to press their request-to-speak buttons now.

Motion debated,

That the Parliament notes the launch of the campaign, Changing Miscarriage Care, which aims to open a conversation and break down the stigma regarding miscarriage, while campaigning for practical changes to the provision of miscarriage services in Scotland; recognises what it sees as the devastating impact that miscarriage can have on couples, who can often be left feeling unsupported and in search of answers; understands that there are already some very good pregnancy services, and notes the aim to make sure that this is the case everywhere in order to provide timely and dignified care to every pregnant woman across Scotland, including in the Dundee City East constituency.

16:34  

I thank my colleagues across the chamber for their support in helping to bring this important, timely and much-needed debate to the Parliament.

For too long, too many women have had to suffer the devastating impact of miscarriage alone and confused, without the opportunity or safe space to talk openly and honestly and to come to terms with its effects on them. If, through today’s debate, we as a society can help to find a place to talk about miscarriage, we can be proud of that.

I must thank so many people and organisations for their support and expertise in helping to shape and support the changing miscarriage care campaign. Tommy’s is the largest charity funding research into the causes of miscarriage, stillbirth and premature birth. Jane Brewin has led the charity for more than 20 years and has grown it to fund five world-leading pregnancy research centres in the United Kingdom, including Tommy’s national centre for miscarriage research and the Tommy’s Edinburgh research centre. The charity provides pregnancy information to more than 2 million people each month.

I also thank the Miscarriage Association for the pin badges marking the baby loss awareness campaign. The association works with more than 60 charities, highlighting the issues surrounding baby loss. Each year, baby loss awareness week takes place around now, giving those who are affected by it the opportunity to raise awareness about pregnancy and baby loss and to drive improvements in the bereavement, care and support that are available for those affected. This year, the week will focus on the isolation that many people experience after baby loss: women, partners, other family members and friends.

Social distancing because of Covid-19 has had a major impact on access to care and support, and it has complicated grief and responses to pregnancy and baby loss. Since the start of the coronavirus pandemic, feelings of isolation have become more widespread, and many people have begun to speak more openly about loneliness.

Now more than ever, we can all come together to let those who have been affected by baby loss know that they are not alone, and that we are all here to support them.

I thank the Scottish Parliament cross-party group on women’s health for helping to promote, support and inform the campaign. I also thank Holyrood magazine and the Sunday Post for their heartfelt interest and their compassionate and sensitive reporting, as well as their influence in bringing the issue to the fore, helping people across the country to discuss it and helping to remove the stigma surrounding miscarriage.

Finally, I thank Nadia El-Nakla and Humza Yousaf for sharing their story. Nadia, who works for me, has been an inspiration to many people in sharing her heartbreaking story, and she has been a catalyst for me to share my story of miscarriage and to get involved in launching the changing miscarriage care campaign.

All those I have mentioned have been so helpful in raising awareness of the issue and in giving people the safe space that they need in which to discuss their experiences. The response to the campaign has been overwhelming. Since it launched, so many people have got in touch with me directly to share their experiences. Mary, who is now 72, first miscarried 54 years ago and still grieves and cries to this day. Karen miscarried during lockdown, and she had no one with her to support her. Lesley suffers from on-going mental health challenges following her miscarriage.

I have been there, and I can relate to so many of the stories that are being shared by women. I believe that, by opening up about our own experiences, we can create the supportive environment that women need and deserve. Women should never be made to feel like they cannot speak about those experiences, and the recent outrageous treatment on social media of Chrissy Teigen and her husband John Legend, after they shared their story of losing a baby, is another reason why the campaign is so important. We need to remove the stigma and create a culture where women can speak freely, without fear of ridicule.

We know that miscarriage can also have a devastating effect on men. However, for a variety of reasons, many men find it difficult to get the support that they need. Many men report feeling like they should put their own feelings aside and be there for their partners at a difficult time, or they feel guilty for also having feelings of loss. Much of that stems from the perception that miscarriage, pregnancy and fertility are primarily women’s issues, not men’s, and we need to change that, too.

We recognise the very good work of the hard-working staff in early pregnancy units, but there is a need for more consistent care across Scotland. The campaign has key aims to improve that, including: the development of care packages tailored to one, two and three-plus miscarriages, which provide an appropriate individualised investigation and management care plan focused on the women’s needs; offering progesterone when bleeding in pregnancy, where that is clinically appropriate; improving access to an early pregnancy unit through strategies to facilitate a seven-day service nationally; increasing the capacity for early pregnancy scanning through training and diversification of scan practitioners; and embedding counselling services in early pregnancy units, as is the case with in vitro fertilisation and, importantly, the follow-up after miscarriage.

The campaign will progress all those aims, and I look forward to hearing the response to them from Joe FitzPatrick, the Minister for Public Health, Sport and Wellbeing. Before that, I thank him for attending the launch of the campaign, when he pointed to a great willingness on the part of the Government to take on board the campaign’s aims. It felt like we were pushing at an open door.

The support from colleagues from all parties who are here in the chamber and, of course, across Scotland, shows that there is a need, willingness and support to end the stigma around miscarriage. By working together to provide the needed care and support, I think that we can bring that change in Scotland.

I remind members to press their request-to-speak button if they want to speak in the debate.

I can now, therefore, call Emma Harper, to be followed by Brian Whittle.

16:41  

I thank the Presiding Officer for reminding me to push my button.

I welcome the opportunity to speak in the debate on changing miscarriage care in Scotland. I thank Shona Robison for her contribution and for bringing the debate to the chamber.

I echo Ms Robison’s points, and I will touch on some of the key aims that she outlined, so that we can raise awareness of the care that needs to be changed and provided for women experiencing miscarriage.

In preparation for the debate, I read a lot about the experiences of women and couples who have lost a baby. I reflected on the time I worked in California, where my colleagues and I engaged with empathy and sympathy when caring for women who had experienced miscarriage. Those were women who needed a procedural intervention following their miscarriage. That added to the trauma of those who had been preparing for a new life with their new born. The distress, despair and emptiness conveyed meant that, on many occasions, quiet hand-holding, reassuring hugs and just being there often helped.

Thankfully, the care available in Scotland is a bit better. However, we have issues that need to be addressed and progressed. A miscarriage can have profound emotional impacts not only on the woman, but on her partner, friends and family. Although there are specific national health service processes, including support groups and bereavement care, additional assistance, which can also be of benefit, can be provided.

The charity SiMBA was formed in 2007. It operates across Scotland, including in Dumfries and Galloway and has been carrying out exceptional work to support families who experience baby loss. The organisation helps bereaved parents by providing memory boxes, support groups, family rooms and trees of tranquillity, with parents able to dedicate a leaf to their lost child. The memory boxes include small knitted teddies, butterfly charms and other items, with room for other memories to be added.

SiMBA has created three different box sizes, depending on the gestation of the loss. I am aware from my case experience how much such boxes can mean to families who have gone through the tragedy of a miscarriage. The boxes, along with events such as the wave of light celebration—the event, which will take place on 15 October, allows families to have a candle-lit display—helps them to remember the loss of their unborn baby and to raise awareness.

Raising awareness addresses the campaign aim for open conversation and breaking down the stigma of miscarriage. In Dumfries and Galloway, a great deal of work has been done to raise awareness of the devastation that a loss can bring. Lauren and Chris Brydson’s fundraising means that a tree of tranquillity will be brought to the Crichton campus. Lauren and Chris Brydson formed a baby loss awareness committee. They, along with other committee members, raised more than £27,000 towards bringing a tree of tranquillity to Dumfries and Galloway. The couple received their first SiMBA memory box after they lost their daughter Tayler. Since then, they have experienced a further four losses, including that of their son Robbie, who lived for just six hours after being born prematurely in March 2019.

The second aim of Shona Robison’s campaign is that investigation needs to happen after one loss, rather than three. I think that that is quite right and I support that aim.

There is no date for when the tree will be in place in Dumfries and Galloway, but 90 leaves have already been sent to parents who want to add their memories to the tree once the site has been secured and the tree has been planted. I want to put on record my thanks to Lauren, Chris and all the other community members for their tireless work for the people of Dumfries and Galloway.

I welcome the debate, and I look forward to the aims of Shona Robison’s campaign being achieved.

16:45  

I, too, congratulate Shona Robison on securing time to debate such an important on-going issue. I declare an interest, in that my daughter is a midwife.

I was privileged to join a Zoom call on the topic, which was hosted by Shona Robison and which I thought was an excellent open discussion on the tragedy of miscarriage. She has just reminded me of Nadia El-Nakla’s story, which was hard to listen to but important to hear. I thought that Nadia was incredibly brave.

What is so surprising is the number of families who are affected. The reason why it is so surprising is that the subject is not openly discussed. That is why we are having the debate and why it is so important. It gives us an opportunity to shine a light on the subject.

On reading Shona Robison’s motion, I thought that it was interesting that she had used the word “stigma” in reference to miscarriage. It is not a word that I would have used in connection with the issue until I heard it in the recent Zoom meeting. I thought that surely there could not be a stigma associated with such an unfortunately common condition. I think that the overwhelming consensus of those who were suffering was that there is a problem of stigma.

I thought about it and I raised the issue—I did so rather tentatively—of the man in the equation, who is likely to be the main support for a woman who has suffered miscarriage. We menfolk may not be best equipped to have that responsibility and may need some help on that. Fortunately, on the call, my point was taken in the way in which was meant, and I was informed that there are organisations that offer that kind of support to the menfolk as well.

Presiding Officer, you may be surprised to hear that we men are not necessarily the best at accepting that we may need help and then asking for it. After all, we are man, the hairy hunter; and we can therefore show no emotion or weakness. However, although we may not have to go through the physical and emotional trauma that our partners go through in losing a child in miscarriage, we lose a child nonetheless and we also have to watch the suffering of our partners after miscarriage, often feeling useless and awkward in our ability to do something about it. I completely recognise that the woman, in the main, has to deal with the physical and emotional trauma, but the person who is charged with supporting that woman through the devastating effects of miscarriage will almost certainly also be suffering and may need a little help and guidance.

The other people in our discussion should be the care givers, midwives and health visitors who have to inform and care for those women as they go through a miscarriage. Those care givers would like training in giving post-miscarriage guidance and advice. In the main, the barrier to delivering that part of the service is time; there is often just not enough time for them to give the help that they want to give. What is more, given the type of people that those medical professionals are, dealing with couples who go through the tragedy of losing a child, whether in miscarriage or during birth, will always affect them. After all, not to put too fine a point on it, they are in the profession to help bring life into the world.

Most speeches in the debate will quite rightly focus on the woman who has tragically lost a child. However, I highlight that, although the woman is by far the most affected, others are also affected. In doing that, I beg forgiveness from ladies who are in the chamber or watching at home.

I will close by once again thanking Shona Robison for bringing the debate. I hope that it will highlight the issue and lead to a much bigger discussion around the country.

16:49  

I, too, congratulate Shona Robison on securing valuable debating time on this important matter, which is a very personal one to her and to many colleagues.

At least one in five pregnancies ends in miscarriage. Although miscarriages are the most common complication during pregnancy, their true scale is unknown. Last year, more than 4,600 women in Scotland required in-patient treatment for a miscarriage, in a year when there were just over 51,000 live births. However, because many women might not recognise that they have had an early miscarriage, the real figure is likely to be much higher.

My first wife, Linda, lost a baby at 13 weeks, and the doctor could provide no reason or explanation. My second wife, Patricia, lost a baby at eight weeks and another at full term, although the latter was due to undiagnosed pre-eclampsia. My mother, too, suffered two miscarriages. Her sister, my twin sister and my father’s three sisters each suffered at least one miscarriage, and none of those five women ever gave birth or enjoyed their own baby to love, cuddle and raise.

Unfortunately, miscarriage remains almost taboo in our society. Women and their partners are simply expected to get on with it. If the issue is mentioned at all, hurtful phrases such as, “It’s just one of those things,” or, “It’s nature’s way,” are too commonly used and further aggravate the pain of bereaved parents. As a result, countless mothers suffer in silence and do not share the physical and emotional difficulties that they endure as a result of a miscarriage.

Too often, we fail to properly empathise with the profound psychological impact that pregnancy loss can have. In some cases, it leads to mental health problems such as post-traumatic stress disorder, anxiety and depression, or it exacerbates existing problems. As a society, it is our duty to talk about miscarriage and to break down the stigma that still exists. I therefore welcome the motion’s aim of breaking the stigma surrounding miscarriage, particularly as the debate coincides with baby loss awareness week.

That event, from 9 to 15 October, gives bereaved parents and their families and friends an opportunity to unite with others across the world to commemorate their babies’ lives. The experience of pregnancy loss is unique to each person, so we must ensure that women and their partners are listened to and given the support that they need. Psychological support is of central importance and signposting to counselling services needs to be enhanced to ensure that parents have the information and help that they require.

Recovering from the physical and psychological impact of miscarriage and finding a way through the experience can be a long journey. The profound impact that the pandemic has had is likely to have increased the isolation that many bereaved families face. Grieving for a lost child is difficult, and finding the root cause of a miscarriage is often vital to the healing process, yet currently women are tested to discover why they have had a miscarriage only after suffering pregnancy loss three times in a row.

It is therefore clear that, despite good services, improvements can and must be made. With only half of Scotland’s hospitals having specialised early pregnancy units, we need to ensure that every woman has equal access to services and we must provide an individualised care package that is tailored to each woman’s specific needs.

Clearly, more research is necessary. Half of early miscarriages are due to curable underlying causes rather than chromosomal abnormalities. I therefore applaud the fantastic work of charities such as Tommy’s, which undertakes vital research into pregnancy loss and premature birth. In 2016, Tommy’s opened the United Kingdom’s first dedicated miscarriage research centre here in Edinburgh. Recent research has found that, among women who had suffered three or more previous miscarriages, a progesterone treatment increased live births by 15 per cent. That could potentially save 700 Scottish babies each year. Caffeine should also be avoided in early pregnancy, as should alcohol, of course.

I commend the launch of the changing miscarriage care campaign. Not only does it aim to raise awareness of an issue that is too often kept quiet, it campaigns for necessary improvements in care, treatment and testing provision across Scotland as well as for funding of vital research into miscarriage, stillbirth and premature birth.

My family greatly feels the loss of so many children who were not born to my twin sister, my second wife and indeed my four aunts. I hope that many other women and their partners in the years ahead do not have to suffer what my family and many other families have suffered over many years.

16:54  

I pay tribute to Shona Robison for bringing the motion to the chamber and for all the work that she has done on the changing miscarriage care campaign. It is difficult to talk about a personal experience, especially one that is surrounded by so much of the taboo and stigma that we have heard colleagues speak about tonight.

I thank Shona Robison for the personal commitment that she has made to the campaign. I was pleased to join the recent virtual parliamentary launch of Shona Robison’s campaign. It was great to have the Minister for Public Health, Sport and Wellbeing there and I am pleased to hear that there is an open door, because that means that the campaign can get a good outcome for the women who need it. On Friday, I chaired the cross-party group on women’s health. We had come together to discuss this very topic and the CPG decided unanimously that we would endorse the campaign. We are writing to the minister to let him know that and to ask him some questions. The campaign feels like it is a positive campaign that everyone can support.

I am grateful to the chief executive officer of Tommy’s, Jane Brewin, who Shona Robison mentioned. Nadia El-Nakla cannot be in the chamber to talk about this because she is not a member, but I hope that as many members as possible get to hear Nadia’s story. It is not about listening to a sob story that we can all sit and cry about, although it is very moving. What is really powerful about Nadia’s campaign and contribution is that it is about the changes that we can make, particularly around prevention. What are the advances in medicine and treatment and what differences can they make? I hope that the minister takes that on board.

At the end of last year, there was a debate in Parliament on a motion by James Dornan on easing the burden and pain of miscarriage. In his motion, James Dornan talked about taboo, and I will not repeat all the points of that debate, but I am pleased that we are back again to make sure that the topic is not off the agenda.

When I co-founded the cross-party group on women’s health, back in 2017, I was encouraged by Kenny Gibson to do so. I did that out of an awareness that there are so many issues around women’s health that remain taboo, which should not be the case in 2020. It is good therefore that we are all here again to make some progress.

Miscarriage remains one of those issues that people struggle to talk about. Sometimes that is because people do not want to put their foot in it. It is not that they do not care, but they do not know what to say. In Scotland, with around one in four pregnancies ending in miscarriage, stillbirth or premature birth, this is not a niche issue. We all have to be part of the conversation.

The changing miscarriage care campaign sets out clearly what we want the Government to do, what we want health boards to do and, importantly, the improved outcomes that we want to see for women in Scotland. I am, again, happy to give my full support to the campaign.

It is good when people in the public eye speak about their experience, as Chrissie Teigan and John Legend did last week, because it makes it easier for others to do so. People do not have to speak out about their experience, but it can help people to know that they are not alone and that support is available.

Others have also spoken about the role of fathers and partners but, as we touched on in the CPG last week, not every woman who is going through pregnancy, miscarriage or baby loss has a partner or husband. We have to remember that and make sure that we are inclusive.

I talked briefly about prevention. What Nadia El-Nakla and Shona Robison have said about progesterone needs to be explored, and I look forward to the papers that are coming out in The Lancet later in the year. I long for the days when we do not need to have campaigns such as Pregnant Then Screwed, which is trying to end the motherhood penalty. Women face so many barriers right across Scotland and across the world, and I hope that, by having debates such as tonight’s, we can become a more progressive society and make things a bit easier for women in future generations.

16:58  

I also thank Shona Robison for bringing the issue to Parliament today. I will confess that I have forgotten to put on my changing miscarriage care badge, but that in no way diminishes my whole-hearted support for the campaign.

I also attended the cross-party group on women’s health last Friday, and I heard the personal and emotional stories of women who have experienced miscarriage. As the motion notes, and as colleagues have discussed, there is still a great deal of stigma surrounding miscarriage, and I think that the fact that we are having this discussion in the chamber this evening is a positive step.

We have previously discussed in the chamber the culture of silence around women’s pain and discomfort, which I think clearly impacts women who miscarry. Women are still frequently advised not to announce their pregnancy until it is “safe”. They are made to feel as though miscarriages should be hidden, for fear of awkward conversations or, perhaps, less-than-understanding employers. Miscarriage is an intensely personal experience, and it is a woman’s choice whether she wishes to disclose it to others—she should never be made to feel that she cannot.

There must also be more awareness of how baby loss impacts the partners of those who are affected. I know that Humza Yousaf has spoken openly of his feelings of helplessness when his wife Nadia El-Nakla miscarried. I commend him for his honesty and bravery in talking publicly about such a painful subject. We need to speak more openly about miscarriage in general, but also about its impact on relationships. Emma Harper spoke of the work of SiMBA, and I, too, would like to thank SiMBA for its excellent work supporting families who have experienced the loss of a baby.

As we have heard, it is important to remember that the level of distress that a woman feels is not linked to how far along her pregnancy was. Everyone experiences miscarriage differently, and it can be a devastating loss whether it occurs at 10 weeks or 20 weeks. We cannot make assumptions based on a woman’s age, how many other children she has, how many miscarriages she has had or how far along she was.

Research that was conducted by Imperial College London has revealed that four in 10 women reported symptoms of post-traumatic stress disorder three months after a pregnancy loss. The team behind the study said that the findings suggest that

“women should be routinely screened”

for PTSD,

“and receive specific psychological support”.

Although that was a UK study, there is learning in it for Scotland. As a first step, counselling services should be embedded in miscarriage support. As we have heard, at least one in four women will experience a miscarriage in their lifetime. That it is a relatively common occurrence among women has created the perception that some pregnancies are just not meant to be. We need to challenge that.

The charity Tommy’s says that half of all early miscarriages are not due to chromosomal abnormalities, but have underlying causes that we can cure. However, under the current system, as colleagues have stressed, women are referred to a consultant only after they have had three miscarriages in a row. Why, if half of all miscarriages are caused by curable underlying causes, are women forced to undergo such a deeply painful and distressing experience three times before they can see a consultant?

Those who miscarry are also more likely to have a pre-term birth or stillbirth, and to have cardiovascular disease and blood-clotting disorders. We should investigate sooner why women are miscarrying, with a view to preventing further miscarriage. Women should receive lifestyle advice after one miscarriage and a referral for basic tests after two, because by that point it is clear that there is an underlying problem.

There must also be tailored support for those women who are more at risk, as well as a commitment to improve pre-conception health. Women must have ready access to information on alcohol consumption, folic acid supplements, smoking cessation, exercise and dietary advice to inform them of the risks and benefits of lifestyle choices and the steps that they can take to protect themselves and their babies. That is essential if we want to improve maternal health.

I appreciate that I am over time, so I will conclude my remarks. I whole-heartedly endorse the motion in Shona Robison’s name.

17:03  

As others have done this afternoon, I thank Shona Robison for bringing this important debate. I realise that I might repeat what others have already highlighted, but the subject is about loss of life and its devastating impact on women and their partners, so I do not think that it can be repeated too often.

The online launch of the changing miscarriage care campaign was both inspirational and heart breaking. It was inspirational because of the passion among the attendees for changing and improving the care and treatment that are offered to women who experience miscarriage. It was heart breaking because of the experiences that we heard. I, too, want to pay tribute to the women who shared their stories with us.

Those of us who are here today will have friends and family members who have had miscarriages, or we might have experienced it ourselves. It is estimated that about one in four pregnancies end in miscarriage, but the reality is that the true scale in Scotland is unknown. The number of people receiving in-patient treatment for a miscarriage has declined, from 7,546 in 1998 to 4,635 20 years later. However, that incomplete picture hides the number of patients who are treated in the community or solely by their general practitioner.

There are many reasons why a pregnancy ends, and many women miscarry before they even know that they are pregnant. Whether it is a one-off experience or multiple miscarriages, the impact can be devastating and can last a lifetime. Some women carry around a feeling of guilt that their miscarriage may have been caused by something that they unintentionally did, even though health professionals will have tried to reassure them that that was not the case. The what ifs and the guilt do not always disappear with the passage of time.

What can we do to make things better? Speaking about miscarriage and raising awareness is a start. It has taken a long time for society to be able to speak without any discomfort about how a woman’s body works, and with no embarrassment when periods, sanitary products, childbirth or menopause are discussed. It is past time to remove any stigma that is associated with miscarriage and to raise awareness of the emotional and physical toll that it can take on the lives of women and their partners.

At the campaign launch, we heard about some examples of good practice. Our aim should be to ensure that there is equity, with quality treatment and care across Scotland—and not only physical care; other members of my party have repeatedly called for better perinatal mental health care. Many women who experience the joy of bringing home a new baby can experience poor mental health during pregnancy and afterwards, and we are now much more aware of the impact that that can have on all the family. It beggars belief, therefore, that someone who has just experienced the devastation of the unexpected end of a pregnancy could be sent home with a leaflet and no offer of counselling or even follow-up calls. We should, and we can, do much better than that. That is why I whole-heartedly support the motion and the changing miscarriage care campaign.

Given the number of members who are still waiting to speak in the debate, I am minded to accept a motion without notice, under rule 8.14.3, to extend the debate by up to 30 minutes.

Motion moved,

That, under Rule 8.14.3, the debate be extended by up to 30 minutes.—[Shona Robison.]

Motion agreed to.

17:07  

I thank Shona Robison for bringing the debate to the chamber and for her commitment to making improvements in this area.

This is the second time that I have spoken in a debate on this issue. I spoke in James Dornan’s members’ business debate, which Monica Lennon mentioned, last year—I cannot remember exactly when it was—and I apologise in advance to the official reporters if some of my speech is the same.

There is a real taboo around miscarriage. If members do not mind, I will share my personal experiences. I can clearly remember the most recent time that it happened to my partner and me. It was during my 2016 election campaign, so I clearly remember the two things running together. It was one of those things that happened that we did not tell anybody about. We just had to get on with it, because we did not want it to have an impact on the campaign or anything like that. I will come back to the thinking around that, because I do not now think that it was right.

Unlike other people who have been in that position, I had what I suppose could be called the honour of being able to say something when I was successfully elected. In my acceptance speech, I made a reference to what had happened, but it was very obscure. Thinking about what others have said in the debate and what I have learned in the four and a bit years since then, I wonder why that was the case. Why did I make that reference so obscure?

Family and friends came up to me afterwards and were hugging me and shaking hands and all the rest of it—that was well before the days of social distancing—and loads of them said, “What did that bit of your speech mean? What were you referring to ‘stars’ for?” I said that it was just something that I wanted to make reference to. In the period after that, I started to be a bit more open about what had happened, but it struck me that that was what I did at first. We hear people talk about the subject being taboo—back then, I was not able even to address it as an issue.

As I have raised the issue in the chamber, much of this is already in the Official Report. However, on that occasion, I did not say that it was the second time that it had happened to us. It is almost a process of opening up: even when I spoke about it in Parliament, I was not ready to talk about the first time that it had happened. If I, as an MSP with the opportunity to speak in Parliament, felt that way, we can easily see how it is a taboo subject.

The more that I have spoken about it to people, the more that friends and family have spoken about it. Four or five years ago, I thought that it was a fairly uncommon occurrence; I am now convinced that, directly or indirectly, it affects almost every person in Scotland. However, as everyone in the chamber appreciates, some people do not want to talk about it, and we need to respect that as well. I have come across people who want to be open about it and hear debates in the chamber, and I have also come across folk who want it never to be mentioned again, so we need to think about that.

Presiding Officer, I see that I have used most of my time, but I will briefly mention the fantastic charity, Baby Loss Retreat. The charity, which started in Coatbridge, first approached me not long after I got elected. I have been supporting it since then, and it has been supporting me. It is a fantastic organisation. The work that it does with my constituents and with people across Scotland is amazing. The specific purpose of the charity, which is run by Bryan and Julie Morrison, is to offer a break to couples who have experienced a miscarriage or child bereavement. The Morrisons believe that there is a gap in services. Some of the feedback that we have had from people who have used the charity’s service has been amazing.

The charity also does a lot of important work around burials and the registration of deaths that come before 24 weeks, and it is joining the campaign this week. The charity is working on something—I will not give anything away, but if anyone is passing through Coatbridge on the M8 and looks up at one of the wee bridges, they might get a surprise.

Brian Whittle spoke about men and baby loss. Bryan Morrison gives really important speeches and presentations on that issue, and also speaks to men’s groups. The Morrisons are doing important work. I would love to go on talking about them; I spoke to Julie today. I take this opportunity to apologise to both of them for not spending more of my four minutes—now five—speaking about them, but I am sure that I will get the opportunity to do so again.

Again, I thank Shona Robison for her work in this area; I am fully behind her campaign. She is a champion in the Parliament and Bryan and Julie Morrison are champions in the community, and we need more people like them.

Mr MacGregor, I have no intention of interrupting any speeches on such a sensitive and important topic. I should have said this earlier, but you might have gone on for 10 minutes.

17:13  

Like everyone else, I thank Shona Robison for bringing the subject to the chamber today. When we go through tough times, we look to others who have had similar experiences and, for that reason if nothing else, it is important that we talk about miscarriage in the Parliament today.

Too often, we are guilty of projecting an image of a picture-postcard perfect life, especially now, in a society that is dominated by social media. I am also guilty of that: with a newborn baby at home, my social media timeline is full of happy, smiling pictures and, to the outside world, it looks as if my wife and I have had three happy, healthy children with no issues at all. Although we have three beautiful, healthy children, for whom we are thankful beyond words, my wife has been pregnant seven times.

Stephanie miscarried early in her first pregnancy—a common story that, full of the joys and anticipation of becoming first-time parents, we were completely unaware of. Stephanie started bleeding and cramping and phoned her midwife for advice. There was no way to arrange a short-notice scan, so we went to accident and emergency, and she was given painkillers and told to come back if things got worse. We got an early scan the following week. Looking back, I can see that that confirmed what everybody else seemed to know but would not say out loud: that she had already miscarried. At the scan we were told, pretty bluntly, “There’s nothing there,” and just sent on our way. It was only then that we realised how many family members had miscarried too. A strange wall of silence exists. We were encouraged not to tell anyone, not to talk about it.

Eighteen months after that, Stephanie had another, much later, miscarriage, but because she had not had three successive miscarriages, there was no follow-up with medical professionals to get answers or get to the bottom of any potential issues. Stephanie fell pregnant a third time, and the consultant suggested taking aspirin—but then again, maybe not, as the science was not particularly clear, so it was left for us to decide. “Take aspirin, don’t take aspirin—see how you go.” Our first daughter came from that pregnancy.

Then came another miscarriage, then a very premature baby, then a miscarriage, and then our son was born, five weeks ago.

All those miscarriages were devastating in themselves. The physical pain that Stephanie went through, the grief, the loss, the guilt, the trauma, the helplessness, the anguish—I cannot express it adequately. I nodded to every word, crying silently at the story Nadia and Humza bravely told recently.

The effect is not restricted to that trauma. Happy baby news from other friends and families leaves you overwhelmed by sadness for what might have been. Then there is the guilt that you feel for feeling sad about other people’s happy news.

There is the impact on every other pregnancy—the feeling that you cannot be helped, you cannot be happy and you cannot be hopeful. There is no point in painting a baby’s room or buying a buggy, baby clothes or a car seat, because there is just so much fear and stress about losing another baby. There is the constant counting of weeks. Eight weeks in, everything is going okay. Nine weeks, 10 weeks, 11 weeks—it goes on and on and on. It is not just one pregnancy that goes with a miscarriage. In your head, you lose every one of them.

I hope that the campaign that is being led by Shona Robison will break down some of the stigma out there. It will send a message to people that they are not alone and lead to much-needed improvement in medical services around pregnancy and miscarriage, and I will do everything that I can to support the campaign in any way.

17:18  

I thank Shona Robison for securing the debate and for trying to, as the motion says,

“open a conversation and break down the stigma regarding miscarriage”.

That is why I wanted to speak in the debate. I want to be part of that conversation.

Janet and I have had four miscarriages over the years. We are absolutely blessed with Cameron in our lives—our four-year-old son is an absolute joy. Others go through the pain and heartache of recurrent miscarriage and have not been as lucky as we are, so I almost feel guilty speaking in the debate, having had that blessing. I would never forget that.

I have never spoken about our miscarriages before. I thought recently about why that was the case. I suppose that, although miscarriage impacts both Janet and me, it is my wife who had to go through the physical and emotional pain and anguish of pregnancy loss. I will never know what that feels like. Like too many, I just block things out and carry on. I do not suggest that that is either healthy or desirable, but it is an honest reflection on what I have done over the years.

Ahead of today’s debate, I chatted with Janet about our miscarriages. Janet said to me that the due dates for our first and fourth babies, although they miscarried, were both around Christmas day, and reminded me that our oldest child would have been eight years old if they had survived through pregnancy. That really made me think. I can only imagine the emotions and feelings that mums who experience miscarriage must have when due-date anniversaries arrive each year.

I want to say a little about our experience. We have been for scans in early pregnancy—scans where you think that you see your baby’s heartbeat but it is maybe not as clear or strong as it should be at that stage. You go back in a week or so, and it is obvious that your baby—your pregnancy—is not going to make it. You feel numb and helpless: numb, because it feels as if it is not real, although it is real, and you are not sure how you are supposed to feel as a partner; and helpless, because there is nothing that you can do to make things better or to help your partner. There are no words that cut it.

The changing miscarriage care campaign is asking for practical change to the provision of miscarriage services in Scotland. I welcome Shona Robison’s leadership on that and in sparking the discussions. I would like to share another personal experience. Early pregnancy services in hospitals are often near or co-located with maternity units. I understand why that is, and of course it makes sense. However, it is pretty tough if you are waiting to find out the worst regarding your early pregnancy, and all too often having that confirmed, to then see the happiness and joy that the birth of a new baby brings to a family at the exact moment that you get your devastating news. You have to watch others arrive to visit new mums and babies, perhaps bringing big brothers and sisters along to share in the joy that a new baby brings. That is as it should be, but it has an impact on you and your family. It compounds the grief and the heartache—there is never jealousy or envy, but there is grief and heartache nevertheless.

That makes me think about how we ensure that there is sufficient emotional and wellbeing support for mums who lose babies in pregnancy loss. It is about how we help and nurture mental health. I have to be honest and say that I cannot recall whether we were offered counselling, or any support, at the point when we were informed of our pregnancy loss or when Janet miscarried. Quite frankly, it is all a blur, but I am pretty sure that there was no follow-up support reaching out to us to find out how we were doing. I am not sure what that support should look like, but I just put that out there as something that we did not get.

When there are recurrent miscarriages, you do not get excited about a pregnancy; you are just worried. Mark Griffin mentioned counting the days and just hoping and hoping that you make it. I feel guilty, because I remember in the past saying to others who were recently married, “Is it not about time you started a family?” or, “When are you adding another kid to your family? That would be great.” No one knows the suffering and history of individuals or couples when we make those points. I now shy away from ever saying that, because you never know about someone’s personal life and their history and experience. No one who has a miscarriage is ever lucky. However, we are lucky to have our four-year-old son, and we count our blessings.

I, too, am privileged to take part in the debate. I thank Shona Robison for leading discussions on such an important issue, for creating a space for me and others to share our stories, and for shining a light on how we can improve miscarriage care and do what we can to ensure that women do not have miscarriages in the first place.

17:23  

I am grateful to Shona Robison for bringing the motion to the Parliament and giving members the opportunity to hear about her campaign and discuss this important topic. I thank all members for their contributions, but particularly those who talked about their experiences. I know that that will help many others to talk about their loss. As Fulton MacGregor said, it is important to recognise that not everyone wants to or is ready to talk about their loss, and that should be respected, too.

Along with many other members, I attended the virtual launch of the campaign last month, when I heard about the aims of the campaign and listened to interesting presentations from two speakers: Jane Brewin, from the baby loss charity Tommy’s, and Dr Maya Al-Memar, from Imperial College London. Most powerfully, I heard Nadia El-Nakla and Kirsty speak about the loss of their babies.

The campaign could not have come at a better time, as it coincides with a series of four research papers on miscarriage, which I understand will be published shortly by The Lancet, as Monica Lennon mentioned.

I am particularly pleased that the debate is taking place so close to baby loss awareness week, which begins on 9 October and runs until 15 October. As Emma Harper outlined, raising awareness is so important. Every year, baby loss awareness week aims to raise awareness of pregnancy and baby loss across the world, and invites everyone to come together, share their experiences, and show their support for those who have experienced the loss of a baby, whether or not they have been directly affected. The Scottish Government buildings at St Andrew’s house and Victoria Quay will be lit up pink and blue for the whole of baby loss awareness week.

As we have heard, miscarriage affects one in five women before the 12th week of pregnancy, and it is estimated that 1 per cent to 2 per cent of second trimester pregnancies miscarry before 24 weeks of gestation. Kenneth Gibson put some figures behind the individual trauma to help us understand the number of parents who suffer loss. Mark Griffin painted a particularly clear and graphic picture that shows that the loss of a baby, no matter the stage of pregnancy, is a significant and traumatic event that affects many women and their families throughout Scotland. I have heard just how devastating that is.

I have also heard about the barriers to support that taboo and stigma present for women and men, as outlined by Shona Robison, Brian Whittle and just about every other speaker in the chamber this evening. We really need to address that stigma. I am clear that it is essential that women and their families who have experienced a miscarriage are provided with the right information, care and support in a way that takes into account their individual circumstances. Where appropriate, that care and support must include further investigation and counselling.

Although health boards should ensure that every effort is made to provide high-quality and sensitive care following a loss, we are aware that care can sometimes be variable, particularly for women who do not present at an early pregnancy unit and for women who present out of hours. We continue to work with partners to consider what more can be done to provide them with more consistent support.

In addition to tailored clinical care, health boards may refer women and their families to an appropriate third sector organisation, such as the Miscarriage Association, Held In Our Hearts, or the organisation that Fulton MacGregor mentioned, which offers counselling and advice to women and their partners following early pregnancy loss.

In recognition of the need for women and their families to receive consistent, high-quality and sensitive bereavement care, the Scottish Government is continuing to fund and support Sands UK to develop national bereavement care pathways for pregnancy and baby loss in Scotland. The pathways provide advice and best practice on bereavement care for five different types of baby loss, including miscarriage, and will improve the quality of, and reduce the inequality in, bereavement care that is provided to parents and families who suffer a loss, building on the good practice that is already in place across health boards.

In developing the pathways, Sands UK has worked collaboratively with other baby loss charities, including the Miscarriage Association, Bliss, Antenatal Results and Choices, Held In Our Hearts and many others; the royal colleges, including the Royal College of Midwives; the Scottish Early Pregnancy Network; bereaved parents; and many professionals in health boards.

Five health boards—NHS Ayrshire and Arran, NHS Fife, NHS Dumfries and Galloway, NHS Grampian and NHS Lothian—began working with the pathways in March this year as early adopter boards. I am delighted that the Scottish Government will continue to fund further work on the pathways, expertly led by Sands UK, for at least the next 18 months. I thank Sands UK and all the partners that are involved in this groundbreaking, much-needed and valuable work to ensure that bereaved parents get the bereavement care and support that they need.

We have also set up a working group, which is chaired jointly by the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists, to consider the possibility of providing a non-statutory, voluntary certificate for loss occurring before the 24th week of pregnancy, which is an issue that many parents have said is important to them. That work had been progressing well, but it was paused due to Covid-19. We look forward to it continuing.

We recognise the significant and long-standing contribution of the Scottish Early Pregnancy Network, which was set up in 2003 by a group of professionals working in early pregnancy. Its members regularly contribute to national audits, Government consultations and the development of high-quality patient information leaflets. The network provides expert input to the production of the miscarriage, ectopic and molar pregnancy national bereavement care pathway and the working group that is developing a certificate for baby loss occurring prior to 24 weeks.

Beatrice Wishart talked about perinatal mental health. We all know that mental health during pregnancy and after birth is hugely important. That is why the Scottish Government has committed £50 million over the next four years to improve mental health services for women and their families during that period. Miscarriage, pregnancy complications and loss can be devastating for families, as Shona Robison outlined, and there can be many additional challenges around mental health following those traumatic experiences. It is key that women and men who experience loss and trauma receive the right mental health support, if needed, and that the support is on-going and available during future pregnancies.

As part of the £50 million investment, the perinatal and infant mental health programme board was established to oversee implementation and improvement of services. That includes psychological support for families using maternity and neonatal services.

Once again, I thank Shona Robison for bringing this important debate to the chamber. As I said, it could not have come at a better time, as it coincides with baby loss awareness week, which runs from 9 October, and the series of four research papers on miscarriage that are soon to be published by The Lancet. I will consider the contents of the research papers, and any recommendations that are made, alongside the aims of the important campaign that we have been hearing about today.

I thank all members who have participated in the debate. I have listened carefully to what they have said, particularly to those who were brave enough to talk about their personal experiences. I look forward to receiving the letter from, and the thoughts of ,the cross-party group. I hope that I have reassured the Parliament that the Scottish Government and I are firmly committed to providing the right support at the right time to women and their families who have sadly experienced a loss. I look forward to reading and considering the research papers from The Lancet when they are published, and to continuing to work with Shona Robison, the cross-party group and others on the important campaign.

That concludes the debate. I thank all members for their contributions, which were extremely interesting.

Meeting closed at 17:32.