"EPAS - MVA Procedure, experience and suggestions"

I arrived at EPAS to have an MVA procedure carried out on a Monday early February 2025. (To date I have had four miscarriages and have already had the MVA procedure to manage a previous miscarriage in June of 2023).

On arrival to EPAS myself and my husband were asked to sit in the main waiting area with other pregnant individuals/couples who were waiting on scans. My husband did raise this with our appointed midwife who was very apologetic and stated that the receptionist was providing holiday cover and hadn't been made aware that we shouldn't have been asked to wait there.

Once we were called for our appointment we were taken along the corridor to a staff/patient sitting room. The room had tea/coffee making facilities, a TV and four chairs, two of which were side by side with a buzzer each and a surgical curtain above them which would split them apart. The midwife explained to us that there was a trial on-going to treat an MVA as a more general 'day surgery'. This would mean that instead of having our own treatment room for the duration of our stay (as we did last time) that we would be expected to stay in this room up until an anaesthetist was ready for us in the treatment room (so we would sign our paperwork and I would take the medication required in this area).

The midwife asked our thoughts and myself and my husband stated we were not comfortable with this and that we thought it was a terrible idea. I asked the midwife what the reasoning was behind this and she explained that it was due to the lack of space within the hospital and that it would allow for more than one procedure to be done at the same time by the anaesthetist. The midwife kindly allowed us through to the treatment room since we were the only people having this procedure done at this specific time, however had that not been the case we potentially would have spent several hours sitting in a patient/staff room alongside someone else preparing for the same procedure and despite there being a surgical curtain we felt that this was highly inappropriate for several reasons:

1. There wasn't enough privacy to have a conversation without being overheard whether that be between myself and my husband or the midwife and myself.

2. Members of staff/public would have potentially been using the tea/coffee facilities whilst we were sat there.

3. The last time I had this procedure I started bleeding before the anaesthetist had arrived, it would be undignified to have a patient vaginally bleeding in a common area with no bathroom in the same room

Overall, I feel like this new trial is not only incredibly undignified, it made us both feel like our loss wasn't very important within a space where it should have been fully recognised. I fully appreciate for staff this is something 'normal', in terms of it being something they deal with everyday but for us (again) it was one of the worst day's of our lives and to have what we were going through, 'generalised' to suit the demands/space within the hospital felt very unfair.

I was also very disappointed to not receive a Simba memory box upon leaving the hospital, especially as I am aware that this contains information regarding the local support group. I think regardless of whether someone is given a memory box that contains support information, this should also be verbalised at the time. At no point throughout being in the hospital was I made aware verbally of any support, nor asked if I needed any.

I would like to add that the staff/midwives could not have been anymore compassionate/caring. The midwife who was appointed to us for the procedure remembered us from last time and was incredibly supportive. The midwife who spoke to us after our scan at the end of January that confirmed our baby had no heartbeat also made a point of coming to check on us the day we had the MVA which I thought was very kind too.

I want to bring this to the attention of the hospital to see if changes can be made to make this process better, I think that:

•Receptionists providing holiday cover need to be briefed on patients coming in who have lost their baby

•I personally believe that the new MVA out-patient process is inappropriate and that potentially asking bereaved parents for their feedback before this was rolled out would have been more appropriate than testing it out on patients who are actually experiencing a loss.

•The simba box could possibly be included on a discharge list (if this is something that exists) to make sure everyone is offered one.

•I think that support should be verbalised and patients made more aware of what is available.

I would appreciate the opportunity to be able to discuss this with someone further in person.