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Bleeding in early pregnancy - Buckinghamshire Healthcare NHS Trust

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This leaflet is to help you understand what may be causing bleeding in early pregnancy.

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Buckinghamshire Healthcare NHS Trust - Birth Choices Website

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Bereavement support - Buckinghamshire Healthcare NHS Trust - Birth Choices Website

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Sadly, sometimes pregnancy does not go to plan. You may have experienced a miscarriage, ectopic pregnancy, termination or the death of your baby. We want to extend our sympathy to […]

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The aim of this padlet is to help guide patients to useful information resources.

Please note that BHT is not responsible for the information and links from outside organisations

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You have been given an appointment to attend the Early Pregnancy Unit. This is normally because you had bleeding or pain in early pregnancy or because you have had complications in the past.

What will happen at the appointment?

When you arrive, please complete the form given to you at the Reception desk. Please check your personal details and add any relevant medical information. Please ask if you need help filling in the form.

The clinic has timed appointments. At times emergency patients will take priority and you may have to wait a little longer for your scan.

A urine sample will be taken to check a pregnancy test. The scan will be performed by a sonographer or consultant gynaecologist.

Do I need a full bladder?

You do not need a full bladder. In most cases the scan will be performed transvaginally (internally).

Why do I need an internal scan?

In the first few weeks of pregnancy, the uterus (womb) is still within the pelvis and it is easier to see a pregnancy and other pelvic structures with an internal scan. The ultrasound probe is inserted into the vagina.

After 9 weeks of pregnancy you will usually have a transabdominal scan with the probe being placed externally on the skin of the lower tummy (abdomen). You may also still require an internal scan, particularly if you have presented with pain or heavy bleeding.

Both ways of scanning are safe and will not increase the risk of a miscarriage. If further information is required we will advise you to have a repeat scan 7-14 days later.

Do I have to have an internal scan?

No. If you do not want to have the internal scan we can still do an external scan. You need to be aware that this will not provide as much information. For an abdominal scan we would advise you not to empty your bladder. Please ask the sonographer/consultant about your choices.

Following the scan the nurse will discuss the scan findings and the next steps in your care.

Blood tests

You may need to have blood tests to check hormone levels and possibly your blood group.

At all times we will talk to you about the findings of the scans and any blood tests that you may have a further scan or blood tests may be recommended at a later stage.

Patient experience survey

If you are happy to give us comments on your visit to the clinic, please write your e-mail address on the form at the Reception Desk so that we can contact you. If you do not wish to be contacted, that is fine too, it will not affect your care in any way. Anything you write will be completely anonymous and help us to improve our service.

Contact numbers:

If you want to ask any further questions please telephone:
Early Pregnancy Unit (Monday-Friday)
Stoke Mandeville Hospital 01296 316469/316143 (8am-5pm hours)

SAU (Surgical Assessment Unit) 01296 316500/316365 (at all other times)

Please Note:

If you have any side-effects or want to ask anything else about your treatment, please contact the Early Pregnancy Unit on the above numbers.

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Early pregnancy unit - Buckinghamshire Healthcare NHS Trust

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You have been given an appointment to attend the Early Pregnancy Unit. This is normally because you had bleeding or pain in early pregnancy or because you have had complications [...]

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Find out what food and drink you can have and what you should avoid or be careful with during pregnancy, such as some cheeses, meats, fish, eggs, nuts, caffeine and alcohol.

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Your rights at work while you're pregnant

If you're working while you're pregnant, you need to know your rights to antenatal care, maternity leave and benefits.

If you have any worries about your health while at work, talk to your doctor, midwife or occupational health nurse.

You can also talk to your employer, union representative, or someone in the personnel department (HR) where you work.

Once you tell your employer that you're pregnant, they should do a risk assessment with you to see if your job poses any risks to you or your baby.

If there are any risks, they have to make reasonable adjustments to remove them. This can include changing your working hours.

If you work with chemicals, lead or X-rays, or in a job with a lot of lifting, it may be illegal for you to continue to work.

In this case, your employer must offer you alternative work on the same terms and conditions as your original job.

If there's no safe alternative, your employer should suspend you on full pay (give you paid leave) for as long as necessary to avoid the risk.

If your employer fails to pay you during your suspension, you can bring a claim in an employment tribunal (within 3 months). This wouldn't affect your maternity pay or maternity leave. The GOV.UK website has more information about maternity pay and leave.

You may worry about using computer screens in pregnancy. But the most recent research shows no evidence of a risk to your baby or pregnancy from visual display units (VDUs) on computers.

GOV.UK, Citizens Advice and Maternity Action have more information on pregnant employees' rights, including your right to paid time off for antenatal care and what to do if you feel you're being treated unfairly.

Coping with pregnancy symptoms at work

You might get more tired than usual, particularly in the first and last few weeks of pregnancy.

Try to use your lunch break to eat and rest. If travelling in rush hour is exhausting, ask your employer if you can work slightly different hours for a while.

Don't rush home and start another job cleaning and cooking. If possible, ask your friend, partner or a member of your family to help you.

Read more about tiredness in pregnancy.

If you're struggling with nausea and vomiting (morning sickness), you might be finding it hard at work.

You can ask your employer about working slightly different hours to avoid times when you feel worse, or working from home on days when the morning sickness is bad.

Speak to a GP or midwife if you feel particularly bad or unwell.

Read more about vomiting and morning sickness.

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Find out how to stay safe and healthy at work during pregnancy, and when you need to take extra precautions.

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It's perfectly safe to have sex during pregnancy unless your doctor or midwife has told you not to.

Having sex will not hurt your baby. A penis or penetrative sex toy cannot penetrate beyond your vagina, and the baby cannot tell what's going on.

However, it's normal for your sex drive to change during pregnancy. This isn't something to worry about, but it's helpful to talk about it with your sexual partner.

You may find having sex very enjoyable during pregnancy, or simply feel you don't want to. You can find other ways of being loving or making love. The most important thing is to talk about your feelings with your partner.

If your pregnancy is normal and you have no complications, having sex and orgasms won't increase your risk of going into labour early or cause a miscarriage.

Later in pregnancy, an orgasm or even sex itself can set off mild contractions. If this happens, you'll feel the muscles of your womb go hard. These are known as Braxton Hicks contractions and can be uncomfortable, but they're perfectly normal and there's no need for alarm. You might want to try some relaxation techniques or just lie down until the contractions pass.

When to avoid sex in pregnancy

Your midwife or doctor will probably advise you to avoid sex if you've had any heavy bleeding in this pregnancy. Sex may increase the risk of further bleeding if the placenta is low or there's a collection of blood (haematoma).

You'll also be advised to avoid sex if:

your waters have broken - it can increase the risk of infection (ask your midwife or doctor if you're not sure whether your waters have broken)

there are any problems with the entrance to your womb (cervix) - you may be at a higher risk of going into early labour or having a miscarriage

you're having twins, or have previously had early labours, and are in the later stages of pregnancy

If you or your sexual partner are having sex with other people during your pregnancy, it's important you use a barrier form of contraception, such as a condom, to protect you and your baby from sexually transmitted infections (STIs).

Good and bad sex positions during pregnancy

While sex is safe for most couples in pregnancy, it may not be all that easy. You will probably need to find different positions. This can be a time to explore and experiment together.

Sex with your partner on top can become uncomfortable quite early in pregnancy, not just because of the bump, but because your breasts might be tender. It can also be uncomfortable if your partner penetrates you too deeply.

It may be better to lie on your sides, either facing each other or with your partner behind. You may also want to try being on top during sex or being penetrated from behind while on your hands and knees. Use pillows to make yourself comfortable.

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Video: Sex during pregnancy

This video explores the myths surrounding sex during pregnancy.

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Find out about having sex safely in pregnancy, including positions that can be more comfortable and when you should avoid sex. With video.

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Bleeding and/or pain in early pregnancy | RCOG

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Buckinghamshire Healthcare NHS Trust - Birth Choices Website

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Blessing

A blessing can take place by the Hospital Chaplain or a Minister known to you. This blessing can occur either with or without you being present. A blessing card can be given to you if you would like it. It will not be possible to determine the sex of the baby, but you may name your baby if you wish to.

Book of Remembrance

You may like to enter your baby's name in the hospital chapel 'Baby Book of Remembrance' or you may wish to write your own thoughts or a special poem in this book. Please speak to a Chaplain or Bereavement Officer about what you would like to enter into the book.

Remembrance Service

An annual Baby Remembrance Service is held in a local church in October. Please contact the Bereavement Office for further information.

Funeral Arrangements

There are a number of options available to you for your baby's funeral, which the Bereavement Officer, Chaplain, Midwives or Nurses will be happy to discuss with you. The Bereavement Officer can also help you to find a Funeral Director in your area.

The hospital can organise the burial of your baby within Aylesbury Cemetery. This is a private ceremony which you are unable to attend. There is a dedicated SANDS memorial stone within the Cemetery if you wish to visit.

If you would like to arrange your own private funeral the Bereavement Office will be able to support you with this.

Having sex and trying for another baby

You should avoid having sex until all of your symptoms have gone. Your periods should return within six to eight weeks, although it may take several months to settle into a regular cycle.

If you don't want to get pregnant you should use contraception immediately. If you do want to get pregnant again, you may want to discuss it with your GP or hospital care team. Make sure you are feeling physically and emotionally well before trying for another pregnancy.

Please Note:

This leaflet explains some of the most common side-effects that some people may experience. However, it is not comprehensive. If you experience other side-effects and want to ask anything else related to your treatment please speak to the Bereavement nurse on 07584 591182.

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Following the loss of your baby - Buckinghamshire Healthcare NHS Trust - Birth Choices Website

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We wish to extend our sympathy to you and offer you our support at this difficult time. We hope this information will offer you help and guidance in your time [...]

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Buckinghamshire Healthcare NHS Trust - Birth Choices Website

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Following the loss of your baby - late miscarriage - Buckinghamshire Healthcare NHS Trust - Birth Choices Website

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We wish to extend our sympathy to you following the loss of your baby. We hope the information in this booklet will offer you help and guidance in your time […]

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Medical termination for fetal abnormality

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Medical termination for fetal abnormality

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Buckinghamshire Healthcare NHS Trust - Birth Choices Website

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Grief may produce physical symptoms, for example disturbed sleep, lack of appetite, nausea or palpitations. These are all normal reactions and may be eased by sharing your feelings and experiences with professionals, family and friends.

Grief throws our lives out of balance and there are bound to be good days and bad days. Try not to panic-all this is normal. Take time to think through any decisions, as major changes at this time could be unsettling.

What to bring into hospital

Your stay may be a few days, so bring enough clothing, nightwear and toiletries for this time. There may be a television and music system; you are welcome to bring CDs/ DVDs. You may like to choose something for your baby to wear; if your baby will be very small, we can give you an outfit and blanket.

Induction for Delivery

At your stage of pregnancy, we feel it is safer to make the uterus (womb) contract to deliver your baby rather than using a surgical method, which might damage the cervix (neck of the uterus) or the uterus itself. We know it is a very difficult time and throughout the procedure your husband, partner or friend can be with you on the ward. You will receive a lot of support from the staff and plenty of pain relief when and if required.

Two days prior to the induction, you will be given a tablet called Mifepristone, which is an anti-progesterone tablet. This allows the uterus to become more sensitive to the later medications we use. After being given the tablet you will go home but will be asked to return if you are unwell. You will be admitted for the induction process two days later.

Occasionally the tablet may cause some bleeding or even contraction pains (similar to strong period pains) and if this occurs you should ring Ward 16B at Stoke Mandeville Hospital on 01296 418110 and we will possibly admit you sooner.

More commonly you may experience some milder pain and in this case you could stay at home and use Paracetamol for pain relief. It is advised that you do not use Aspirin or the Ibuprofen -type of tablets as they may interfere with the medication.

When you return to the ward two days later, Prostaglandin tablets will be inserted into the vagina by the staff caring for you. These tablets are given to start the uterus contracting. After that you will be given regular medication until delivery. The time interval until delivery can be very variable-usually later in the evening but very occasionally it may take longer. You should plan to stay overnight in case this is necessary. Facilities will be available for your partner to stay with you overnight if required. You will be given plenty of pain relief, usually by injection, although some women may require an epidural anaesthetic (an injection of spinal anaesthetic which is given into the lower back). If you are being cared for on Ward 16B and require an epidural, you would be transferred to the Labour Ward at this time.

At the time of delivery the placenta (afterbirth) may come away on its own but occasionally it may be necessary to take you to theatre to have this removed under a general anaesthetic.
The amount of blood loss at the time of delivery is variable and on rare occasions may be quite heavy necessitating a blood transfusion.

If your blood group is Rhesus negative, an injection of Anti-D will be given to you following delivery.

You may go home once you are feeling well and the timing of this will depend on whether you needed to have a general anaesthetic, and your physical condition. The nursing/ midwifery staff will keep you informed at all times.

Seeing and Holding your Baby

You may be anxious about seeing your baby, but most parents are pleased to have this precious memory. You will be offered the opportunity to see and hold your baby if you would like to do so. It is possible to take your baby home; if you would like to do this please ask staff caring for you.

Photographs and Mementoes

We take photographs of your baby for you. These photographs are taken with a digital camera and will be available immediately. If at this time you do not wish to have the photographs, they are then kept in your notes for up to 25 years in case you change your mind. The photographs will be scanned into your electronic notes and can be made available to you at a later date. You can also take your own photographs.

It may be possible to provide hand and footprints if you would like them. You may also like to keep your baby's identity bands-please ask.

Naming your Baby

It may not always be possible to identify the sex of your baby at the time of the birth. Therefore it may be advisable to choose a name that is suitable for either a boy or a girl.

Blessing your Baby

Your baby can be named and blessed by the Hospital Chaplain or a Minister known to you. This blessing can occur either with or without you being present. A blessing card will then be given to you.

Book of Remembrance and Remembrance Service

You may like to enter your baby's name in the hospital chapel 'Baby Book of Remembrance' which is situated in the Prayer Room. You may wish to write your own thoughts or a special poem in this book. Please speak to a Chaplain or a Bereavement Officer about what you would like to enter.

An annual Baby Remembrance Service is held, normally in October. You will receive an invitation for this.

Arrangements for your Baby's Funeral

There are a number of options available to you for your baby's funeral, which the Bereavement Officer, Chaplain, Midwives or Nurses will be happy to discuss with you. The Bereavement Officer can also help you to find a Funeral Director in your area. If you have met one of the Chaplains during your stay they may be able to carry out the funeral for you. We can also help you find a funeral celebrant if you prefer.

The Post Mortem (PM) Examination

This can be performed from 15 weeks gestation and may give you or the doctors reasons why your baby died; over half of PMs give some useful information. They may also then be able to tell you whether the same problem is likely to affect any pregnancy you may have in the future. If no cause is found this usually means future pregnancies have a good chance of success.

If you choose to have this examination, it would be performed by a specialist Paediatric Pathologist at the John Radcliffe Hospital, Oxford and you will be given the results at your follow -up appointment.

Follow-up care

The hospital staff will answer any immediate questions you may have, but it is difficult to think of everything at this time. You may have a visit from your Community Midwife, but this will be discussed with you prior to discharge.

An appointment will be made for you to see your Consultant 8-10 weeks later. It is important that you ask any questions you like-it may help to make a note of them beforehand so that you do not forget anything. At this appointment you will be able to discuss the results of any investigations that have been carried out and any implications they may have for future pregnancies. This appointment may or may not include a physical examination.

Aftercare

You are advised to see your GP after discharge. Bleeding may continue for 2-4 weeks and sometimes may be quite heavy, although some women continue with a light loss until their next period. You are advised to wear sanitary towels, not tampons, to assess blood loss and prevent infection. You are advised not to resume sexual intercourse until the bleeding has stopped.

It is important that you contact your GP if you experience any of the following:

Prolonged heavy bleeding with clots

Vaginal discharge that looks or smells offensive

Rise in temperature

Pain when passing urine.

You may start to produce milk about 3 days after delivery. This can obviously be very distressing for you and medication is available to stop this process occurring if you wish. You may also want to take a mild painkiller such as Paracetamol. You will be more comfortable if you wear a well fitting bra until the process is finished. You can also buy breast pads to soak up any leaking milk.

You may have already been introduced to the Bereavement Support Midwife, who will be available for guidance and support after your discharge from Hospital.

Financial help

You may be entitled to maternity leave or benefits; please see moneyadviceservice.org.uk. Returning to work is an individual choice depending on your emotional and physical wellbeing; be guided by professionals, family and friends.

Having sex and trying for another baby

You should avoid having sex until all of your symptoms have gone. Your periods should return within six to eight weeks, although it may take several months to settle into a regular cycle.

If you don't want to get pregnant you should use contraception immediately. If you do want to get pregnant again, you may want to discuss it with your GP or hospital care team. Make sure you are feeling physically and emotionally well before trying for another pregnancy.

Please Note:

This leaflet explains some of the most common side-effects that some women may experience. However, it is not comprehensive. If you experience other side-effects and want to ask anything else related to your treatment please speak to Ward 16B on 01296 418110 or the Bereavement Support Midwife.

Useful Contact Numbers

Bereavement Office
Stoke Mandeville Hospital 01296 316646

Chaplaincy Department
Stoke Mandeville Hospital 01296 316675
Wycombe Hospital 01494 425072

Bereavement Support Midwife
077 1712 7740.
Please leave a message and your call will be returned.

Consultants' Secretaries

Stoke Mandeville Hospital
01296 315000 and ask for the Obstetric & Gynaecology Secretaries

Wycombe Hospital
01494 526161 and ask for the Obstetric & Gynaecology Secretaries

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Following the loss of your baby - medical termination for fetal abnormality - Buckinghamshire Healthcare NHS Trust - Birth Choices Website

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We wish to extend our sympathy to you and offer you our support at this difficult time. We hope this information will offer you help and guidance in your time [...]

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Buckinghamshire Healthcare NHS Trust - Birth Choices Website

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We wish to extend our sympathy to you and offer you our support at this difficult time.

We hope this information will offer you help and guidance in your time of need.

If you need any help, please do not hesitate to ask any member of staff involved in your care.

Feelings

Losing a baby is an experience that many will share, but we all react differently. For some, expressions of grief will be overwhelming and public. For others they may be very private, but no less deeply felt. Partners, family and friends may all find it difficult to show their emotions. Many of us need to share our emotions in order to be able to cope with them. These feelings are real and painful, but they are also acceptable and understandable.

Grief throws our lives out of balance and there are bound to be good days and bad days. Try not to panic-all this is normal. Take time to think through any decisions, as major changes at this time could be unsettling.

Grief may produce physical symptoms, for example disturbed sleep, lack of appetite, nausea or palpitations. These are all normal reactions and may be eased by sharing your feelings and experiences with professionals, family and friends.

Causes of Late Miscarriage

About 1 in 5 pregnancies end before 24 weeks, although most miscarriages happen in the first 13 weeks. It is less usual to miscarry between 14 and 24 weeks, although some of the causes may be the same.

The pregnancy may have been abnormal in some way. Abnormalities include problems with the baby's chromosomes, which may cause a genetic problem. It may be possible to test for a specific gene, if it is known. Sometimes abnormal genes can cause fatal conditions.

Structural abnormalities of the baby, such as heart defects, or anatomical problems of the mother can also cause miscarriage. Infections can either directly affect the baby, or infection in the amniotic fluid surrounding the baby.

Spontaneous Miscarriage

This is where the miscarriage has occurred naturally. Most women feel uncomfortable or have labour pains and the waters may break. It can happen quickly, the neck of the womb dilating too fast to stop the miscarriage happening. The placenta may not always deliver spontaneously and may require removal under an anaesthetic.

What to bring into Hospital

Your stay may be a few days, so bring enough clothing, nightwear and toiletries for this time. There may be a television and music system; you are welcome to bring CDs. You may like to choose something for your baby to wear; if your baby will be very small, we can give you an outfit and blanket.

Inducing Labour

At your stage of pregnancy, we feel it is safer to make the uterus (womb) contract to deliver your baby rather than using a surgical method, which might damage the cervix (neck of the uterus) or the uterus itself. We know it is a very difficult time and throughout the procedure your husband, partner or friend can be with you on the ward. You will receive a lot of support from the staff and plenty of pain relief when and if required.

Two days prior to the induction, you will be given a tablet called Mifepristone, which is an anti-progesterone tablet. This allows the uterus to become more sensitive to the later medications we use. After being given the tablet you will go home but will be asked to return if you are unwell. You will be admitted for the induction process two days later. Occasionally the tablet may cause some bleeding or even contraction pains (similar to strong period pains) and if this occurs you should ring Ward 16B at Stoke Mandeville Hospital on 01296 3418111 and we may admit you sooner. More commonly you may experience some milder pain and in this case you could stay at home and use Paracetamol for pain relief. It is advised that you do not use Aspirin or the Ibuprofen-type of tablets as they may interfere with the medication.

When you return to the ward two days later, Prostaglandin tablets will be inserted into the vagina by the staff caring for you. These tablets are given to start the uterus contracting. After that you will be given medication to take by mouth every 3 hours until the contractions become more regular. The time interval until delivery can be very variable-usually later in the evening but very occasionally it may take longer. You should plan to stay overnight in case this is necessary. Facilities will be available for your partner to stay with you overnight if required. You will be given plenty of pain relief and anti sickness medication, usually by injection.

At the time of delivery the placenta (afterbirth) may come away on its own but occasionally it may be necessary to take you to theatre to have this removed under a general anaesthetic.
The amount of blood loss at the time of delivery is variable and on rare occasions may be quite heavy necessitating a blood transfusion.

If you blood group is Rhesus negative, an injection of Anti-D will be given to you following delivery.

You may go home once you are feeling well and the timing of this will depend on whether you needed to have a general anaesthetic and your physical condition. The staff will keep you informed at all times.

Seeing your Baby

You may be anxious about seeing your baby, but most parents are pleased to have this precious memory. You will be offered the opportunity to see and hold your baby if you would like to do so. It is possible to take your baby home; if you would like to do this please ask the nurse or midwife caring for you.

Photographs and Mementoes

We take photographs of your baby, if possible. These photographs are taken with a digital camera and will be available immediately. If at this time you do not wish to have the photographs, they are then kept in your notes for up to 25 years in case you change your mind. You can also take your own photographs.

It may be possible to provide hand and footprints if you would like them.

Naming your Baby

It is rarely possible to identify the sex of your baby at the time of the birth. Therefore it may be advisable to choose a name that is suitable for either a boy or a girl.

Blessing your Baby

Your baby can be named and blessed by the Hospital Chaplain or a minister known to you. This blessing can occur either with or without you being present. A blessing card will then be given to you.

Book of Remembrance and Remembrance Service

You may like to enter your baby's name in the hospital chapel 'Baby Book of Remembrance' which is situated in the Prayer Room. You may wish to write your own thoughts or a special poem in this book. Please speak to a Chaplain or a Bereavement Officer about what you would like to enter.

An annual Baby Remembrance Service is held, normally in October. You will receive an invitation for this.

Blood Tests

You may be offered a variety of blood tests which may help to determine why your baby has died. These will usually be carried out before the baby is delivered but can be carried out later if circumstances make this more acceptable to you. Please ask the staff for more information regarding these tests.

The Post Mortem (PM) Examination

This can be performed from 15 weeks gestation and may give you or the doctors reasons why your baby died; over half of PMs give some useful information. They may also then be able to tell you whether the same problem is likely to affect any pregnancy you may have in the future. If no cause is found this usually means future pregnancies have a good chance of success.

If you choose to have this examination, it would be performed by a specialist Paediatric Pathologist at the John Radcliffe Hospital, Oxford and you will be given the results at your follow -up appointment.

Arrangements for your Baby's Funeral

There are a number of options available to you for your baby's funeral, which the Bereavement Officer, Chaplain, Midwives or Nurses will be happy to discuss with you. The Bereavement Officer can also help you to find a Funeral Director in your area. If you have met one of the Chaplains during your stay they may be able to carry out the funeral for you. We can also help you find a funeral celebrant if you prefer.

Follow-up care

The hospital staff will answer any immediate questions you may have, but it is difficult to think of everything at this time.

You may have a visit from your Community Midwife, but this will be discussed with you prior to discharge.

An appointment will be made for you to see your Consultant 8-10 weeks after the birth. It is important that you ask any questions that you like-it may help to make a note of them beforehand so that you do not forget anything. At this appointment you will be able to discuss the results of any investigations that have been carried out and any implications it may have for future pregnancies.

This appointment may or may not include a physical examination.

After care

You are advised to see your GP after discharge. Bleeding may continue for 2-4 weeks and sometimes may be quite heavy, although some women continue with a light loss until their next period. You are advised to use sanitary towels rather than tampons to assess bleeding and reduce infection. You are advised not to resume sexual intercourse until the bleeding has stopped.

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Following the loss of your baby - miscarriage before 20 weeks of pregnancy - Buckinghamshire Healthcare NHS Trust - Birth Choices Website

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We wish to extend our sympathy to you and offer you our support at this difficult time. We hope this information will offer you help and guidance in your time [...]

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Black women in the UK are four times more likely to die in pregnancy and childbirth than white women, and Asian and mixed-race women are twice as likely.

Download our report Systemic Racism, Not Broken Bodies, the evidence from our year-long inquiry into racial injustice in maternity care.

What are my human rights in pregnancy and childbirth?

Do I have the right to a home birth? How do I make a complaint? Can I choose my midwife or doctor? Our factsheets cover everything you need to know about your basic human rights in pregnancy and childbirth.

If you are thinking about pregnancy, are pregnant or have recently given birth and need further information or advice, our team is here to help you.

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Birthrights - your human rights during pregnancy and maternity care

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✓ Information and advice during pregnancy & childbirth ✓ Factsheets ✓ Translated pregnancy factsheets ✓ Maternal requests for caesareans ✓ Homebirths ✓ Training for healthcare professionals, doulas and childbirth educators ✓ Campaigning for change ✓ Your human rights during pregnancy and childbirth

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A miscarriage is legally defined as the loss of a baby during the first 24 weeks. Going through a miscarriage can be extremely difficult. We’re here to answer your questions and support you as best as we can. Some people who experience a late miscarriage may feel that our information about stillbirth is more helpful.

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Sands - Saving babies' lives. Supporting bereaved families.

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Sands supports anyone who has been affected by the death of a baby before, during or shortly after birth. Bereavement support is at the core of everything we do.

Sands is here to help you choose the right support for you. Some of the services that we offer include a Helpline for parents, families, carers and health professionals; a UK-wide network of support groups with trained befrienders; an online Facebook support group; a Sands online message board enabling bereaved families to connect with others and a wide range of leaflets, books and other resources available online and in print.

Although we don't offer counselling, our Helpline can help you find what is available in your area and help you request a referral from your GP.

Our free to call Helpline

The Sands National Helpline provides a safe, confidential place for anyone who has been affected by the death of a baby. Whether your baby died long ago or recently, we are here for you.

The telephone helpline is free to call from landlines and mobiles on 0808 164 3332.
Helpline calls are answered by trained bereavement support staff. If counselling is needed we recommend you seek support via your GP who can help you with a referral to your local team.
Language interpreters can be accessed via Language Line. If you are ringing to request support for for a non-English speaker please ring our Helpline and our staff will be happy to help.

The helpline team can also be contacted at helpline@sands.org.uk
Find out about more about our Helpline here
In 2017-18

The Sands Bereavement Support app

The Sands Bereavement Support app was created for anyone who has experienced the death of a baby.

It aims to help bereaved parents and families to find the right information and support at the right time. The app can also be used by healthcare professionals, who would like to know how best to support bereaved parents and their families.
Find out more about the App and how you can download here
Our Sands Groups

Many parents feel that only others who have experienced the death of a baby can offer real understanding. Our countrywide network of over 104 local support Groups, usually run by bereaved parents and family members, offer you the chance to meet others, gain support and share your experience.

Most Sands Groups offer either regular support meetings, telephone support or email support.

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Support for you | Sands - Saving babies' lives. Supporting bereaved families.

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Sands supports anyone who has been affected by the death of a baby before, during or shortly after birth. Bereavement support is at the core of everything we do.

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Get the DadPad app!

Welcome to the DadPad app download page.

If you are using an Apple device, please click on the App Store button below.

If you are using an Android device, please click on the Google Play button.

Once you've downloaded the app onto your device, you will be prompted to enter your postcode. From here, you will be invited to select the most relevant app for your area, containing information on local services, support groups and hospitals.

Please note that the content can only be accessed in areas of the country with a current DadPad app licence.

If it is not available but you wish that it was, please get in touch to let us know! We are working on and launching the app in new areas all the time, to ensure that it is accessible to as many dads-to-be and new dads that need our help as possible. Please keep an eye on our social media pages (e.g. Twitter and Facebook) and News page, as well as your own local newspapers, radio and television, for details of each new DadPad area as it is launched.

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DadPad | DadPad app | Essential guide for new dads

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Welcome to the DadPad app download page. If you are using an Apple device, please click on the App Store button below. If you are using an Android device, please click on the Google Play button. Once you've downloaded the app onto your device, you will be prompted to enter your postcode.

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An ectopic pregnancy is when a fertilised egg implants itself outside of the womb, usually in one of the fallopian tubes.
The fallopian tubes are the tubes connecting the ovaries to the womb. If an egg gets stuck in them, it won't develop into a baby and your health may be at risk if the pregnancy continues.

Unfortunately, it's not possible to save the pregnancy. It usually has to be removed using medicine or an operation.

In the UK, around 1 in every 90 pregnancies is ectopic. This is around 11,000 pregnancies a year.

Symptoms of an ectopic pregnancy

An ectopic pregnancy doesn't always cause symptoms and may only be detected during a routine pregnancy scan.

If you do have symptoms, they tend to develop between the 4th and 12th week of pregnancy.

Symptoms can include a combination of:

But these symptoms aren't necessarily a sign of a serious problem. They can sometimes be caused by other problems, such as a stomach bug.

Read more about the symptoms of an ectopic pregnancy.

When to get medical advice

Contact your GP or call NHS 111 if you have a combination of any of the above symptoms and you might be pregnant - even if you haven't had a positive pregnancy test.

An ectopic pregnancy can be serious, so it's important to get advice right away.

Your GP will ask about your symptoms and you'll usually need to do a pregnancy test to determine if you could have an ectopic pregnancy.

You may be referred to a specialist early pregnancy clinic for further assessment, where an ultrasound scan and blood tests may be carried out to confirm the diagnosis.

Read more about ectopic pregnancy tests.

When to get emergency help

Call 999 for an ambulance or go to your nearest accident and emergency (A&E) department immediately if you experience a combination of:

a sharp, sudden and intense pain in your tummy

feeling very dizzy or fainting

feeling sick

looking very pale

These symptoms could mean that your fallopian tube has split open (ruptured). This is very serious and surgery to repair the fallopian tube needs to be carried out as soon as possible.

A rupture can be life threatening, but fortunately they're uncommon and treatable, if dealt with quickly. Deaths from ruptures are extremely rare in the UK.

How an ectopic pregnancy is treated

There are 3 main treatments for an ectopic pregnancy:

expectant management - you're carefully monitored and 1 of the treatments below is used if the fertilised egg doesn't dissolve by itself

medication - an injection of a powerful medicine called methotrexate is used to stop the pregnancy growing

surgery - keyhole surgery (laparoscopy) is performed under general anaesthetic to remove the fertilised egg, usually along with the affected fallopian tube

You'll be told about the benefits and risks of each option. In many cases, a particular treatment will be recommended based on your symptoms and the results of the tests you have.

Some treatments may reduce your chances of being able to conceive naturally in the future, although most women will still be able to get pregnant. Talk to your doctor about this.

Read more about treating an ectopic pregnancy.

Help and support after an ectopic pregnancy

Losing a pregnancy can be devastating, and many women feel the same sense of grief as if they had lost a family member or partner.

It's not uncommon for these feelings to last several months, although they usually improve with time. Make sure you give yourself and your partner time to grieve.

If you or your partner are struggling to come to terms with your loss, you may benefit from professional support or counselling. Speak to your GP about this.

Support groups for people who have been affected by loss of a pregnancy can also help.

These include:

Read more about dealing with loss and find bereavement support services in your area.

Trying for another baby

You may want to try for another baby when you and your partner feel physically and emotionally ready.

You'll probably be advised to wait until you've had at least 2 periods after treatment before trying again to allow yourself to recover.

If you were treated with methotrexate, it's usually recommended that you wait at least 3 months because the medicine could harm your baby if you become pregnant during this time.

Most women who have had an ectopic pregnancy will be able to get pregnant again, even if they've had a fallopian tube removed.

Overall, 65% of women achieve a successful pregnancy within 18 months of an ectopic pregnancy. Occasionally, it may be necessary to use fertility treatment such as IVF.

The chances of having another ectopic pregnancy are higher if you've had one before, but the risk is still small (around 10%).

If you do become pregnant again, it's a good idea to let your GP know as soon as possible so early scans can be carried out to check everything is OK.

What can cause an ectopic pregnancy?

In many cases, it's not clear why a woman has an ectopic pregnancy. Sometimes it happens when there's a problem with the fallopian tubes, such as them being narrow or blocked.

The following are all associated with an increased risk of ectopic pregnancy:

pelvic inflammatory disease (PID) - inflammation of the female reproductive system, usually caused by a sexually transmitted infection (STI)

previous ectopic pregnancy - the risk of having another ectopic pregnancy is around 10%

previous surgery on your fallopian tubes - such as an unsuccessful female sterilisation procedure

fertility treatment, such as IVF - taking medication to stimulate ovulation (the release of an egg) can increase the risk of ectopic pregnancy

becoming pregnant while using an intrauterine device (IUD) or intrauterine system (IUS) for contraception - it's rare to get pregnant while using these, but if you do you're more likely to have an ectopic pregnancy

smoking

increasing age - the risk is highest for pregnant women aged 35 to 40

You can't always prevent an ectopic pregnancy, but you can reduce your risk by using a condom when not trying for a baby to protect yourself against STIs, and by stopping smoking if you smoke.

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An ectopic pregnancy is when a fertilised egg implants itself outside of the womb, usually in one of the fallopian tubes. The fallopian tubes are the tubes connecting the ovaries to the womb. If an egg gets stuck in them, it won't develop into a baby and your health may be at risk if the pregnancy continues.

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Shared Decision Making

If you are asked to make a choice, you may have lots of questions that you want to ask. You may also want to talk over your options with your family or friends. It can help to write a list of the questions you want answered and take it to your appointment.

Ask 3 Questions

To begin with, try to make sure you get the answers to 3 key questions, if you are asked to make a choice about your healthcare:

1. What are my options?

2. What are the pros and cons of each option for me?

3. How do I get support to help me make a decision that is right for me?

*Ask 3 Questions is based on Shepherd et al. Three questions that patients can ask to improve the quality of information physicians give about treatment options: A cross-over trial. Patient Education and Counselling, 2011;84:379-85

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This patient information leaflet provides information about the effects of smoking during pregnancy and support available to help you to stop.

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9828 MA preg loss (miscarriageassociation.org.uk)

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This information is for you if you want to know more about nausea and vomiting of pregnancy or about hyperemesis gravidarum, which is the most severe form of the condition. It may also be helpful if you are a relative or friend of someone who is in this situation.

The information here aims to help you better understand your health and your options for treatment and care. Your healthcare team is there to support you in making decisions that are right for you. They can help by discussing your situation with you and answering your questions.

Within this information we may use the terms 'woman' and 'women'. However, we know that it is not only people who identify as women who may want to access this information. Your care should be appropriate, inclusive and sensitive to your needs whatever your gender identity.

A glossary of all medical terms is available.

Key points

Nausea and vomiting of pregnancy is a common condition that settles by 20 weeks in 9 out of 10 pregnant women.

Hyperemesis gravidarum is a severe form of this condition and can affect up to 3 in 100 pregnant women.

Nausea and vomiting and hyperemesis gravidarum can affect your mood, your work, your home and your social life.

While most women can be treated at home or as outpatients in hospitals, 1 in 5 affected women may need admission to hospital for treatment.

Several different anti-sickness medicines are available that may help your symptoms. While some of these medicines may not be licensed for use in pregnancy, they are considered safe for you and your baby.

Sources and acknowledgements

This information has been developed by the RCOG Patient Information Committee. It is based on the RCOG Green-top Clinical Guideline The Management of Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum.

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Pregnancy sickness (nausea and vomiting of pregnancy and hyperemesis gravidarum) | RCOG

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This patient information leaflet provides advice for women on pregnancy sickness.

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Our small yet tenacious team, backed by heartfelt donations and committed supporters, drives vital research and advocacy to tackle these conditions.

Our goal is simple yet profound: to expand our reach, offering hope and delivering expert support.

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Our small yet tenacious team, backed by heartfelt donations and committed supporters, drives vital research and advocacy to tackle these conditions. Our goal is simple yet profound: to expand our reach, offering hope and delivering expert support.

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How to apply for a Baby Loss Certificate following the loss of a pregnancy before 24 weeks.

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Aching Arms - the charity bringing comfort after baby loss

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The charity Aching Arms is here to support and help you if you've suffered the loss of a baby during pregnancy, at birth or soon after.

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Saying Goodbye - support for miscarriage and baby and infant loss

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Coping after miscarriage | Relate