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A few weeks ago, I had the privilege to attend a funeral for babies lost to miscarriage. Perhaps this doesn\u2019t sound like an event that would prompt gratitude, but I found it to be an incredible gift. It was a gift to grieve alongside my friend who had lost her baby and to have a place for our grief. It was a gift to hear words of consolation and hope paired with the validation that loss is a difficult journey. It is a gift to have somewhere to go when we miss these little ones and to be able to visit them alongside our other departed family and friends. It was also a gift to see miscarriage validated for what it is: the loss of a child<\/a>. <\/p>\n\n\n\n Medical professionals, who are often one of the few people to know about a miscarriage, regularly fail to offer answers or sympathy for this loss, and often refuse to investigate an underlying cause unless a woman has experienced three or more miscarriages. However, as reported by Sky News<\/a>, Tommy’s (a UK-based pregnancy and baby charity) is challenging the status quo in regards to miscarriage with a new study that claims that \u201coffering women further tests after their first miscarriage could prevent more than 10,000 baby losses a year in the UK.\u201d<\/p>\n\n\n\n In the United Kingdom, women are eligible for specialist care to prevent future miscarriages only if they have a diagnosis of recurrent miscarriage, defined by three or more losses. (The American College of Obstetrics and Gynecology<\/a> has an updated definition of two or more losses, but waiting for three losses to investigate is still common in the United States, too). <\/p>\n\n\n\n The reasoning behind this rule is the estimation that half of miscarriages are the result of a chromosomal abnormality. The reasoning goes that, in the case of chromosomal abnormality, there is no treatment that could have prevented the loss, and little reason to assume it will happen again. So, a 50\/50 chance that treatment would be beneficial is deemed \u201cnot enough,\u201d and couples are simply encouraged to \u201ctry again\u201d without any diagnostic prior work-up or intervention. Having two<\/em> additional miscarriages is a very strong indication that there is an underlying condition preventing a healthy pregnancy, and therefore usually prompts investigation.<\/p>\n\n\n\n In its recent study and in the resulting report,<\/a> Tommy\u2019s pushes back on the \u201cthree-miscarriage rule\u201d as \u201ca systemic failure to recognise miscarriage as a serious health event with lasting consequences.\u201d For the people affected by the estimated 250,000 annual miscarriages in the UK and 23 million annual miscarriages globally (a figure Tommy\u2019s uses throughout their report but also assumes is an underestimate), they propose a new standard of care that is \u201ceasily achievable, shows potential to reduce the risk of future miscarriage, improves health outcomes overall and delivers substantial cost savings.\u201d And, equally importantly, their proposed standard \u201crestores dignity and compassion to care, offering families answers, support and hope when they need it most\u201d [1].<\/p>\n\n\n\n Tommy\u2019s proposed \u201cgraded model of miscarriage care<\/a>\u201d offers care after the first<\/em> miscarriage, and increases the level of support with each miscarriage experienced.<\/p>\n\n\n\n Under Tommy\u2019s model, after one miscarriage, there is a meeting with a specialist nurse to discuss optimizing preconception health (for mom as well as dad!), and to evaluate mental health and make appropriate referrals. Critically (and a familiar recommendation<\/a> to anyone who has long followed Natural Womanhood) they also discuss how progesterone<\/a> may be appropriate for their next pregnancy.<\/p>\n\n\n\n Under Tommy\u2019s model, after one miscarriage, there is a meeting with a specialist nurse to discuss optimizing preconception health (for mom as well as dad!), and to evaluate mental health and make appropriate referrals. After two miscarriages, the same care is offered along with additional blood tests, including full blood count and thyroid tests<\/a>. Future pregnancies will include additional “reassurance scans\u201d via ultrasound imaging and progesterone level monitoring, if indicated.<\/p>\n\n\n\n After three or more miscarriages, the same care for one and two losses is offered, along with specialist care and a more comprehensive investigation [1].<\/p>\n\n\n\n Tommy\u2019s did a pilot study for their graded model through the recurrent miscarriage clinic within Birmingham Women\u2019s Hospital\u2014a UK university hospital. They collected data under the standard method of care (no intervention until three miscarriages) for six months, trained staff on the new model for one month, offered the graded model of care to 203 women, and then collected data on 203 control group women (receiving the standard method of care), and collected follow-up data on all of the women for one year. <\/p>\n\n\n\n It\u2019s important to note that this study was conducted as a feasibility study meant to assess acceptability, feasibility, outcomes, and costs. As such, the impact on miscarriage prevention was only one aspect of the report, and not the main focus.<\/p>\n\n\n\n Of the 203 women in the graded model group, 201 reported being \u201csatisfied or highly satisfied.\u201d Women reported that having a plan and steps to take after their miscarriage was empowering, offered hope, and was helpful in reducing anxiety. Women also reported how much they appreciated feeling cared for by their medical team, having space to grieve, and that the mental health services available through the program were very beneficial. <\/p>\n\n\n\n All 15 medical professionals involved in the study found the program \u201cacceptable,\u201d found that appointments were less stressful and more efficient when women were aware of a plan to offer support and knew how to access that support, and were happy to be part of a program that was making such a positive impact on patient\u2019s lives.<\/p>\n\n\n\n 86% (174\/203) of women in the graded model group had at least one modifiable risk factor identified compared to only 58% (118\/203) of women in the control group. Women in both groups received information on BMI, smoking, and alcohol use, but only women in the graded model group consistently received counsel on factors like caffeine use, vitamin D, and folic acid. <\/p>\n\n\n\n Women in the graded model group were also much more likely to access services to help them improve their health like meeting with a bereavement team, perinatal mental health, and weight management. About 9% (19\/203) of women in the graded model group started a smoking cessation program while only 1% (12\/1200) of women receiving care during the baseline time period enrolled.\u00a0<\/p>\n\n\n\n Of the 40 women who had blood testing done after their second miscarriage, 4 had anaemia and 4 had an underactive thyroid. Although a relatively small sample size, a full 20% of women in this study who experienced two miscarriages had a health condition that can be treated right away, has known impacts on pregnancy outcome, and has immediate quality of life benefits with treatment.<\/p>\n\n\n\n The study reports a 10% relative reduction in the odds of miscarriage for the women in the graded model group compared to the control group, which, when adjusting for other risk factors, becomes a 4% absolute risk reduction for miscarriage. Unfortunately, the explanation for this figure is simply \u201canalyses.\u201d It is assumed that this figure comes from information on subsequent pregnancy outcomes during the 1-year follow up, but the numbers used to create this stat are not provided. Although, about 4% of women (8\/203) in the graded model group had a preexisting condition identified, which may account for the differences between this group and the control group. More than 40% of participants in each group had experienced three or more miscarriages, so nearly half of each group were eligible for the same level of intervention. The study itself notes that this statistic involves uncertainty, but notes that it is nonetheless a positive trend and calls for clinical trials to further investigate.<\/p>\n\n\n\n Applied to the current estimate for miscarriages in the UK (250,000) to 4% risk reduction for miscarriage with the new graded model of care gives the stat of 10,000 preventable miscarriages a year. Applied to the United States, which has five times<\/a> the population of the United Kingdom, this could theoretically translate to 50,000 annual preventable miscarriages in the US (assuming most women in the US currently receive care comparable to the UK model). <\/p>\n\n\n\n Applied to the current estimate for miscarriages in the UK (250,000) to 4% risk reduction for miscarriage with the new graded model of care gives the stat of 10,000 preventable miscarriages a year. Applied to the United States, which has five times the population of the United Kingdom, this could theoretically translate to 50,000 annual preventable miscarriages in the US. <\/p><\/blockquote><\/figure>\n\n\n\n The graded model of miscarriage care treats women, their partners, and their children with the dignity and comprehensive care that lies at the heart of Restorative Reproductive Medicine<\/a> (RRM). While RRM goes further when a woman charts her cycles with an evidence-based method of fertility awareness (fertility awareness has an uphill battle in the UK<\/a>), and testing HCG, progesterone, and thyroid function with each pregnancy, the Tommy’s graded model of care does look for and treat root causes, strives to care for the patient as a person, and values each life. Furthermore, by acknowledging miscarriage as a sign that there may be a significant health factor going on, it helps women get the treatment they need much sooner to start feeling better. <\/p>\n\n\n\n Doctors in the study also found that women are much more willing to make lifestyle changes when trying to achieve a healthy pregnancy than at other times, so this intervention model helps doctors to encourage changes for a healthier life at a time when women are particularly receptive to making difficult changes like quitting smoking.\u00a0<\/p>\n\n\n\n In preparing this article, I shared what I learned with many of my friends. Those who experienced miscarriages themselves warmly supported this model of care, and shared that the assurances of extra help and the list of risk factors to work on after a first-time loss would have eased their anxieties around trying to achieve a future pregnancy. One friend shared that the current model feels like, \u201cwaiting for enough bad things to happen until you can finally do something,\u201d since many doctors are unwilling to investigate before three losses, even when there are reasons to suspect an underlying condition. Tommy\u2019s report on the pilot study for this model summarizes the importance of intervening after each loss beautifully: \u201cThis is not only a matter of science and healthcare, it’s a matter of compassion, justice, and humanity.\u201d<\/p>\n\n\n\n [1] Kaur R, Fitzsimmons L, Bolbocean C, Scott N, Madoc N, Newman-Sanders A, Pergolizzi C, Devall A, Coomarasamy A. The Tommy\u2019s graded Model of Miscarriage Care. Tommy\u2019s; 2026 Apr.<\/p>\n\n\n\n <\/p>\n","protected":false},"excerpt":{"rendered":"\u041c\u0435\u0442\u043e\u0434\u044b, \u043a\u043e\u0442\u043e\u0440\u044b\u0435 \u0443\u0436\u0435 \u0434\u0430\u0432\u043d\u043e \u043f\u0440\u043e\u043f\u0430\u0433\u0430\u043d\u0434\u0438\u0440\u0443\u044e\u0442\u0441\u044f \u0432 \u043e\u0431\u043b\u0430\u0441\u0442\u0438 \u0432\u043e\u0441\u0441\u0442\u0430\u043d\u043e\u0432\u0438\u0442\u0435\u043b\u044c\u043d\u043e\u0439 \u0440\u0435\u043f\u0440\u043e\u0434\u0443\u043a\u0442\u0438\u0432\u043d\u043e\u0439 \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u044b, \u0441\u0442\u0430\u043d\u043e\u0432\u044f\u0442\u0441\u044f \u043e\u0431\u0449\u0435\u043f\u0440\u0438\u043d\u044f\u0442\u044b\u043c\u0438","protected":false},"author":98,"featured_media":24802,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_kad_blocks_custom_css":"","_kad_blocks_head_custom_js":"","_kad_blocks_body_custom_js":"","_kad_blocks_footer_custom_js":"","csco_singular_sidebar":"","csco_page_header_type":"","csco_page_load_nextpost":"","csco_post_video_location":[],"csco_post_video_url":"","csco_post_video_bg_start_time":0,"csco_post_video_bg_end_time":0,"footnotes":""},"categories":[5509],"tags":[843,5713],"class_list":["post-24798","post","type-post","status-publish","format-standard","has-post-thumbnail","category-pregnancy-loss","tag-miscarriage","tag-pregnancy-loss","cs-entry","cs-video-wrap"],"acf":[],"yoast_head":"\nThe \u201cthree-miscarriage rule\u201d<\/span><\/h2>\n\n\n\n
Tommy\u2019s graded model of miscarriage care<\/span><\/h2>\n\n\n\n
Critically (and a familiar recommendation to anyone who has long followed Natural Womanhood) they also discuss how progesterone may be appropriate for their next pregnancy.<\/p><\/blockquote><\/figure>\n\n\n\nInitial findings<\/span><\/h2>\n\n\n\n
Patient and doctor response<\/span><\/h2>\n\n\n\n
Identifying risk factors and medical conditions <\/span><\/h2>\n\n\n\n
Miscarriage prevention<\/span><\/h2>\n\n\n\n
Saving lives in the future and healing families in the present<\/span><\/h2>\n\n\n\n
Reference: <\/span><\/h4>\n\n\n\n