Catholic Medical Quarterly Volume 73(3) August 2023

The IPLR and Certificates for pre 24 week miscarriage, progressive O&G care?

by Dr Adrian Farrell

BabyWith the Commons in recess, Sat 22nd July saw the release of The Independent Pregnancy Loss Review (IPLR): A vision for improving the care and support when baby loss occurs before 24 weeks gestation.  Just 3 days earlier pro-abortion MPs had been arguing for and against action to end prison sentences for unlawful abortion! The link?- Dame Maria Caulfield, who is ministerially responsible for the Independent Pregnancy Loss Review’s (IPLR) implementation, proposed a 10 minute Rule Bill re Sentencing Guidelines. The absence of such guidance recently led to a 28 months sentence of imprisonment for the mother of an unborn child which was a 32 week abortion. That sentence was reduced to 14 months suspended on appeal.

Post 24 weeks, parents of children born alive but who die soon after, receive both Birth and Death certificates. Parents of stillborn children receive a Medical Certificate of stillbirth enabling registration and issuance of a form enabling burial or cremation. This is not the case for Baby Loss pre 24 weeks.

The wide ranging 207 page IPLR addresses current failures in Early Pregnancy Loss (EPL) care and proposes certification similar to that for stillbirths. The IPLR also marks a change in attitude especially re terminology. Significantly “baby is used to describe the child from the earliest stages of pregnancy” explaining that “parents identify their baby as an individual from when they know they are pregnant”. ‘Baby loss’ is defined as losses which occur in the first 24 weeks of pregnancy. There are 74 recommendations in total, many around service provision but also “Care For the Baby”, “After loss” and the “Certification Scheme”.

Despite NHS pressures the Government response to the IPRL was published concurrently and identified specific recommendations for immediate action. Top is 61 re Certification on request, backdated, regardless of the type of loss, not requiring evidence, with a non legal but official document i.e. not just commemorative. This is followed by 35-7 and 39 -Sensitive handling and storage of EPL remains, 43 -Care for Sporadic and Recurrent Miscarriage, 57­ Bereavement plus 4 others.

The IPRL poses a question re whether the many consequences of spontaneous EPL are similar or worse for parents and particularly women completing Medical Abortions? Parents getting backdated documents due to EPL via Medical Abortion is not excluded.

The failures re EPL care to date and numerous Obstetric Scandals suggest wholesale changes in attitudes are required by NHS Obstetric and Gynaecology Services towards women, babies (both born and unborn) plus families. Unlawful abortions are a predictable failure of non Face to Face (F2F) consults and drug induced abortion by telephone, which surely increases Provider profitability? The resulting windfall/excess profits should be clawed back by the DH, curtailed by reducing the NHS Tariff and the savings re-invested into providing the Obstetric Care we deserve and implementing the IPLR. However, the Ockendon independent review of maternity services at the Shrewsbury and Telford Hospital NHS Trust (among other reports) suggest that money alone is a partial cure- it is attitudes which need to change.


Dr Farrell is a Consultant Rheumatologist in Northwest England.