To ask the Minister of Health (i) to detail the care and support made available to pregnant and pre-conception women who have suffered (a) one; (b) two; and (c) three or more miscarriages; and (ii) what steps he is taking to introduce a specialist care pathway for high risk women wishing to conceive.

Women who have suffered miscarriage may be referred by their GP to the gynaecology service for investigation. The criteria for referral currently are:

all women with 3 or more consecutive miscarriages;

all women with 1 or more second trimester miscarriages;

all women with a history of miscarriage and an associated condition such as antiphospholipid syndrome, PCOS, chronic medical disorder; and

all women over 35 years old with 2 or more miscarriages.

In addition to trying to establish the cause of a miscarriage, all Trusts in Northern Ireland have a bereavement midwife, early pregnancy unit and services available for women who have experienced miscarriage.

In January 2021, I announced funding to establish a new specialist perinatal mental health community service model, to respond to the varying mental health needs of mothers, including those who have experienced a miscarriage. Specialist perinatal mental health services are being implemented on a phased approach, with phase one focussing on the roll out of community perinatal mental health teams across the region. Services in the Belfast Trust and the South Eastern Trust are operational and accepting referrals, with work being progressed in the other Trust areas to commence service delivery as soon as possible.

In parallel, preliminary scoping work has also commenced on the establishment of a Mother and Baby Unit for the region which includes engagement with Health and Social Care Trusts.

The existing Antenatal Core Care Pathway helps to identify those women, including those women at high risk, who require some or all of their care by an obstetrician and ensures that this care is provided in line with individual needs.

In addition, a Pre-Conceptual Care Sub-Group of the Maternity Strategy Implementation Group has been established which will address the need for a care pathway for women with long-term conditions who are planning to conceive or who are pregnant.

Furthermore, the National Institute of Health and Care Excellence Guideline NG 126, ‘Ectopic pregnancy and miscarriage: diagnosis and initial management’, which was endorsed by the Department in June 2019, was updated in November 2021 to reflect new recommendations on the use of progesterone in cases of threatened miscarriage. It is expected that the HSC will implement these new recommendations.