Public hospitals compound the grief of miscarriage: inquiry

Women’s mistrust of the hospital system is running so deep that many are choosing not to return to hospital when they miscarry, a parliamentary inquiry has heard.

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The heartbreak of pregnancy loss and stillbirth is compounded by fragmentation between health systems and poor continuity of care, the NSW Legislative Council inquiry into fertility support and assisted reproductive treatment heard today.

The inquiry heard from four women with personal experiences of miscarriage, who spoke of poor access to miscarriage services outside office hours, inflexible rules to access counselling, short leave arrangements and having the administrative burden placed on them in the midst of grief.

The inquiry also heard from experts including CEO and founder of the pregnancy loss support service Pink Elephants Support Network, Samantha Payne, who said too many women and families were leaving healthcare settings without referrals for support following pregnancy loss.

Women were often forced to repeat the same story of miscarriage to every healthcare worker because there was no continuity of care and health services still relied on old paper-based records with no digital integration, she said.

“We’re in 2026 and … we still have things like yellow cards that a woman is required to carry around with her,” Ms Payne told the inquiry.

“When the worst is happening … are you going to have that with you? Then where do you put that information?”

Ms Payne said women reported receiving phone calls when they missed sonography appointments because they had miscarried. 

“How come the health system doesn’t know that I miscarried my baby? Why is it on me, the woman in grief, to be able to make a call to tell them? Why should I be getting reminders?” she said.

“It’s often placed on the woman who’s going through the loss to bear that administrative burden and load.”

The inquiry heard that approximately 92,000 people in NSW miscarry each year.

Ms Payne said the role of midwives was often overlooked, but they were vital in providing continuity of care for women and reducing fragmentation in the healthcare system.

“I can’t tell you how many women tell me how painful it is to retell their story to another health professional all the time,” she said.

Ms Payne spoke about the systemic issues of pregnancy services that only operate within business hours, recalling her own experience of miscarrying and being referred to have an evacuation of retained products of conception (ERPC).

“It literally felt like the floor opened up beneath me, but there was no one there to catch me. It was upon me to leave the sonography clinic, to make an appointment with a GP, to wait in a public waiting area, while crying and bereft.

“It was Friday, I couldn’t access an appointment until the Monday, because within NSW and nationally, we have early pregnancy assessment services that operate on business hours, despite the fact that miscarriages happen 24/7.

“When I arrived at hospital, I was deeply triggered and confronted by women who were heavily pregnant, cute little babies in bassinets, shops that were celebrating the arrival of newborns.

“I was there to have my baby taken away from me.

“I left that hospital through the very same doors that I’d left with a baby in my arms two years earlier, yet this time, I was given no referral for support, no access to emotional help, and broken by the silence that surrounded miscarriage.”

A decade since her first and subsequent pregnancy losses, Ms Payne said she continued to hear stories from women with similar experiences, and of women who no longer trust the hospital system to care for them during pregnancy loss.

“A decade of working in this space, I still hear stories that mirror my story today, and it’s no longer good enough.

“Just two weeks ago, we held a community reference group, and we listened to more experiences, and we heard from women clearly telling us they no longer wish to return to hospitals for health care when they’ve had a miscarriage, because they do not trust the system.

“They do not feel seen supported in any way.

“It’s time for change. If one in four pregnancies end in loss, and again, we know that that’s an estimate, then this is an urgent public health issue that deserves addressing.”

Despite NSW now having legislated five days of leave following a miscarriage, public awareness of leave entitlements was low, Ms Payne said.

“We still have women coming to us not knowing that they’re entitled to bereavement leave.”

Pregnancy loss contributed to presenteeism and absenteeism, and it was up to businesses to meet their obligations to provide bereavement leave, she said.

“If we consider a woman’s age, when she’s going through reproductive challenges, it’s usually when she’s stepping up in leadership positions.

“And often what I hear qualitatively … is they’ve been stepping back from leadership. Women’s workforce participation is being impacted every day, because they cannot balance reproductive challenges, going through failed IVF cycle after another IVF cycle … and then finally getting pregnant and then losing that baby.

“These journeys are not moments in time. These experiences are often profound and last for years.

“Systems change isn’t reliant just on government. Systems change requires the whole of us to come together to address this issue.”

Four women with personal experience of miscarriage and stillbirth spoke at the inquiry, giving heartbreaking detail of their experiences and feeling abandoned by the healthcare system.

Karina McShane, whose son Rafael was stillborn in January 2024, said she was told she could only access mental health support if she had a miscarriage or was undergoing cancer treatment.

When Ms McShane subsequently gave birth to a healthy daughter, she attended a lactation group with other mums.

The lactation consultant – who hadn’t read Ms McShane’s clinical notes – asked whether this was her first baby and if not, whether she had breastfed her first child.

“I then had to explain myself and say, well, actually, I didn’t breastfeed him because he died,” Ms McShane said.

“I could see that she was absolutely mortified, but the assumption … had been made. I know that … not every pregnancy ends in loss, of course, but when it does, it is utterly, utterly devastating, and it completely changes your entire life.”

Ms McShane also spoke of the frustrations with box-ticking in public hospitals and not being eligible for mental health support.

“We were told by the hospital that I could only access mental health support through the hospital if I had a miscarriage or if I was undergoing cancer treatment.

“Those were the only two instances in which we could get any kind of support. We had to rely on not for profits, in particular, Bears of Hope, who provide free counselling for anyone that’s undergone pregnancy or baby loss.”

Executive director of clinical operations at the Gidget Foundation, Karen Edwards, said women needed adequate time in hospital to be connected with other services before they were discharged.

“I do think that is something very practical that this committee can recommend, is that there is adequate time given for women to access support services within the hospital and to … spend time just navigating next steps before they’re discharged home and expected to navigate on their own.”

Ms Edwards said language could stigmatise the way in which people view pregnancy loss.

“Even well-meaning euphemisms can minimise or downgrade the significance of what’s happened and undermine people’s capacity to seek help or to feel that their grief is normal or is to be expected.

“Stigma is a very big barrier, and the more conversations we can have, the more we can legislate pathways and minimum … service delivery standards that talk to open and honest conversations … the closer we get towards making parents experiencing loss feel that not only are their services available and that they can access them, but that they should access them.

“They are entitled to access them, and they will benefit from accessing them.”