Scotland is set to publish the UK’s first dedicated miscarriage patient charter, giving women and families clear information on NHS care and support.

Commissioned by the Scottish Government and developed with baby-loss charities Tommy’s, Held In Our Hearts and the Miscarriage Association, the charter sets out minimum standards for compassionate, clinically appropriate and culturally competent miscarriage care across Scotland.

It builds on the Scottish Government’s Delivery Framework for Miscarriage Care, which has already changed practice across NHS boards.

Jenni Minto, Scottish public health and women’s health minister, said: “Miscarriage is devastating, and for too long women have not had the care and support they deserve.

“That is changing. Scotland will become the first country in the UK to publish a miscarriage patient charter, meaning women know exactly how they will be supported by health services following their loss.”

Unlike previous UK-wide norms, where women were typically offered enhanced support only after three miscarriages, Scotland’s approach means women can receive appropriate support after their first miscarriage.

The charter also sets out clear rights and expectations so every woman, regardless of location or circumstance, understands the care she should receive.

It includes access to private rooms in hospitals rather than busy clinical areas or maternity settings, progesterone treatment where clinically appropriate, compassionate and culturally competent bereavement support, and clear information in 18 languages, including British Sign Language and audio formats.

Progesterone is a hormone that growing evidence suggests may help reduce the risk of miscarriage in certain cases when given to women who meet specific clinical criteria.

The Scottish Government said the charter is designed to ensure personalised, respectful care and to address long-standing inequalities experienced by women during miscarriage.

It is intended to provide clarity on the support women can expect, consistent standards across all NHS boards, stronger awareness and confidence among healthcare professionals, and better access to emotional and practical support services.

Charities involved in its development said many women still report feeling dismissed, uninformed or unsupported during miscarriage.

They said the new charter marks an important step towards making sure every woman feels heard, respected and cared for.

The charter aligns with Scotland’s wider Women’s Health Plan, which is improving care across reproductive, menstrual, maternal and perinatal health.

Recent national developments include greater investment in women’s health services, improved training for healthcare staff, new digital and in-person support tools, and targeted action to reduce inequalities in access and outcomes.

Together, these measures aim to create a more compassionate and equitable women’s health system.

Minto said: “This charter is a landmark moment.

“It tells women clearly what they should expect from their NHS, and it holds services to account for delivering it.

“Scotland is leading the way, and I am proud of the progress NHS boards and our charity partners have made together.”

The model is expected to inform wider UK discussions on miscarriage support, bereavement care and early pregnancy services.

The charter will be made publicly available, offering women, partners and families clear guidance on their rights and the standards they can expect when seeking care.

By Adrianne Nickerson, founder and CEO, Oula

The numbers get the headlines. Maternal mortality rates. Access deserts. Workforce shortages. These are real and urgent problems, but they’re not the whole story.

There’s a quieter breakdown happening inside routine appointments, and it’s driving outcomes in ways that never show up in formal reports.

Women describe maternity care that feels rushed and transactional.

They talk about repeating their medical history at every visit, leaving appointments with questions they never got to ask, and receiving advice so generic it doesn’t seem to account for their actual lives.

These aren’t just complaints about bedside manner. They’re signals that the system is losing the thread, and when that happens, clinical risk follows.

A patient who doesn’t feel heard may decide a new symptom isn’t worth mentioning.

A patient who leaves an appointment without clear next steps may wait too long to call when something changes. These small moments of disconnection are where complications quietly take shape.

The system is structured to rush

This isn’t about individual clinicians failing women. It’s about a care model built around short, physician-led visits with limited coordination across roles — applied to pregnancies that are often medically and emotionally complex.

Clinicians are covering more ground in less time, and patients feel that compression. Women in marginalised communities feel it most acutely.

Reports of dismissal and bias are well-documented, and the consequences compound: when trust erodes, communication breaks down, and the window for early intervention narrows.

What women are actually asking for

Younger women in particular are entering maternity care with different expectations. They want explanations for recommendations, not just instructions.

They want to understand tradeoffs and have their preferences carry forward from one visit to the next. They’re not looking to reduce medical oversight, they’re looking for care that makes sense as a whole.

That’s driving real interest in collaborative care models that bring OBs, midwives, nurses, and behavioural health professionals into a coordinated framework.

When roles are clear and communication is shared rather than siloed, the experience changes, and so do outcomes.

Experience is clinical performance

Health systems are sophisticated at tracking infection rates and readmissions. The experience of care deserves the same level of attention, because it’s often where the clinical picture first starts to slip.

The fixes aren’t mysterious. A longer first visit can prevent confusion that compounds over months. Integrated mental health support surfaces concerns that might otherwise go unspoken.

Clear communication across the care team eliminates the mixed messages that erode confidence.

Postpartum services like pelvic floor therapy and lactation support – when easy to access and clearly explained – extend the impact of care well beyond delivery.

Workforce shortages and financial pressure make all of this harder. They also make it more urgent.

When women feel respected and informed, they raise concerns earlier, follow care plans more consistently, and seek help sooner.

That’s not a soft outcome – that’s how complications get prevented.

Simply put: adjusting how care is delivered is one of the most direct ways to improve clinical outcomes.

Women felt pressured into procedures during maternity care, with some told they were “not allowed” to make choices, a report found.

Charity Birthrights collated the experiences of 300 people in England who said they had felt or witnessed coercion within a maternity setting.

The charity said caregivers used authoritative language that undermined the idea of women being able to make informed decisions regarding their maternity care.

Hazel Williams, chief executive of Birthrights, said: “This crucial report documents the rise in coercive practices as a systemic problem across the maternity system, with Black and Brown women and birthing people facing the worst attacks on their human rights, choice and bodily autonomy.”

“Women and birthing people are repeatedly being told you are ‘not allowed’ or threatened with children’s services referrals, not given full facts and denied genuine informed choice.

“Coercion has no place in safe maternity care and must stop now.”

Experiences shared in the report include healthcare professionals telling women they must accept a vaginal examination or they will not be able to be admitted to the birth centre, and women feeling put under pressure to accept an induction without it being explained why it was necessary.

One woman recounted feeling forced into having a caesarean without having the reasons why it was necessary explained.

She said: “I remember a doctor saying to me: You can choose to have a C-section now or you can wait a few hours and I’ll press that buzzer behind your head and you’ll have one anyway.”

Megan Rogerson, a 37-year-old domestic abuse practitioner from Hull, said she had felt forced into having a caesarean.

She said it was never explained why she could not have a vaginal birth.

“For my second birth, I was all set and approved for a VBAC [vaginal birth after caesarean],” Rogerson said.

“But when I went to hospital experiencing Braxton Hicks I was told that I’d be scheduled for a C-section without any conversation as to why. I was just told that I couldn’t give birth that way.”

She added: “I felt like I didn’t have a choice, I felt that I was spoken to like a child doing something wrong. It was a really sort of belittling experience.

“I was just told we can’t do that rather than it being explained why that was the case.”

According to guidelines from the Nursing and Midwifery Council, women using maternity services should be provided with evidence-based information to make an informed choice and should be able to stop conversations around their care, regardless of their reason for doing so.