The state hospital is in the process of setting up an early pregnancy unit where expectant mothers experiencing problems, such as a miscarriage, will be supported in an area separate from others hosting women in an advanced state of pregnancy or after giving birth.

The logistics, including where to house the unit, are still being planned, the health ministry said. But the aim is to separate patients experiencing early pregnancy problems from others in a more advanced stage of pregnancy, reduce the need for follow-up visits and possibly offer home visits.

This will alleviate the emotional and psychological stress on women who are miscarrying or who just miscarried. At present, they are seen in areas surrounded by other pregnant women or women who have just given birth – magnifying their loss.

In a recent interview with Times of Malta, a woman who had to fly to the UK to terminate an unviable 17-week pregnancy after being told that her much-wanted baby girl would soon die, spoke about her fear going through the miscarriage in Malta.

“I did not want to have to go through it in Malta where women who are miscarrying are a bed away from pregnant women or those who just had babies,” she said.

Another woman who experienced a miscarriage described the situation in hospital as “horrible”.

As she miscarried the much-desired pregnancy, she and her husband had to wait at gynae emergency where several other women were miscarrying.

“The waiting room is bang in the middle of the passage where people with newborns pass. You’re sitting there, helpless, trying to make sense of things while terrified your life could also be at risk, and you’re forced to go through all this. For me, it was more painful than the miscarriage itself,” she said.

“It’s not just bad for the women. My husband had to wait alone while I miscarried, watching other men walk in with flowers and cots. We both needed therapy after”.

Average of 300 miscarriages a year

A miscarriage is the loss of a pregnancy during the first 23 weeks. The main signs are vaginal bleeding, which may be followed by cramping and pain in the lower abdomen. Not all bleeding during pregnancy results in miscarriage.

International research has recognised the psychological impact of miscarriages. According to the UK NHS, “a miscarriage can be an emotionally and physically draining experience” and women can “have feelings of guilt, shock and anger.”

The American Psychology Association notes that, because it is medically common – occurring in 20 per cent of pregnancies – the impact of miscarriage is often underestimated.

My husband had to wait alone while I miscarried, watching other men walk in with flowers and cots

Every year there are over 200 miscarriages in Malta. According to figures obtained from the Health Ministry last year, there were 4,477 births and 221 miscarriages while in 2020, there were 4,578 births and 350 miscarriages.

Over the years, the way miscarriages are handled has been raised several times but, so far, it has not been addressed.

Back in 2007, the government had said that women who suffer a miscarriage will be kept in a separate room from those who have just given birth once the obstetrics services moved to Mater Dei Hospital which opened that year.

So, what happens at Mater Dei when a woman is miscarrying?

The ministry spokesperson explained that, when a woman presents with bleeding in pregnancy, she is first seen in the admission room of the Department of Obstetrics and Gynaecology.

If the symptoms are mild, the patients are sent home on medication and told to rest. In severe cases, women are admitted for observation. In both situations, an ultrasound is performed to ascertain viability. Management is then tailored to the course the pregnancy takes. 

“A few years ago, hospital management started the practice to transfer patients who suffered a miscarriage from the Obstetric Ward to recover in the Gynaecological Ward. Unfortunately, the staff in the gynae ward are under MUMN directives not to accept these patients,” the spokesperson said.

Paul Pace, who heads the Malta Union of Midwives and Nurses, explained that this was because the gynae ward was not equipped with the right staff to handle miscarrying women.

Sources explained that miscarrying women are meant to be treated in a separate area in Obstetrics Ward 2. But the high demands and lack of space lead to a mix of cases across the three obstetrics wards.