TFMR Care Survey
2024 TFMR Care Survey
In 2024, ARC conducted an online survey on experiences of care for termination for medical reasons (TFMR) in the UK within the last 4 years. The survey was designed to get an up-to-date overview of experiences of care when people decide to end a wanted pregnancy after a diagnosis, with questions covering diagnosis, choice of and views on method of termination, and care and support during and after termination.
Most parents had good care
Overall, the majority of survey respondents (84%) rate their care as excellent (42%), very good (29%), or good (13%). Parents who experience good care are grateful to staff, and emphasise the importance of receiving such good care during a potentially traumatic time. While any TFMR is a difficult experience for parents, good care can help parents cope during and after the procedure.
“The midwives were so understanding … They really made the most awful situation as nice and calm as it could be. I’m forever grateful to them.”
Only 9% of survey respondents say their care was poor (4%), or very poor (5%). However, any level of poor care is concerning.
What parents value
We asked survey respondents to share the most helpful and positive aspects of the care they received. We found eight main themes in the responses:
1. Compassionate care
The importance of kindness to parents going through TFMR was an overwhelming theme in the survey responses. Being treated with kindness and compassion can support parents in their grief for the loss of a wanted baby. It also helps alleviate parents’ fear of judgment for making the decision to end their pregnancy.
“Midwives, nurses and consultants were all kind and compassionate. They did not pass judgement on us and knew it was a very painful decision.”
2. Adequate pain relief
Parents value being given information about the full range of pain relief available to them, and timely access to appropriate pain relief in labour.
“The midwives were supportive and sympathetic. I was offered plenty of pain management options”
3. Offer of memory making
Receiving information about options for memory making is important to parents. Parents prefer having information in advance to give them time to make decisions and help them prepare. Supportive, trained staff can help parents who may be unsure about how they will feel and act on the day.
“Midwives informed us of professional photography service by remember my baby, and this was just so precious to have done. Hospital also provided a cuddle cot so our baby could come home with us, which allowed us five very cherished days at home with our baby before we said our final goodbyes.”
Respect for whatever decisions women and partners make is also crucial. Different people will choose to memorialise their baby in different ways, or not at all. Those who choose not to memorialise or mark the loss of the pregnancy should feel equally supported.
4. Privacy with partner support
Parents value having access to a private space and for a partner or support person to be with them during their TFMR care, wherever possible.
Parents having their care in NHS hospitals generally want to be in a separate space apart from general antenatal waiting areas and people on maternity wards having healthy, living babies.
“When we first arrived at the hospital we were made to wait in area surrounded by new mothers and pregnant women with baby monitors on. Hearing healthy babies, and strong heartbeats was incredibly difficult at that point.”
5. Continuity and contact details
Parents appreciate continuity of care where possible. Parents understand this may not always be feasible but are grateful when they are cared for by staff who are aware of their circumstances, and when they receive sensitive follow-up care. Parents also value having a point of contact with healthcare professionals if they have questions or need support between appointments or after TFMR.
“We had an amazing fetal medicine midwife and consultant who were both very caring and supportive and followed up during and after the termination. Our consultant came to see us while I was in labour.”
6. Clear information
Receiving as clear information as possible at every stage is very important to parents. Knowing what to expect during the TFMR procedure is very important to women; for example, being prepared for possible complications can help if complications do occur.
“The midwives explained every aspect of what to expect including the possibility of retained placenta which then helped when this actually happened”
7. Time to ask questions and make decisions
Receiving a diagnosis and ending a pregnancy are highly distressing and stressful experiences. Even with staff doing their best to provide clear information, parents may struggle to take in information at these times and appreciate staff giving them time to ask questions and make decisions.
“We never felt rushed, everything was in our own time. They were informative and took time to answer all questions we had.”
8. Short waits for appointments, with choice of timing
Parents value being offered follow-up appointments quickly, and having choice of timing for their termination.
“I think it was best that everything moved so quickly once we had decided to end the pregnancy there was no reason to prolong the heartache”
Improving aftercare
While most parents report receiving good care during their TFMR, support afterwards was rated much less highly, with many parents raising it as an area of care in need of improvement
71% of parents did say their care after TFMR was excellent, very good or good. Parents who did have supportive aftercare are very grateful and talk about how it helps them cope with their grief after TFMR. Many parents value having ongoing support from a bereavement midwife.
However, other parents note that more proactive aftercare should be offered as standard, and beyond the support of a bereavement midwife. Parents suggest a pre-booked appointment to discuss physical and emotional recovery and referral to specialist maternal/perinatal mental health services where appropriate.
“I was referred for low cost counselling a few months after my loss for anxiety and also had CBT on the NHS. This was very useful but I think some kind of support should be offered as standard and quicker – beyond the bereavement midwife.”
Choice of method
Finally, the survey also asked whether people were offered a choice of method (medical or surgical termination), which method people chose and whether they felt that method was the right option for them.
We found that less than half of respondents (48%), excluding pregnancies over 23 weeks +6 days, were offered a choice of method of termination. Of those respondents, 29% had a surgical termination; some of these parents describe having to research and arrange their own surgical termination.
“It was difficult to arrange the surgical procedure and there were additional layers of trauma that came from having to do this”
Others say they would have preferred a surgical termination but couldn’t face longer waiting times or travelling to access this care and decided to proceed with medical termination that could be arranged sooner and closer to home.
There are also significant disparities between countries when it comes to choice of method. Only 7% of Scottish respondents say they were offered a choice of method and 100% of them went on to have a medical termination.
Importantly, overall, both methods were rated similarly. We asked ‘what extent do you feel the type of procedure you had was the right one for you?’, with a sliding rating scale numbered 1-100. Among those who had medical, the average rating was 80 and among those who had surgical, the average rating was 82.
“I would have liked all the options to be provided. One consultant subsequently explained that we were so overwhelmed with the “decision” that they didn’t want to give us more to think about – it’s very important that women have autonomy over their bodies during such procedures and labour.”