Patient experience: Early Pregnancy Assessment Unit

Nell Frizzell (picture courtesy of Al Kinley-Jones)

Nell Frizzell was eight weeks pregnant when she started to bleed. Four days later she would visit the Early Pregnancy Assessment Unit (EPAU), located at Rose Hill Community Centre in Oxford, to discover she had miscarried.

Nell has written publicly about how she got through her miscarriage – from loving friends and family to supportive staff – and how she was helped by the community-based EPAU, run by Oxford University Hospitals (OUH).

Invited to share her experience, Nell told her story and provided her feedback – both positive and constructive – at the Trust's in-person Board meeting in July 2024.

Nell spoke movingly about her experience, praising the 'many small acts of kindness' from members of the EPAU team, and she said how lucky she felt that her care when she lost her baby happened in an environment which doesn’t look or feel like a medical setting. Below is her written account.

Yvonne Christley, Chief Nursing Officer at OUH, said: "On behalf of the Board, we are grateful to Nell for bravely sharing her experience with us. Her heartfelt story emphasises the importance of empathy and compassion from healthcare professionals when supporting someone through early pregnancy loss.

"We take pride in the unique service that our EPAU provides and its pivotal role in supporting and ensuring that women and families receive holistic and personalised care during pregnancy loss."

It was raining, the day I finally got an appointment at the Early Pregnancy Assessment Unit. Raining so hard, in fact, that if you were to put it in a screenplay, it would probably be dismissed by the director as being 'a bit heavy-handed on the symbolism'.

Eight weeks into my second pregnancy, I had started bleeding. A smear of red on a tissue, early on Saturday morning. This was the point at which my life split into two, concurrent, realities. After years of writing about women's health, I knew that this bleeding might be fine, common, something that would stop. Or it might be the end of the pregnancy. And as the Early Pregnancy Assessment Unit wasn’t open until Monday, and couldn’t get an appointment until Tuesday, I wouldn’t know which, for three days.

I rang the out of hours number and spoke to the Gynaecology Ward, who told me that if the bleeding got heavier – if I was having to change my pad more than once an hour, to come in. But if it stayed as it was, then there was nothing I could do but wait. Wait, for three days, while my mind coexisted in these two opposite but simultaneous truths. I was fine; I was having a miscarriage. It was a bump in the road; it was the end of the road.

I was worried about traffic so cycled up to Rose Hill on Tuesday morning. It was a huge relief, to me, that I already knew the space. I had been here for a children’s birthday party. It did not feel medical, there were not heavily pregnant women or excited partners waiting with me.

As I came in, the receptionist offered to hang up my waterproofs over a door to dry. It was the first of many small acts of humanity and kindness I was to experience that day. The most significant of which was when I went to the toilet. On the back of the cubicle door was a sign that said: "We had sanitary pads, wet wipes, spare leggings, underwear and bags available in our clinic. Some of these items have been donated by our local Cradle charity ambassador. Please ask one of the nursing assistants at reception if you require any help and they will discreetly provide these for you."

In that moment I knew, with a huge influx of relief, that I was somewhere that really understood what was happening to me.

The only moment of discord – and one that has been echoed by several women I know who have miscarried – was the music blaring out of the radio in the waiting room. Call Me Maybe by Carly Rae Jepsen, Dance With Me Tonight by Olly Murs, Torn by Natalie Imbruglia; never have bouncing pop hits and tortured emotive anthems felt more at odds with their surroundings. While some noise is important for patient confidentiality, as the sign next to the radio explained, it would be surely much, much better to have some nondescript classical radio station, as we wait, nervous and sensitive and worried?

I took my friend with me to the scan. She had been here several times herself, for her own miscarriages, and it was reassuring to sit beside someone who had also stared out of the waiting room window at a children’s playground.

When I entered the room for my scan, the staff introduced themselves. They were warm-voiced, kind but not jarringly jolly. They turned out the lights, so I could lie there, nervously waiting, feeling protected by the dark. The sonographer tried at first scanning my stomach but quickly things moved to an internal examination. Her absolute, unreadable, calm as she pushed the sensor around my womb was admirable. Her face betrayed nothing. Until, very gently, and very sympathetically, she told me that there was no longer any sign of a pregnancy. In those three days of waiting I had bled it all out.

However, as there was no sign of any pregnancy in my womb, and my bladder had obscured her view of one fallopian tube it was actually classified as a 'pregnancy of unknown location', meaning an ectopic pregnancy couldn’t be ruled out until I did a pregnancy test a week later, which showed just the one blue line.

I sat up, turned to my friend and cried into her shoulder. And, like a mother, she rubbed my back and held me and held me and held me. Sadness, in many ways, is easier to bear than uncertainty. And so I got dressed, I went back into reception to retrieve my waterproofs and, with the rain still hammering, I cycled home.