Women's health toolkit
This Women’s health toolkit is categorised into sections best representing the needs of women at different stages of their lives.
Pregnancy loss and abortion care
A woman who fears that she is losing her pregnancy in the first trimester may present first to the GP; whilst her medical management will be carried out in hospital, our empathetic approach is important and may be remembered long after the event. Women will also come back to primary care after a later miscarriage or a stillbirth for management of any ongoing related physical or mental health issues. Some women will miscarry due to a thrombophilia such as antiphospholipid syndrome; referral for investigation of this should be done after one miscarriage at ≥ 10/40, three miscarriages at < 10/40 or one premature birth at ≤ 34/40.
Women who have a miscarriage before 24/40 are not entitled to any maternity pay and will therefore need a fit note if they are not able to return to work straight away, whereas those who have a miscarriage or stillbirth at ≥ 24/40 are usually entitled to maternity leave in the same way as if they had delivered a live baby. They may also be entitled to parental bereavement leave – if a patient is finding these issues difficult to navigate then referral to a social prescribing link worker may be useful.
Not every woman is happy to be pregnant; our language should be cautious when a woman discloses an early pregnancy, and it isn’t clear whether she wants to continue with it. In most cases, the involvement of primary care in termination of pregnancy is limited to passing on the contact details of the locally commissioned provider, but in some areas, services may be commissioned such that GPs also sign the form HSA1 as the first of two doctors to approve the termination. Those GPs who have a conscientious objection to any involvement in the process must make arrangements for the patient to see another suitably qualified colleague and cannot opt out of treatment necessary to save a life or prevent grave injury. Women in England and Wales can now access a medical abortion at home, after the legal provisions for this during the pandemic were made permanent in August 2022.
More information can be found in the following resources: