In summary, Özlem experienced heavy bleeding in the seventh week of her pregnancy and was told by health personnel that she had probably had a miscarriage, without any examinations being carried out. She took blood tests to confirm the miscarriage, even though health personnel thought it was not necessary. She never got an answer to the test results. After almost four weeks with persistent pregnancy symptoms, Özlem visited a private gynecologist, who confirmed that she was still pregnant. The Midwives’ Association and the Amathea foundation express that Özlem’s experience is not unusual, and criticize the lack of systematic follow-up and investigation in the event of suspected miscarriage. The Ministry of Health and Welfare believes that the system for follow-up in the event of miscarriage is good, but acknowledges that there is always room for improvement. The summary is made by an AI service from OpenAi. The content is quality assured by news journalists before publication. – How could they not check anything? Özlem Demirkol Tønnesen is seven weeks pregnant when she suddenly has heavy bleeding while at work. Shocked, she rushes to the emergency room, and her husband Tord Demirkol-Tønnesen follows. Together they wait four hours before they are allowed to enter. – I tell the doctor what has happened. She replies that since I’m seven weeks along, it’s probably a miscarriage. The doctor says it’s sad, but that miscarriage is very common in the first trimester. Usually the body arranges the physical on its own. Now it is important that she goes home and rests. Will take a blood test The doctor mentions that she can take a similar blood test, to demonstrate that the hormone level is decreasing and that it is actually a miscarriage. – But they say that it is not actually necessary. Özlem would like to take the blood test anyway. After many hours at the emergency room, Özlem and her husband go home. – The first days are overshadowed by fear. I’m scared, because I’ve never had such heavy bleeding before, and I wonder what’s happening to me. It is only after a while that the sadness comes. She feels more and more useless. – I was wearing jeans the day the bleeding started. For a long time afterwards, I start to laugh just seeing the trousers in the closet. In the first days after the bleeding, Özlem mostly stayed at home, fearing it would happen again. Photo: Sissel Rikheim / news Didn’t get a reply Özlem has been on the waiting list for a GP in Bergen since April 2023, when she and her husband moved from Oslo to Bergen. She must therefore take the next blood test at Bergen Health Center. When a week has passed, she calls her GP. Özlem finds it difficult to go to work and wants to ask for sick leave. In addition, he can get the results after the blood tests. – The doctor gives me sick leave. But he believes that the results of the blood tests do not matter. The most important thing is that Özlem does not have a fever and that she is healthy, says the GP on the phone. During the first weeks, she contacts both the health center and the GP’s office several times to get the test results. The health center can give her one test, but it was useless without the other. 21 June 2024 ÖTÖzlem Demirkol Tønnesen: Hi, I took blood tests last week at the Bergen emergency department for hCG levels and I want to find out the results. Can you check? I do not need a consultation, and just want to find out the difference between the two tests. 27. June 2024CACarl Berner legekontor AS: Hello, Unfortunately we have no answers here. Please contact the Bergen emergency room. Etc. Carl Berner doctor’s office Carl Berner’s doctor’s office told news that they received the test result from the Bergen emergency room by post, only one month after the test was taken. They have never received the test results from Bergen health center. In the end, Özlem gives up on getting hold of the results. She thinks that she must trust what the health personnel have told her: That it was a miscarriage. – You don’t want to enter into a false hope and believe that you are still pregnant, when all the doctors around you say that you have had a miscarriage. Tired and angry She tries to get on with the weekday. She joins a summer party, eats sushi and drinks champagne. But she is weak, nauseous, worried and restless. In addition to the grief she prays for, she feels nausea and other pregnancy symptoms on a daily basis. – My midwife tells me that hormones and symptoms can linger a bit, but that they pass after a couple of weeks. After three weeks with pregnancy symptoms, Özlem began to doubt herself and wonder if she was imagining the symptoms. Photo: Sissel Rikheim / news When Özlem enters the third week with pregnancy symptoms, she starts to get bored. And angry. – I am extremely angry with everyone involved in my care. Because how could they not check anything? Why can’t I get an ultrasound? What if something is left? Özlem and the man want to be sure that Özlem’s physical health is in order and get a definitive answer to what has happened. Without a GP in Bergen, they don’t know where to turn. On 1 July they go to a private gynaecologist. – She listens to me. She takes an ultrasound. The screen comes on. And there’s the baby. Ten weeks and five days, which is exactly as old as it should be! The fetus in the womb was ten and a half weeks old, completely healthy and is expected until next year. Photo: Privat Özlem’s situation is not unusual. Andrea Skaarer Kreutz is the day-to-day manager of the Amathea foundation, a nationwide health service with follow-up services before, during and after abortion. She is not surprised by Özlem’s story. Andrea Skaarer Kreutz, day-to-day manager of the Amathea foundation. Photo: Amathea – It is very rare that one is offered an explanation to deny or confirm that it is actually a miscarriage in the first trimester. – Does that mean that one actually has to find out on one’s own? – Yes, answers Kreutz. Nor is she very surprised that the one test result has disappeared from the system. – It shouldn’t happen, but we hear that it does. If it is actually confirmed that it is a miscarriage, the system does not ensure that you get an answer to what has happened, or further follow-up. – You have to go through three miscarriages before you are referred for treatment in Norway today, says Kreutz. If a miscarriage is suspected Symptoms of a miscarriage can be: Heavy bleeding Pain in the lower abdomen or lower back It is common to have minor bleeding in the first trimester of a pregnancy, without there having to be signs of a miscarriage. When should you contact a healthcare professional: In case of severe pain In case of heavy bleeding If you are unsure about something during pregnancy If you suspect a miscarriage you should contact your GP or other healthcare personnel. How to deny or confirm a miscarriage: Health personnel typically use the following methods to clarify what has happened. Gynecological examination Similar blood tests that measure the development in the level of the hormone HCG Ultrasound Ordinary pregnancy tests can be positive several weeks after a miscarriage, and are therefore not a safe method. Source: helsenorge.no Many questions and needs, but few answers According to the Norwegian Institute of Public Health, there are approximately 83,000 pregnancies in Norway each year. Of these, 17 percent end in miscarriage. This means that around 14,110 women go through a miscarriage each year. The Amathea Foundation is in daily dialogue with women who experience this. Kreutz says that those who experience a miscarriage often have many questions and need follow-up. – They wonder what is happening to the body, what they have done or not done and how they should go about a possible new pregnancy. Many also go through a grieving process and need help to deal with thoughts and feelings. Promised better follow-up in 2020 Hanne Charlotte Schjelderup, political leader of the Midwives’ Association NSF, believes that follow-up after abortion is too bad in Norway. – We have no national procedure on how to handle a miscarriage. So it will be random, based on who you contact and what investigations are done. A miscarriage should be verified with a gynecological examination, ultrasound or blood test. And the couple should be called in for a meeting with a midwife if they need it, says Schjelderup. – We have a lot to go on when it comes to women’s health in Norway, says Schjelderup. In 2020, the Storting passed resolution 713, which said the following: “The Storting asks the government to ensure that everyone who undergoes a miscarriage is offered follow-up by health personnel.” – Unfortunately, it is probably only a paper decision, says Schjelderup. If there is to be an offer where women can receive abortion follow-up, it requires more resources in the healthcare system, both in hospitals and in the municipalities, she believes. – There have been no extra allowances from the state budget for this. So we have not seen any change, neither in the professional environment nor for the women. The ministry thinks the system is good State Secretary Ellen Rønning-Arnesen in the Ministry of Health and Care thinks it’s a shame that Özlem has experienced a failure in health care and says it shouldn’t be like this. But she disagrees that there have been no changes after the decision in 2020. – We have strengthened the basic funding of the GP service, so that women of childbearing age will receive better follow-up. She also pointed out that the Amathea foundation receives state funding for the work with follow-up, and that there is information about miscarriage at ung.no and helsenorge.no. According to Rønning-Arnesen, there are no concrete plans to improve the system for follow-up in the event of miscarriage. – The system is good. But it is always the implementation that we have to become even better at in the entire health service, she says. Calling for a better system Özlem and Tord describe the whole experience as a rollercoaster ride. – At first we were just shocked, says Özlem about the visit to a private gynaecologist. Tord says that they first see a fetus in the stomach, and thinks that something is left after the miscarriage. – Then she turns on the sound, and we hear the heartbeat, says Tord. Özlem and Tord are closed about the fact that they are still expecting their first child, but hope that others will not have to go through the same thing that they have experienced. Photo: Sissel Rikheim / news They tell of an overwhelming closure, but also other sensations. – It was a mixture of anger, over the process and that the pregnancy had to turn out like this. But also close, of course. Özlem wanted to complain about the follow-up she has received, but says that she cannot find a suitable way to complain. She is not angry at individuals, but at the system. – As long as we don’t have a proper system in place, we can’t hold anyone responsible, she says. Hi! Do you have any thoughts, input or tips about the GP scheme or the healthcare system? Then I would like to hear from you! Published 22.08.2024, at 17.26
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