The Current - Why Canada needs to improve miscarriage care

Episode Date: October 18, 2024

Many women experiencing a miscarriage end up in the ER, where they can face long wait times and a lack of compassion. A report published this week is calling for investments in early pregnancy care in Canada, arguing it would reduce the substantial suffering of pregnancy loss.

In 2017, it felt like drugs were everywhere in the news, so I started a podcast called On Drugs. We covered a lot of ground over two seasons, but there are still so many more stories to tell. I'm Jeff Turner, and I'm back with Season 3 of On Drugs. And this time, it's going to get personal. I don't know who Sober Jeff is. I don't even know if I like that guy.

On Drugs is available now wherever you get your podcasts. This is a CBC Podcast. Hello, I'm Matt Galloway and this is The Current Podcast. In total, I have had eight losses. Four were miscarriage, four were ectopic. Nicole Shannon knows the pain of pregnancy loss. She was 37 years old when she had her first ectopic pregnancy. That's when the fertilized egg attaches itself to an area outside of the uterus. It can be fatal if untreated. Nicole knew something was wrong. It just felt different. I mean, I'm very aware of my body and I knew something felt there was more pain. There was pain in

different areas of my body. You know, the classic miscarriage signs as well, though, you know, some spotting, some irregularities in general. Nicole had emergency surgery to remove the ectopic pregnancy and while she is grateful to the health care providers who helped her she says she wishes she'd been given more support given the number of losses she'd experienced. My first reaction was probably not something I should say on air. Basically, it was, you've got to be kidding me. Like, what is going on? Like, you get into the self-blame. What did I do wrong? What could I have done differently? Why is this happening? Why is nobody helping me? Where is the help? Like, it just snowballs into, like, what the hell? Like, why?

As many as a quarter of all pregnancies in canada and in a miscarriage this week the canadian medical association journal published a review of canada's approach to early pregnancy loss the report pointed to the number of women who end up in crowded ers where they can face long wait times and a lack of compassion it called for better early pregnancy care we'll hear more on that in a moment, but first I'm joined by Caitlin Geiger-Bardswitch. She experienced a miscarriage two years ago. Caitlin, hello. Hello. What was going on in your life when you first learned you were pregnant? Well, it was very planned in a sense. So I am married to a woman, so clearly we

can't have children the old-fashioned way. We've am married to a woman, so clearly we can't have children the old fashioned way. We've been going to a fertility clinic from the beginning. I'd had several IUIs that had failed. So IUIs are when sperm is introduced into the uterus to try to make fertilization happen that way. And we were on the list waiting for IVF. We finally did get the call that the funded cycle for IVF had come up. So we decided to go ahead with that and try reciprocal IVF. So that's where we used my wife's eggs and my uterus. So this was my first embryo transfer. It was the first transfer that worked. So that was very exciting. Exciting. But then at a certain point, you

realized something was wrong. Tell us about what happened. So basically, I was pregnant. That was exciting. We went to our ultrasound. We found out even more news, which was that the embryo had split into identical twins. They saw both heartbeats. Everything looked great. This was about eight weeks. And then four weeks later, I had spot spotting and this was where things started to kind of fall apart because I was in between doctors. I wasn't yet being seen. I was like three days out from being seen by the high risk OB because of, I was having, um, identical twins. Um, and I had graduated from the fertility clinic, so they also weren't really seeing me. So I called both of them and they suggested I go to the emergency room. Okay. And tell us what that experience was like.

I was there a total of about 12 hours. My wife wasn't allowed to come in with me. And then when they asked me to get up to come do some blood work, I could feel something happening. And I felt like I was miscarrying. I could feel like something was about to happen. And I sort of begged for them to let my wife in. And they did. And I went to the bathroom and sort of everything kind of happened. But I wasn't having any cramping. So we still weren't sure if this was just a normal blood loss.

There can be hematomas or sort of blood clots. So it took me until about 1 a.m. to see an actual doctor. And she did an ultrasound. I'm curious, this is how long after you went to the bathroom? Four hours. Okay. So you knew something was dramatically wrong. You assumed something was happening and still you waited four more hours? Yeah. So I had a lot of blood loss. I went to, the nurses were talking me through. They said they weren't concerned because I was I wasn't super pale. I looked fine. I sort of was saying I'm like, I'm really concerned something like I'm concerned I'm losing both babies. I'm concerned like what is happening. And they were they were great, but they were just like, you have to wait till till a doctor comes. And what happened when you saw the doctor? What did you learn? What did they recommend?

saw the doctor what did you learn what did they recommend i didn't learn much so they did an uh external ultrasound and it wasn't the greatest ultrasound machine she's the doctor said she said like she couldn't really see much on on the screen but that didn't mean anything it was it could be just the machine um she said it was great that i wasn't cramping eventually gave me a an injection because i'm rh negative so because of the blood loss to make sure I didn't have any complications with that. And they sort of sent me with a one pager, sent me on my way, which just sort of said, you know, if you start experiencing extreme bleeding, like filling a pad more an hour at a time, come back to the ER. Otherwise you should get a phone call tomorrow with the early pregnancy clinic.

So at that point, you still didn't know for sure that you were miscarrying? Correct. Wow. And so did you go back to that appointment the next day? So the next day, they called me to make the appointment, but it wasn't until the Friday. So it was two days after I'd gone to the hospital that I was actually seen by the early pregnancy clinic. And the blood loss had dissipated quite a bit. So again, we weren't really sure what was happening. And we went in there and that's when I had an internal ultrasound and sort of said to the technician, you know, we're not sure if we're going to see two babies, one baby, no baby, like we're not sure what's

happening. And she did the internal and just said to me, I see nothing resembling fetuses here. What was that like? What was that moment like? That was pretty devastating. I mean, it had been over a year and a half that we'd started trying to get pregnant. We'd spent a lot of money on this process. It was, I was almost, like it was 11 and a half weeks. I was almost at the second trimester. We thought we were in the clear. It was also sort of devastating to realize that I've probably passed both fetuses in the washroom and the toilet was an automatic flush. So like, there was never an opportunity to sort of gather fetal tissue and find out what happened or anything like that. How did you get through those days between thinking something was happening before learning that in fact you were right, your worst

fear had happened? So I did have a therapist that I'd been seeing sort of on and off for the last, like, let's say 10 years. And I hadn't seen her for a couple of years, but I called her and said, like, can you fit me in? And we basically just sort of, my wife stayed home from work, I stayed home from work, and we just sort of watched mindless TV, snuggled with our dog and tried to just like not think about things too much. I mean, it was very hard because every time I went to the washroom, there was this panic and anxiety of like, is something else going to happen? So it was very stressful. Having been through that experience, you and your wife, what gaps do you see? I mean, they're pretty evident just by your story, but what changes do you think we might have here in Canada that allows for people in your situation to receive better care, better emotional care, even knowing what was happening? Yeah, I think just being told that there were supports out there.

So I had to Google to try to find support. I ended up having to call my cousin's wife, who's a nurse, the night that my miscarriage was confirmed to kind of ask her to walk me through the physical symptoms and steps of what could happen next. It would have been helpful

if that was clearly said to me, like, these are the organizations you can reach out to for support. Caitlin, we're just about out of time here, but I want to end on a happier note if that was clearly said to me, like these are the organizations you can reach out to for support. Caitlin, we're just about out of time here, but I want to end on a happier note because how are you doing today? We're doing well. My wife gave birth to her son Theo six months ago.

So that's been very healing and exciting for us. How is he? I understand his name is Theodore. Theodore, yes. So he is great. He's smiley. He's super large. He's super large. He's very tall for his age and is just bringing so much joy to both of us.

Well, congratulations to you and your wife, Caitlin. Thank you for speaking with us. Thank you. Caitlin Geiger-Bardswich experienced a miscarriage when she was 12 weeks pregnant. We reached her in Ottawa. In 2017, it felt like drugs were everywhere in the news. So I started a podcast called On Drugs. We covered a lot of ground over two seasons,

but there are still so many more stories to tell. I'm Jeff Turner, and I'm back with season three of On Drugs. And this time, it's going to get personal. I don't know who Sober Jeff is. I don't even know if I like that guy. On Drugs is available now wherever you get your podcasts. Dr. Catherine Varner is an emergency physician in Toronto, and she wrote the editorial that went with the review of early pregnancy loss in the Canadian Medical Association Journal. Dr. Varner, hello.

Hi, Rebecca. Thanks so much for having me. When you listen to Caitlin's story, what do you think? I understand it's not an uncommon experience. Well, first, I'm grateful to both Nicole and Caitlin for sharing what must be experiences that are difficult to revisit. We know through research in this area are far more common than we'd like to think. What does your report, what does the report reveal about how Canada's health care system currently manages these sorts of cases? It reveals that like a lot of patient populations who feel abandoned by the health care system, They are relying heavily on the emergency department to seek

and receive care. And these, in particular for patients who are experiencing symptoms of early pregnancy loss, are not an optimal environment because of the long waits and overcrowded waiting rooms and the unfortunate events like Caitlin described of experiencing a miscarriage, not understanding and not being told what's happening and not having clear description of what to expect next, what the follow-up plan will be. Is the gap then mostly in emotional care or are there questions around a woman's safety during a miscarriage? I mean, is there ever a time that it could be dangerous to the woman's health? So unfortunately, I think it's both. We've been doing research in early pregnancy care and emergency medicine. And in Canada, what we find is that patients are at risk of both physical trauma as well as psychological trauma through the experience

of miscarriage because of inadequate follow-up care and because of the difficulty of seeking care at that first instance of when people start having symptoms of early pregnancy loss. So like Nicole's story, it's when a patient starts having pain or bleeding, it's very important to have an ultrasound to see if there's a possibility of an ectopic pregnancy. And when an early pregnancy is not seen, which is a common scenario, it's critically important for that patient to have urgent follow-up. Why are so many women experiencing early pregnancy loss? Why are they ending up in ERs? Physicians may not have access to timely diagnostic imaging like ultrasound and also blood work that is necessary for caring for this patient population. People don't expect to have symptoms of bleeding and pain in early pregnancy. And so when they start having symptoms, they are often not quite sure what to do, who to call.

And if they call phone numbers like 811 or telehealth, they're often told to attend an emergency department. And how equipped are ER healthcare providers in helping a person who's dealing with pregnancy loss? Emergency physicians are often most skilled in the care of patients who are experiencing life-threatening emergencies. So most skilled in caring for the patient who is having a ruptured ectopic pregnancy or a massive hemorrhage related to pregnancy loss. And many emergency departments and emergency medicine training programs don't focus on the compassionate care that's necessary and providing care to patients who are experiencing early pregnancy complications and loss. So there in the research shows a mismatch in what

the providers are trained and how to care for patients with symptoms of early pregnancy loss. It is often to exclude that life-threatening condition like an ectopic pregnancy, whereas patients' needs and psychological needs in particular in this area go far beyond than what they receive in an emergency department setting. I know the Canadian Medical Association Journal is calling for a more streamlined approach, something called early pregnancy assessment centers or EPACs. Tell us a little bit more about what they are and how they actually already exist in other parts of the world and are used quite frequently. It's interesting when we

speak to researchers and emergency physicians in places like the UK or the Netherlands, they'll say they never see this patient population in their emergency department. And it's because they have access to a self-referral pathway to early pregnancy care. So when a patient starts having symptoms of early pregnancy loss, like spotting, bleeding, or pain, they can go directly, even out of hours, to a clinic where they'll see a midwife or a nurse practitioner or a physician who is skilled in the care of early pregnancy assessment. who is skilled in the care of early pregnancy assessment,

and they have their ultrasound at that clinic where they receive the information about what is happening in their pregnancy. And if it's unclear, then follow-up care is set up with them. And so it's a much more compassionate environment. You know, it sounds like a wonderful thing that women, that people should have access to these early pregnancy assessment centers. But when we know there are 6 million Canadians without a family doctor right now, is it more of a nice to have than a need to have? The research shows that the psychological impact of early pregnancy loss, rates of anxiety, depression and PTSD can last beyond a year, especially when patients'

experiences are difficult. I think it speaks to the need for more streamlined access to care. And what the evaluations of the early pregnancy assessment clinics have shown in other places is that they're economically advantageous in addition to having better patient outcomes. And just before you go, what happens if we don't fix this problem, that women who are miscarrying don't have access to this kind of care? I think the societal impact is quite unmeasured, but the impact on patients' psychological health, we know that the research shows that their future relationships with future offspring can be challenged by traumatic experiences with early pregnancy loss, as well as

patients' ability to get back to their normal lives after an early pregnancy loss is quite affected. And so not attending to their care needs during the acute time has prolonged effects on their ability to return to work and also on their relationships with their family. Dr. Catherine Varner, thank you for taking the time this morning. Thank you so much for having me. Dr. Catherine Varner is an emergency physician in Toronto and deputy editor of the Canadian Medical Association Journal. For more CBC Podcasts, go to cbc.ca slash podcasts.