Laura Payton and her four-year-old daughter, Ciara. Payton went through a miscarriage in 2019 and believes more could be done to support patients.Ashley Fraser/The Globe and Mail
Laura Payton remembers going into a bathroom at an emergency room in Ottawa with blood-drenched clothes. She miscarried in December, 2019.
Ms. Payton was 39 at the time. She saw bleeding begin a few days earlier, but it was so light, she wasn’t concerned about losing her pregnancy at 13 weeks. The cramping that began on a Sunday evening intensified to the point where she needed urgent medical care, prompting the ER visit.
Tens of thousands like Ms. Payton miscarry every year in Canada, and losses prior to the 20th week of gestation are estimated to affect between 15 and 25 per cent of all pregnancies.
Gynecologists say the fallout is not only physical, but also psychological. Patients are at higher risk for depression, anxiety and post-traumatic stress.
On Monday, the Society of Obstetricians and Gynaecologists of Canada will issue new clinical guidelines for early pregnancy loss that are designed to improve care for patients. The recommendations include a call for more early pregnancy assessment clinics to be established across the country, similar to the ones in Britain that improve care and reduce waiting times.
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The SOGC guidelines, set to be published in its medical journal, also will recommend that patients who experience loss receive mental health screening and support if needed.
“I think one of the things that is coming to the forefront, or we realize now, is the impact that these early losses have on women,“ said SOGC president Lynn Murphy-Kaulbeck, who has specialized in maternal fetal medicine for more than 20 years. ”I think they’ve been minimized in the past.“
Dr. Murphy-Kaulbeck said compassionate care is often overlooked, particularly at an emergency room but also at other locations not equipped to help patients.
“I’ve heard from women who have sat and actually bled in the emergency room and then walked into the public washroom and passed a fetus,“ she said. ”That’s not okay.”
Payton has written about her experience with miscarriage and says more support in emergency rooms would make a ‘huge difference.’Ashley Fraser/The Globe and Mail
This is what happened to Ms. Payton. The journalist turned communications professional wrote about her experience, including how a hospital staff member came to help her clean up in a bathroom, while she folded a fetus into a cloth in her hand.
Loss is hard enough, she said, but the situation is worsened in a swamped emergency room where staff must attend to other urgent-care issues.
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Looking back, she said the health care workers who helped her were sensitive to what she was going through. But she believes that having a place to go where someone could walk her through the experience would have made a “huge difference.”
Modupe Tunde-Byass, an obstetrician and gynecologist, says emergency rooms are not built to support patients suffering from pregnancy complications and loss.
She works at North York General Hospital’s Early Pregnancy Assessment Clinic, where urgent care is offered to patients up to 20 weeks pregnant and who are experiencing symptoms such as bleeding, abdominal pain and cramping.
Dr. Tunde-Byass said the SOGC guidelines legitimize efforts to design better care for patients.
Dr. Modupe Tunde-Byass, an obstetrician and gynecologist in North York, Toronto, says the SOGC guidelines legitimize efforts to design better care for patients.Laura Proctor/The Globe and Mail
Trained in Britain, where early pregnancy clinics were available in the 1990s, Dr. Tunde-Byass saw a gap when she came to practice in Canada. She started at North York General in 2004 and began the early pregnancy assessment clinic then.
A team works with patients three days a week. A nurse collects patient history before they are seen by a gynecologist. An ultrasound is performed. An emphasis is also placed on psychological supports.
Last fall, Dr. Tunde-Byass and fellow researchers wrote in the Canadian Medical Association Journal about how psychological effects or pregnancy loss can be “mitigated by empathetic communication and supportive follow-up.”
Health care providers, they said, should not underestimate the role of compassionate care in patient assessment and management.
For medical management, the SOGC’s new clinical guideline will say that patients should be able to access two medications, mifepristone and misoprostol, free of charge.
In July, 2015, Health Canada approved Mifegymiso, the brand name for mifepristone and misoprostol. The medications are commonly dubbed “the abortion pill” but are taken separately. Typically, misoprostol is taken within 24 to 48 hours after mifepristone.
Dr. Murphy-Kaulbeck hopes the new SOGC clinical guidelines will see patients being able to receive appropriate physical and psychological care while they experience pregnancy loss.
“These guidelines are sorely needed.”
