Early Pregnancy Assessment Centre in Saskatoon

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I will be sending this letter to the City of Saskatoon and MLA alongside other Saskatchewan women who have had similar experiences. I will also be sending a copy to both hospitals.

I am looking for support by way of signatures, so please let me know if you would like to sign with me on this letter and we will arrange to do so.

December 11, 2017

Dear Saskatoon,

I have been a Saskatoon resident for the past 7 years. I became pregnant for the first time in April 2017. I was 5 weeks pregnant when I found out. I was having some light spotting, which is not necessarily abnormal in early pregnancy. I took a test, told my husband, and booked an appointment with a doctor, who confirmed I was pregnant. She was concerned about my spotting and send me for an ultrasound and a referral to an obstetrician downtown. I was reassured that my pregnancy was normal and healthy by all accounts. I received WinRho as a precautionary measure, due to the bleeding.

A few days later at 10:30 pm, I started to have heavy bleeding and pain, right before the Easter long weekend. Many emotions emerged: I was confused as to whether I was losing the baby and I didn’t know what was happening or what it would mean. I called my mom – although it has no genetic relationship and is unrelated to my experience, she had many miscarriages before becoming pregnant – and she confirmed that she thought I may be miscarrying. In tears, my husband and I drove to the Royal University Hospital.

Wondering what would be done for me, I was admitted into emergency and to my surprise, asked to wait in the pediatric emergency unit. Apparently, this is where nonemergent adults are sent. The Registered Nurse assigned to me was 40 weeks pregnant. I understand how this may have been a difficult position for her to be in, but I do not see it as an excuse for the care I received that night. My husband and I were given a room and my vital signs were taken. The nurse ignored us for the rest of the night, aside from coming in to check my vitals again once. She offered no support, no comfort, and completely ignored us. She had loud conversations with other health care providers outside the door about her baby and pregnancy, and spoke about how excited she was that this was her last shift. I understand what it is like to be in a busy hospital setting. I am about to become a graduate nurse this month. I understand that time is limited. I even understand that she was in an uncomfortable position. I do not see these as excuses to avoid providing appropriate, responsive, in the moment care. Better training is a must.

We arrived at 10:45 pm and were in an extremely uncomfortable exam room, listening to sick children crying for several hours while losing my own, and waiting to see a doctor until 3:30 am. I had to track down a nurse myself to ask for more pads for the bleeding because there were none in their bathrooms. I understand long wait times and the busy pace and environment, especially in emergency medicine. But in that moment, I had no idea why I had been told nothing about what was going on or what was happening to me, and I had no idea why I was even there. I felt that I could do a better job of caring for myself in the comfort of my own home if I was indeed miscarrying. I asked my husband if we could leave and go home many times, but he was understandably concerned for my welfare, and wanted me seen, and so I stayed.

At 3:30 am, a very tired emergency doctor came to see us. The first thing he asked us was whether he had seen us or not already. He wouldn’t look us in the eye, offered no supportive words, and told me that I was probably having a threatened miscarriage. He said we could wait for an ultrasound, but that it would probably take a very long time and wasn’t worth the wait. I decided to use a referral I had been given to get an ultrasound elsewhere. I was exhausted, angry, and confused as to why I had even bothered going in.

I spent the next day trying to get an ultrasound appointment but there are no ultrasound clinics open in Saskatoon on the weekend except specialty 3D image clinics that refused me as their area of expertise was in women who were pregnant, healthy, and well rather than miscarrying. I was not technically emergent and did not feel it was appropriate to scope out walk-ins to see if they would ultrasound me, which left me in a sort of limbo. I could not have gotten an ultrasound until the following Tuesday. All of the information I received between this time on miscarriage was on the internet. If I had not been a student nurse, I likely would have been quite misinformed on the subject.

A few days into the weekend, I started having even heavier bleeding and more pain. I soaked two pads in a very short period of time and didn’t know whether I should be concerned. Since it was during the day and it was open, I decided to go with my husband to Saskatoon City Hospital. Half an hour later I was in a room, and forty-five minutes later we were seen. The doctor who saw us that day was kind and compassionate. He used the ultrasound machine available to them to confirm that I had indeed miscarried. Although I was starting to understand that it had happened, it helped to hear the words and have it confirmed. They drew blood and confirmed that my Hcg levels had dropped as well. The obviously experienced doctor apologized needlessly for the short wait, acknowledged my loss, and instilled hope for the future, all in the short five minutes that he saw us. I left feeling much differently than I had in my previous experience.

Today is my due date, and I want it to be meaningful. Healing has been a long road, first physically and then emotionally. I found support in friends and family, and I discovered a supportive online group for Saskatchewan women who have experienced early miscarriage. I am not the only one who has had this type of experience right here in Saskatoon. There are others. As a future nurse, I believe we can do better.

Approximately one in five pregnant women will have a miscarriage (SOGC). Miscarriage is most common in the first 8 weeks (SHA) but can occur up to 20 weeks. Intense grieving often follows miscarriage (HealthLink BC). This type of loss is very different from other types of loss including stillbirth, and needs to be approached with nurses, doctors, and other staff who are trained to respond to it. An Early Pregnancy Assessment Clinic by referral for non-emergent women, of which one function is to assess women experiencing possible miscarriage signs, is already in effect in Regina. We would like to see something similar in Saskatoon. Research on women with early miscarriage in Canada and Saskatchewan is woefully lacking, and a centre such as this would help us address the unique needs of these women.

Although miscarriage can be a medical emergency, it is most often not. However, I can tell you from personal experience that these women are still in crisis, and healthcare providers responding to them at point of care can influence how traumatic this experience will become for them and prepare them for the long road ahead. My story is not the most traumatic story I have heard. Although I will not discount my own very painful loss, there are other women who were pregnant longer, experienced more miscarriages, had to have surgery to evacuate their long-gone baby, and have been treated even worse because of their culture or race, or other healthcare barriers.

The number one thing I have heard most women say about their miscarriage is, people do not understand what we have been through. I think this is extraordinarily true. Our job as health care providers may not be to fully understand, but it is our responsibility to respond to the needs of women experiencing miscarriages. Some common themes I have identified are denial, confusion, and lack of support. In keeping with these themes, I offer two suggestions:

1) Create an evidence-based, helpful pamphlet to send with women experiencing early miscarriage. Recognizing the possibility of loss or true loss, providing accurate information from an appropriate source, and anticipating the long-term effects and the need for information and supports is important to this population.

2) Create an Early Pregnancy Assessment Clinic with trained and responsive staff that is able to meet the needs of women with possible symptoms of or with threatened and confirmed miscarriages with the example set by Regina. Meeting these women in the crisis they are experiencing will enable them to prevent loss when possible as well as access the right supports and grieve appropriately when loss occurs.

Meeting these needs will improve the health of women in Saskatoon and surrounding Saskatchewan area through appropriate health care provider responses, provide opportunity for much needed research to improve the needs of these women in our population, and build the capacity of women who have experienced this type of loss by empowering and supporting them.

Signed,

Rene Gustus



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