ER not best place to treat miscarriages: letter to patient

Barb
Barb Sweet
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A decade ago, hospital officials in St. John’s acknowledged the drawbacks of the emergency room as a place to treat patients suffering miscarriages.

Emergency rooms, such as this one at St. Clare's in St. John's, usually have time to deal with children if a parent feels their child needs help. It's better to be safe than sorry, says Dr. Simon Hoogewerf, head of emergency departments at south Vancouver Island hospitals. - Telegram file photo

“We know the emergency de­part­ment is not the ideal place to treat these people and we have now established an early pregnancy unit,” a patient relations officer for the then St. John’s Health Care Corp. wrote to a woman who had complained about the way her miscarriage was handled in 2003.

The official referenced the unit as being among initiatives to improve supports for patients and families undergoing miscarriage and other pregnancy problems.

The letter from the corporation — which was amalgamated into Eastern Health in 2005 — acknowledged the “psychological impact of a pregnancy loss” and promised efforts would be made to ensure “the most suitable location possible.”

Eastern Health does operate an early pregnancy assessment clinic for women fewer than 20 weeks pregnant. Patients suffering some abnormal symptoms can be referr­ed by a family doctor or obstetrician, or even the ER, but the clinic — part of the women’s health clinic — isn’t intended to treat miscarriag­es, according to a spokeswoman.

The patient who received the 2003 letter told her story to The Telegram last week in outrage after reading about recent patients who are concerned about miscarriages being treated in emergency, particularly at the Health Sciences Centre.

In the last few weeks, more than a dozen people — women who suffered miscarriages and some spouses of patients who had gone through the ordeal — contacted The Telegram after a story appeared about an expectant mother who in August, at nine weeks pregnant, waited in the ER, told a nurse her bleeding and pain were getting worse and finally miscarried in a toilet in the ER area.

Days later, she found out a nurse on duty, backed by the opinion of a colleague, made the decision to flush the remains, she said. Meanwhile, she waited in a room for hours.

Overwhelmingly, those who have contacted The Telegram about their personal experiences have express­ed dismay at being treated in the ER, where they say the emotional trauma of their pregnancy ending falls by the wayside.

According to current Eastern Health policy, women who are less than 20 weeks pregnant are first assessed in the ER; women who are 20 weeks or more along in their pregnancy are sent to the labour and delivery unit for assessment. So are women who don’t know how far along they are.

All patients in the emergency room — where cases run the gamut of injuries, viruses, illnesses and trauma — are triaged to ensure the most urgent are seen first.

Eastern Health said a pregnant woman who presents with bleeding needs an ER assessment to see if it’s related to the pregnancy or not.

When the Mount Pearl woman, upset about her emergency room ordeal in 2003, contacted the then St. John’s Health Care Corp. about her concerns, administrators set up a meeting with her.

And in April that year, the woman received a followup letter in which the city-based health authority said, “As was discussed during our meeting, we intend to implement certain changes in our practices as a result of your feedback.”

The woman said after she first spoke to The Telegram, she went looking on the weekend for the correspondence, long ago packed away in boxes. The documents included a letter advising her a meeting would take place as well as the followup letter.

“I sat down in my basement, sat back and I read them,” the woman said Monday.

“This letter I had gotten 10 years ago had brought me peace that I had made a difference at that particular time. … (Now) I feel like I have been told what I wanted to hear to shut me up and move on.”

Among those changes supposed to take place in 2003 were:

• Providing support for women who have just been informed that their pregnancy will end. Through this measure, a staff member was to accompany and support the patient and there was to be a place where patients could go for privacy while dealing with their loss.

• An information sheet was to be passed to women who suffered miscarriages about what is normal or abnormal.

“We understand this is a stressful time and much of the verbal information given by the doctor may not be remembered,” the letter said.

Patients were also supposed to be given a phone number for a nurse in the women’s health clinic they could speak to for advice if they had concerns.

• Patients were also to be offered bereavement supports and the support of a psychologist for counselling.

According to Eastern Health’s current policy, when a miscarriage occurs, emergency department staff can consult the psychiatric nurse on duty to support a patient who is in crisis, and there are full-time social work staff in the city’s hospitals.

Patients are also supposed to be offered the number for its mental-health crisis line, where support can be provided and a referral made for counselling.

However, most of the patients who contacted The Telegram said they were not offered any of those services, not even the mental-health crisis line phone number.

An Eastern Health spokeswoman said Monday informational material — including brochures, fact sheets and contact information — are handed out at the early pregancy clinic.

But the authority encourages women who experience heavy bleeding to go to emergency.

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Read the full letter here.

Organizations: The Telegram, Health Care

Geographic location: Eastern Health, Mount Pearl

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Recent comments

  • Michelle Noftall-Andersen
    December 18, 2013 - 05:19

    I myself went through the same fate in July of 2007. After a 13 hr visit to the ER of which the first 6 hrs was spent curled up in racks of pain in the ER waiting room on the uncomfortable chairs hemorraging and 2 trips to bathroom to change blood soaked clothes....continuous complaining to triage the pain and bleeding was worse where after 6 hrs they finally moved me into an overflow room inside where after a couple more hrs of waiting an intern finally took blood and examined me and got a Dr who examined me as well and confirmed I had a miscarriage. At which point they told me I had to have a shot and they moved me into another room that had another patient in there. At no point was I shown any compassion or told about any type of grief counselling. I was left in the other room for another couple of hrs to wait for the shot. The only other interaction I had with staff while waiting was that a nurse came in and told me to keep down the noise because the patient in the next bed hadn't slept all night....what they called so called noise was me crying from the pain and despair, much later they came in and gave me the shot then released me without as much as a kind word...so to say there not equipped to handle miscarriages is a mild understatement....but this lady's encounter was in 2003 mine 2007, 4 yrs later they were made aware of the problems in the system obviously they don't want to change them ....very sad indeed

  • J
    November 19, 2013 - 19:54

    I had a miscarriage at 5 weeks just last Wednesday. I went to the ER waited 2 hours, was poked, examined and told well your not really that pregnant so its probably an early miscarriage. I was referred to the Early Pregnancy Clinic for later that day. They did an ultrasound and I was told nothing except to go get blood work done for the next three days to see what was happening, I was not rescheduled at the clinic but left to try to get into see my family DR for results. Later that day back to the ER as the pain and bleeding became worse. Again, 2 hour wait, to which I was finally told your uterus is empty, you weren't really that pregnant at 5 weeks go home and it should all be over in 5-7 days. I was given no information or phone numbers. Nothing.

  • The Hurting never stops
    November 19, 2013 - 10:19

    Its nice to know that some good has already come from our stories fror the last two weeks in the Telegram....at least Catherine was advised of an early pregnancy clinic and the attempt was made to get an appointment, it sounds like the staff also treated her better....but this is just lip service to what we hav gotten out there as survivors of having a miscarriage at the ER. Wonder how long Eastern Health will keep their act together? I give it a month maybe two then is will go back to as it was (if not worse). I hope and pray that Eastern Health has changed for good and respect and treat those women experiencing such loss. My advise to al pregnant women, if you get mistreated or disrespected, complain....get the media involved and get your word out there......maybe things will not change in time for us to see but what about our daughters? Maybe they will see a better experience at Emergency Rooms for miscarriages.

  • Catherine
    November 19, 2013 - 09:07

    I had a miscarriage 6 weeks ago when I was 10 weeks pregnant, I started spotting on a Friday, went to the ER on Saturday lunch time, I finally got in to see a Dr. around 7 pm, I did not get a handout , they did try to get me into the early pregnancy clinic for Monday but there was no appointment available and I was told to come back to ER the next day, which I did, they did an ultrasound and they set up an appt for me to get seen at the early pregnancy clinic for Tuesday and sent me home. In the meantime I ended up miscarrying at home on Monday by myself which was very painful and emotional, the health care system really does need a better way to deal with this situation!

  • Catherine
    November 19, 2013 - 08:57

    I had a miscarriage 6 weeks ago when I was 10 weeks pregnant, I started spotting on a Friday, went to the ER on Saturday lunch time, I finally got in to see a Dr. around 7 pm, I did not get a handout , they did try to get me into the early pregnancy clinic for Monday but there was no appointment available and I was told to come back to ER the next day, which I did, they did an ultrasound and they set up an appt for me to get seen at the early pregnancy clinic for Tuesday and sent me home. In the meantime I ended up miscarrying at home on Monday by myself which was very painful and emotional, the health care system really does need a better way to deal with this situation!