Former miscarriage patients look forward to promised changes

Barb Sweet bsweet@thetelegram.com
Published on December 3, 2013
The entrance to the emergency department at the Health Sciences Centre in St. John’s.
— Photo by Joe Gibbons/The Telegram

Some women who told their miscarriage stories to The Telegram are glad to see Eastern Health has taken action, but they are cautious about the promise.

Eastern Health said Tuesday it has asked staff to make sure psychosocial support is offered to women who miscarry.

That request was made as the health authority discusses the concerns of women who have gone through the experience. Numerous women and their spouses — nearly 20 people — have contacted The Telegram, and the newspaper has been telling some of those stories over the past month. Most of them involved the Health Sciences Centre ER in St. John's.

I hope it does change. I really do have high hopes, but not necessarily high expectation," said the first woman to contact The Telegram about her miscarriage experience.

"It's something that needs to be talked about. The situations and the unfortunate circumstances need to be in the forefront, need to be talked about constantly."

In August, at nine weeks' pregnant, the woman waited in the Health Sciences ER, told a nurse her bleeding and pain were getting worse, and finally miscarried in a toilet.

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.

The woman said the health-care system is reactive rather than proactive, but she hopes change will finally occur.

"You can have all the protocol you want. None of it matters if you don't follow it," she said Tuesday.

When she first emailed this reporter in November, she said she didn't expect any interest in her concerns, let alone the issue to be pursued and responded to by many more who'd had similar experiences.

"I didn't expect it to be on the front page with a graphic-content label. But I am so glad it was there. It brought shame to Eastern Health like it should," she said.

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

Women 20 weeks pregnant or more suffering miscarriages go to the labour unit, while those under 20 weeks are advised to go to the ER for assessment. Many of those who told their stories described the treatment as emotionally harsh, as they left the ER with no information about their recovery.

Some women who had ongoing physical symptoms — such as the passing of the remains of their pregnancy — felt they had not been adequately prepared for what was happening to them.

Eastern Health's existing policy when a miscarriage occurs suggests emergency department staff can consult the psychiatric nurse on duty to support a patient 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 Eastern Health's mental-health crisis line, where support can be provided and a referral made for counselling.

But many who contacted The Telegram said they did not receive as much as a phone number.

Monday, The Telegram asked if any changes were being made to address the patients' concerns.

Eastern Health said Tuesday it is discussing women's care and trying to ascertain why the protocol was not always followed previously.

"Discussions around the care of women experiencing a miscarriage are currently ongoing; however Eastern Health has asked its staff to ensure that psychosocial support is offered to women following a miscarriage," Eastern Health said in an emailed reply.

"On a regular basis, Eastern Health reviews its policies and protocols to improve the quality of care for its patients. It should be noted that changing a policy or protocol may require extensive discussion and research and, as such, can take time."

Among the people who contacted The Telegram in the past month was a Mount Pearl woman who'd complained a decade ago to the then St. John's Health Care Corp.

At the time, she attended a meeting and received a followup letter that acknowledged the ER isn't the ideal place for patients to be treated for miscarriages.

It also acknowledged the psychological impact of the ordeal and promised a number of changes.

That woman said she lost faith in the health authority after reading The Telegram's stories.

"The only way I can gain trust back in the system we have is once I start hearing stories that they have changed and they are making a difference," she said.

"I have heard this before. Are they going to do something about it or is this just a tactic right now?"

She hopes women will come forward in six months or a year's time to tell about their experiences, good and bad, and that Eastern Health will be open about any changes it makes to services for patients who suffer miscarriages.

"I am actually really happy with all the women who have spoken out. It takes a lot of courage to come forth with this kind of tragedy in their lives," she said of Telegram coverage.

"I had a chance to tell my story and I am glad so many other women did."

Another woman, who had a miscarriage in September, said she'll believe change has happened when she sees examples.

"I really hope they follow through. No one should have to go through that again," she said.

Candace Piercey of New Harbour contacted The Telegram this week about her 2009 experience at the Carbonear hospital, because she hopes things will be easier for other patients in the future.

"That day and night was the worst night of my life and I had never felt so unimportant in my life," she said.

"It's a horrible experience to go through, and to feel like you shouldn't even be there in the hospital ...

"I didn't see no compassion. ... Health care needs to change their policies."

 

bsweet@thetelegram.com

•••

(Tuesday story)

Eastern Health has asked its staff to make sure psychosocial support is offered to women who miscarry, a spokeswoman told The Telegram today.

That request has been made as the health authority discusses the concerns of women who have gone through the experience. Numerous women and their spouses have contacted The Telegram and the newspaper has been telling their stories for weeks.

 A common thread among the stories is their concern about having to go to the ER for treatment — women pregnant 20 weeks or more suffering miscarriages go to the labour unit — and the lack of support they were offered in the wake of their losses. Many described the treatment as emotionally harsh as they left the ER with no direction as to their recovery. Some women who had ongoing physical symptoms — such as the passing of the remains of their pregnancy — felt they had not been adequately prepared for what was happening to them.

Eastern Health’s existing policy when a miscarriage occurs, suggests emergency department staff can consult the psychiatric nurse on duty to support a patient 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 Eastern Health’s mental-health crisis line, where support can be provided and a referral made for counselling.

But many who contacted The Telegram said they did not receive as much as a phone number.

Monday, The Telegram asked if any changes were being made to address those concerns.

Eastern Health said this morning it is discussing women’s care and why the protocol was not always followed previously.

"Discussions around the care of women experiencing a miscarriage are currently ongoing; however Eastern Health has asked its staff to ensure that psychosocial support is offered to women following a miscarriage,” Eastern Health said in an emailed reply.

“On a regular basis, Eastern Health reviews its policies and protocols to improve the quality of care for its patients. It should be noted that changing a policy or protocol may require extensive discussion and research and, as such, can take time."

 The health authority also said anyone who has questions or concerns about the care they received can contact their client relations office toll-free at 1-877-444-1399, or at 709-777-6500.

 •••

(Earlier story)

Women implore Eastern Health to act on miscarriage complaints

Two more women who have contacted The Telegram about their miscarriage experiences want to know what Eastern Health is doing to ensure all women who lose their pregnancy are treated with equal compassion.

“I don’t know if they’re trying too hard to be professional that they end up coming off as cold,” a

St. John’s woman said of the health-care staff she encountered.

“But there is absolutely no compassion.”

The woman contacted The Telegram after reading of similar experiences — at least 15 people have raised concerns directly as a result of the initial story of a woman suffering a miscarriage in a bathroom outside the Health Sciences emergency room this summer.

Among the latest to come foward, a woman who said she miscarried in 2010, went to the

St. Clare’s emergency room and was referred for an ultrasound at the Janeway. She thought she was around 11 weeks pregnant at the time. While having the diagnostic test, a student technician was in the room, which the woman found jarring when the technician pointed out an abnormality to the student.

Next, a doctor informed her the scan showed an eight-week-old fetus with no heartbeat.

“I am still appalled at the cold, callous treatment I received, and the fact that, like so many of these other women, nothing was given to me — no crisis number to call, no visit from a counsellor or nurse even though I was literally breaking down in that exam room, no information on what to do. My husband and I left the exam room and had to walk past several very pregnant, happy-looking mothers in the waiting room as I sobbed the whole way back to my car,” the woman said.

“Care in both the ER and the Janeway ultrasound clinic seriously needs to be reassessed, as these are two places in the health-care system where expectant mothers, no matter how far along, can literally have their hearts broken.”

The woman said she will never forget the starkness of the experience, along with the grief and said every woman who goes through it should be handed an information packet on miscarriages.

Sure women can Google some information, but they may not know what websites are trustworthy and coming from the doctor, it is a measure of care and following up on the situation that takes little of the physician’s time, she said.

When women give birth, she noted, they receive a package that tells them what to expect and the same should be done when they lose their pregnancy.

“For a woman trying to have a baby, the second you see a positive on the pregnancy test, there’s a baby inside of you,” the woman said. “When you take a loss, whether it’s full term or six or seven weeks, you’re grieving it the same way. (Nurses and doctors) don’t look at you that way. It’s another ailment.”

According to Eastern Health protocol, women 20 weeks pregnant and over are referred to the labour unit, while those less than 20 weeks along are advised to go to the ER for assessment.

In the woman’s case, she had a wait of weeks to see her family doctor, so went to the ER when she experienced some bleeding.

For another metro woman, the ordeal started out in St. John’s in 2011 and ended at the Grand Bank hospital.

Her boyfriend brought her to the Health Sciences Centre and she was given a referral to the women’s health clinic for the next day.

The doctor informed her the fetus was dead and gave her three choices — take a pill to speed up the process, have a dilation and curettage (D and C) — a procedure to scrape and collect tissue in the uterus — or let it happen naturally. The woman decided to let nature run its course and had been planning to visit family on the Burin Peninsula and was told to proceed with her trip.

But then she experienced unbearable pain for which she was unprepared and her father called the Grand Bank hospital.

“I thought I was bleeding to death,” the woman said. “I was totally blindsided.”

She passed what she thought was the baby’s remains and then was told to wrap it in tissue, which she brought to the hospital. But she said she recalls seeing the remains on the table next to her being put in the garbage by staff “as if it was nothing.”

“Through this ordeal I felt the doctors and nurses failed me and didn’t take the time out of their day to explain what I was about to experience,” said the woman.

“To doctors and nurses when you are not in your second trimester, you’re not really pregnant. … If you are pregnant, no matter how many weeks along, you should go to the caseroom.”

The woman said she and others like her deserve an apology from Eastern Health and assurances the treatment will change so there is compassion and a recognition of the emotional effect of the loss.

Eastern Health’s current policy, when a miscarriage occurs, suggests 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 Eastern Health’s mental-health crisis line, where support can be provided and a referral made for counselling.

But most of the women who contacted The Telegram said they did not receive as much as a phone number.