Seeking help during early pregnancy loss can mean waiting hours in a Halifax ER

Lauren Howe knew something was dangerously wrong when she started having a miscarriage at her Lucasville, N.S., home earlier this month, but she hesitated to call an ambulance.

The Grade 9 teacher and mother of three-year-old twinsdreaded what would happen after she arrived at the hospital. She'd been through it before.

Because there's no adult emergency department at theIWK Health Centre in Halifax, people in the areaseekingurgent medical carebefore they're 20 weeks pregnant must gototheHalifax Infirmary's emergency department.

It can meanwaiting hours in abusy place at a very difficult and vulnerable time.

"We don't talk about it, and I understand why," said Howe. She was seated next to her husband, Nick, during an interview at their home.

"It's a lot easier not to talk about it but there's so many women in the city going through it, and there's a huge, huge, huge problem in our medical-care system that these women are not being seen unless they're 20 weeks pregnant."

On March 3, Howe saidshe waited 14 hours at the Halifax Infirmaryonly to have an IWK doctor visit her thereand tell her she needed to be transferred to the IWKfor a 20-minute procedure.

Not all people who experience pregnancyloss will need emergency care, but Howe said those who do deserve tobe seen by reproductive health specialists right away. She'scalling for an adult emergency department to be set up at the IWK.

From the Cobequid,to the QEII, to the IWK

The Howes havebeen through the grief and trauma of pregnancy loss four times.

Howe hashad three ectopic pregnancies, which iswhen the fertilized egg grows outside the uterus, often in one of thefallopian tubes. It can be dangerous for both the mother and the health of the pregnancy.

The Howessaid each timethey called an ambulance,they were first taken to the Cobequid Community Health Centre, the closest emergency department to them. From there, they were taken by ambulance to the Halifax Infirmary, and finally to the IWK.

The couple learned at their eight-week ultrasound in late Februarythat the latest pregnancy had been lost,and knew a miscarriage would follow.

Knowing how long she'd waited to receive care in the past, Howe said she was relieved when paramedicstook her straight to theIWKearlier this month.

But she said when the ambulance arrived, they were told she couldn'tbe admitted and would need to go to the Halifax Infirmary instead.

Howe said the emergency department was packed that night as she waited on a stretcher in the hall for fourhours before beingtransferred to a waiting room, where she sat for another two hours.

"I was crying to the nurses saying, you know, 'I'm losing a lot of blood. I can't sit up straight. I need to be laying down,' and it was basically just, 'Well, there's nowhere we can put you,'" she said.

In a letter Howesent to the hospital about her experience, she said when a nurse finally arrived to take her to theroom, she questioned loudly if Howe was"the girl having the miscarriage."

Going through it alone

She was also going through this allalone because her husbandhad been told he couldn't join her due to COVID-19 protocols.

Nova Scotia Health said visitor rules changed in late February, and exceptions are nowmadefor people who need a support person when they visit emergency. But it is at the discretion of staff if the department is overcapacity, the health authority said.

"Just being stuck, and being helpless and waiting in the waiting room for, you know, two hours after they told me I couldn't be there," said Nick.

Howe was admitted around6:30 p.m. and said she saw the ER doctor around 4 a.m., who called the IWK. When the doctor from the IWK arrived about 45 minutes later sheconfirmed what Howe knew all along.

"She said, 'Yeah, we need to bring you up to the IWK,' and I just looked at her and I said, 'Of course you do, that's where I should have been taken from the very beginning.'"

When she thinks about finally arriving at the IWK, she begins to cry.

"It's a huge relief by the time you get there because you're greeted with the nurturing, loving, like it makes me emotional because women should get that from the beginning. They shouldn't have to go through all the hoops to get there."

About 20 hours after she left home, Howe said she saw a doctor at the IWK who performed a 20-minute procedure known as dilation and curettage, or D&C. She recovered for an hour and was sent home.

"This last time I just said, 'I'm not going to leave today and just forget about this and leave this all unsaid,"' she said.

Certified doula Caet Moir, who supports people and partners experiencing pregnancy loss, said she's heard similar experiences from several clients who've waited hours at the Halifax Infirmary, andfelt dismissed or overlooked.

Many people assume the IWK is the place they should go if they're having a miscarriage, she added.

"You're already upset and worried and scared, being able to just go to one place and know that you have the best care in the province there is probably the best thing for you," said Moir, whoowns Novadia Creative Wellness in Windsor but worked in Halifax for many years.

She said while one in four pregnancies will end ina miscarriage, it's rarely talked about openly.

Safest place is the Halifax Infirmary, says IWK

No one from the IWK Health Centre was made available for an interview this week. In an email, a spokesperson said the centre is not equipped to treat emergency cases because it doesn't have an adult emergency department, an ICU or a Level 1 operating room.

"The safest care for a woman arriving by EHS in the central zone is to be assessed in an emergency department where emergency care is readily available if needed," wrote Ben Maycock.

Maycock said some patients experiencing pregnancy loss aretransferred from the Halifax Infirmaryto the IWK, as was the case with Howe, but that it's not routinely done.

The Department of Health and Wellnesssaid an adult emergency department at the IWK is not being considered at this time.

"Pregnancies under 20 weeks are assessed at emergency departments because potential complications at this earlier stage may not be related to the pregnancy," the department said.

Dr. Mary-LynnWatson, an emergency physician at the Halifax Infirmary, is also the newly appointed medical director for the emergency department's quality and safety committee.

She said the committee recently began looking into"alternatives to how we provide care and support for patients who are experiencing pregnancy loss," but saysit's too soon to determinewhat those alternativescould be.

While Watson said she couldn't speak to Howe's case due to privacy reasons, her letter"potentially did expedite" the decision to reviewthis issue.

"As an institution I think we need to try to determine why we were unable to provide the care that they felt we should be able to provide, and the expectations of our patients are very important to us," Watson said.

Watson said it's rare for patients to betransferredto the IWK, but it does happen if they need anoperation or ifcomplications arise that can't be treatedat the Infirmary.More often, she said patients dealing with pregnancy loss are treated byemergencystaff or asked to go home and return for reassessment.

In some cases, they may be sent to aclinic at the IWK, which is only open during weekdays, Watson said.

"If you are experiencing bleeding or an emergent issue with your pregnancy, and you are less than 20 weeks gestation ... we are the place where you need to be," Watson said.