Warning: This story includes details about miscarriage and early pregnancy loss.
‘I was really nervous about it,” Laura Payton recalls, reflecting on a 2020 essay she wrote online describing her miscarriage in 2019.
Just a day after she became 13 weeks pregnant, Payton visited an emergency room in Ottawa after experiencing intense cramps that would eventually lead to the loss of her unborn child.
Her account of unexpected pain, heavy bleeding and the “fullness of her experience” quickly became a lifeline for readers, who like her had struggled to find anything beyond clinical terms for early pregnancy loss (EPL).
“I had been so desperate for this kind of information when I was going through it,” Payton told CTVNews.ca in an interview Tuesday.
“I feel like I have a more profound understanding of the number of people affected by it,” Payton says.
Payton unfortunately isn’t the only one. According to the Society of Obstetricians and Gynaecologists of Canada (SOGC), early loss occurs in about 15 per cent of pregnancies. The society also adds that early pregnancy loss can lead to “significant psychological distress, including post-traumatic stress disorder.”
“When you’re trying to get pregnant or if it’s an unanticipated pregnancy, it’s a private thing. If you experience a loss in either of those situations, that also tends to be a private thing. And so, we don’t talk about it enough,” Payton says.
While alone in the washroom of the emergency room triage, Payton says that’s when the fetus passed through. “That was the most painful thing I’ve experienced in my life. And I mean that emotionally,” she said.
She remembers vividly what a health-care worker told her: “‘This doesn’t dimmish the value of your baby,’” Payton recounts. “I still think of that moment because she knew exactly what to say and I could feel the passion in her voice that she really emphasized with it.”
Now, five years after Payton’s loss, a Canadian gynecologist organization has issued new national clinical guidelines designed to improve the diagnosis and treatment of early pregnancy loss.
The guideline, published Monday in the Journal of Obstetrics and Gynaecology of Canada, suggests best practices for identifying and managing miscarriages that occur in the first trimester.
What’s new in the guideline?
The SOGC’s guide spotlights the emotional and psychological toll of a miscarriage and calls for compassionate communication and trauma-informed care.
It says health-care providers should make patients aware that most early pregnancy loss is not preventable or treatable and that feelings of isolation and self-blame are common.
“We are seeing different levels of emotional complications from acute grief, self-blame to things like anxiety, depression, PTSD,” Toronto-based OBGYN Modupe Tunde-Byass told CTVNews.ca in an interview Tuesday. “Once you miss the emotional aspect, it’s very difficult to recover from losses, and most times we don’t ask, we don’t screen for it,” she added.
Health-care providers are urged to validate patient experiences, provide clear explanations on next steps and offer referrals to mental health-care providers when needed.
Payton said despite the busyness of the emergency room, in the end she felt the support of health-care workers.
“There are resources that we can link our patients to,” Tunde-Byass said, while also noting that health-care workers undergo bereavement training.
The SOGC guide also said clinicians should screen patients diagnosed with pregnancy loss for depression.
The society is calling for more Early Pregnancy Assessment Clinics, or EPACs, within Canada, which serve as an alternative to emergency departments for women experiencing symptoms of pregnancy loss.
“Women who are undergoing complications that are not urgent can be seen through a walk-in clinic dedicated for this purpose,” Tunde-Byass said. She explained that this approach allows women to receive care in a comfortable environment where they can fully express their experiences and make informed decisions about their treatment.
The SOGC’s updated recommendations give specific criteria for confirming early pregnancy loss using ultrasound and hormone testing. Clinicians are also advised to proceed with caution and ensure that viable pregnancies are not misdiagnosed.
The goal is to avoid unnecessary delays or premature decisions that could lead to emotional distress or medical complications, the guide says.
Payton hopes that governments are listening because these recommendations require funding.
“Having EPACs is not going to be cheap,” she says. “I hope that it would alleviate some of the emergency room weights and backlogs that we’re dealing with.”
Tunde-Byass hopes EPACs can become a standard of care across Canada like having a colonoscopy or endoscopy in every hospital. “We’re not talking about breaking the bank,” she insists. “We’re talking about leveraging existing resources.”
The model could be implemented with minimal additional infrastructure – a dedicated room, trained staff and access to ultrasound services, she explained.
The guideline is particularly crucial for rural areas, where access to specialized care can be limited. “Everywhere in Canada, it’s important that wherever you live, wherever you are, your care should not be different,” Tunde-Byass emphasized.
The SOGC also proposed three management options: expectant management (waiting for a natural resolution); medical management (using medication to simulate a natural process); and surgical management.
Post-miscarriage care
Payton explains that “when all you’re leaving with is a brochure, you don’t feel cared for the way you do when you’re with somebody like a health-care worker.”
In cases when the placenta doesn’t pass through during a miscarriage, that tissue needs to be removed through a procedure. “The follow-up care is very medical in nature,” Payton says.
The SOGC cites in its guide that, “Adverse mental health outcomes are common in EPL and are present in up to 30 per cent of people one month after experiencing EPL.”
Tunde-Byass said it’s not limited to the person undergoing the loss – it also affects the partner and existing children.
The SOGC says clinicians should consider the need for time off for grieving patients and offer psychological support resources.
“I hadn’t anticipated the depth of the grief because I hadn’t really talked to friends who had gone through it,” Payton says.
For those in similar circumstances, Payton doesn’t shy away from the pain. “It’s going to be a really tough time in your life. Take care of yourself, accept all the help that friends and family offer you. Don’t be afraid to talk about it.”
“The silver lining for me is that then it gives you the experience to be able to help and support others. I want people to be prepared.” Payton adds.
Tunde-Byass says health-care professionals need to merge what is done medically with how patients feel.
“They shouldn’t have to feel guilty,” she said. “They shouldn’t have to think they’re wasting anybody’s time.”
