'I felt really stranded': B.C. woman says she struggled to access care after miscarriage

When Ivana Horacek suspected she was losing her pregnancy last October, the worry was unbearable.

As it turned out, her struggle to find the care she needed was even worse. 

"I felt really stranded," said the Port Moody resident. "There was nothing, nothing that anybody would do."

According to Doctors of B.C., 10 to 15 per cent of all pregnancies end in miscarriage, but Horacek says there are inadequate resources for women going through what can be a frightening and upsetting ordeal. 

Horacek says she was unable to get timely, compassionate medical attention. Her miscarriage involved several hours spent waiting in an emergency room, unreturned phone calls to clinics and, eventually, a visit to an obstetrician that was possible only because of a personal connection.

And she's not alone. Dr. Kathleen Ross, president of Doctors of B.C., said that while Horacek's experience was a "deviation from the usual course of treatment," she has heard of similar cases recently in the Tri-Cities area.

Non-viable pregnancy

Horacek's concerns began with spotting seven weeks into her pregnancy. An early ultrasound showed a heartbeat, but also showed the embryo was smaller than normal.

She was still spotting several days later and, on her midwife's advice, went to the emergency room after learning it could take as long as three days to get into the Early Pregnancy Assessment Clinic (EPAC) in Surrey. 

Horacek had several waits as long as five hours in the emergency room at Royal Columbian Hospital over the next two days.

Since Horacek wasn't critically ill, the ER didn't seem like the appropriate place to be, she said. 

"They knew why I was there, but there was absolutely no empathy at all," she said.

Once a doctor had diagnosed her pregnancy as non-viable, Horacek struggled to find follow-up care.

She was worried the miscarriage might take weeks to happen on its own, or that there might be tissue left behind, which could cause complications or delay her attempts to get pregnant again.

Horacek, 40, says she felt she had no time to waste.

But the ER doctor said she was not a candidate for either a surgical or pharmaceutical treatment to end the pregnancy.

Long waits and unreturned calls

Her midwife referred her to the EPACs in Surrey and Vancouver but they said it would be up to two weeks before she could get an appointment. She was advised to call abortion clinics but was warned the focus of those clinics is different than that of an EPAC.

She called two, but says she was unable to get through. 

Since she didn't have a family doctor, Horacek had to use a personal connection to get an appointment with an obstetrician. That doctor prescribed pharmaceutical treatment to end the pregnancy, and referred her for follow-up counselling at the Surrey EPAC. But Horacek never heard back from the clinic. 

"There should be people out there that can help women through this without women having to fight for themselves to this extent," said Horacek. "Just because [miscarriage] is common, doesn't make it normal and doesn't mean it should be normalized and treated like it doesn't really matter."

In an emailed response, Fraser Health said the Surrey EPAC strives to see patients within three to five business days, and patients with more urgent needs are given priority. They said they're currently able to see all referred patients within five days. 

The Provincial Health Services Authority said the EPAC located at B.C. Women's Hospital in Vancouver aims to see patients within two business days of a referral, and the wait time is currently within 48 hours. 

'We can do better'

Ross, president of Doctors of B.C., said the ER was the best place for Horacek to go to ensure there weren't serious complications. But she said physicians unfamiliar with treatments for non-viable pregnancies may not feel qualified to prescribe them, and may not be able to offer the necessary follow-up. 

Ideally, she said, a woman in Horacek's position would be able to access a primary care network. Doctors of B.C. is working with the Ministry of Health to establish these networks of connected physicians, midwives, nurse practitioners, physiotherapists, and counsellors that work together as a team. 

Ross also emphasized the need for health-care providers to understand the psychological aspects of pregnancy loss. 

"Certainly having women left on their own to navigate the system ... would not do much to support them emotionally as they went through this. We can do better," she said.

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