N.W.T. woman says undiagnosed miscarriage could have cost her life
'I was just another native woman that had had too many kids and just wanted to go on a trip'
When Theresa Kakfwi was told she was nine weeks pregnant this past autumn, she knew not to get too excited. The 37-year-old had already had multiple miscarriages, one for which she was hospitalized.
What Kakfwi didn't know was that the fetus had already died and a delay in diagnosis could potentially cost her her life.
The mother of seven says she was ignored by health care professionals in Norman Wells, N.W.T., when she told them she thought her baby had died.
Kakfwi says she asked repeatedly for further tests, including an ultrasound in Yellowknife, to confirm her baby was still alive. But she says nurses in the community told her it was too early and that everything was fine.
"It was like I didn't know what I was talking about," Kakfwi says of how she was treated.
"I was just another native woman that had had too many kids and just wanted to go on a trip. I felt that."
'Something is wrong'
Kakfwi found out she was pregnant in September when she was visiting family in her home community of Colville Lake, N.W.T. She says a nurse there told her she was nine weeks along.
When she returned home to Norman Wells a few days later, she visited the local health centre. She says she informed the nurses of her previous miscarriages but was told everything looked normal and that it was too early to hear her baby's heartbeat.
A few days later, Kakfwi says, she began to feel like something was wrong.
"There are certain things — your body changes. I know all of those because I've been pregnant so many times," says Kakfwi.
"And these were things that weren't happening. I had lost weight."
Kakfwi says she saw nurses in Norman Wells two more times in the following two weeks.
She says she told the nurses: "'Something is wrong. I feel like this pregnancy has come to a stop. I feel like I am no longer pregnant.' I used those exact words."
Kakfwi says in 2009, while living in Fort Smith, she had her first miscarriage. It caused excessive bleeding and she was hospitalized. Every miscarriage she has had since then was followed by a dilation and curettage (D&C), a common surgical procedure that removes fetal tissue from a woman's uterus. The American Pregnancy Association says D&C is the most common procedure to stop bleeding and infection after a miscarriage.
Diagnosed while in Calgary
When she was 14 weeks pregnant, Kakfwi went to Calgary for a conference. While there, she visited a doctor and underwent an ultrasound.
The results confirmed her worst fears: the fetus had died seven weeks prior.
According to Kakfwi, the doctor asked if she would like to have an immediate D&C, but exhausted, upset and alone in the city, she refused the procedure. She says she planned to get the procedure done a few days later while she was in Edmonton visiting family.
"It's hard to make people understand if you haven't been through it," she says of refusing the procedure.
"It's not like losing a child you see, but you still lost a child that you carried. It was a lot to take in."
Two days later, while in Edmonton, Kakfwi had a natural miscarriage. She was rushed to the emergency room after she collapsed. Kakfwi says she had an emergency D&C after doctors told her she had lost too much blood.
According to Kakfwi, had her miscarriage been diagnosed when she sought care in the N.W.T., she could have received treatment earlier and avoided what became a potentially life-threatening situation.
She worries about what would have happened if she had miscarried in Norman Wells instead of Edmonton.
"I felt that had this happened when I was here [Norman Wells] it would be a different story," she says. "I know how long medevacs take."
The N.W.T. Department of Health and Social Services refuses to comment on specific cases. Leigh Wells with the Stanton Territorial Health Authority told the CBC in an email that an ultrasound is performed "in early pregnancy" to determine the baby's due date. She added that a second ultrasound is done around 18-20 weeks, to "visualize the anatomy of the fetus."
Guidelines from the Society of Obstetricians and Gynaecologists of Canada says, ideally, every pregnant woman should be offered a dating ultrasound — to assess how far along the pregnancy is and predict a due date — in their first trimester or 12 weeks into the pregnancy.
But Dr. Sujata Chandra, a maternal fetal medicine specialist at the University of Alberta, says generally women with high-risk pregnancies have ultrasounds much earlier.
"For women who have had multiple miscarriages, general practice would be to offer an early ultrasound at seven or eight weeks to assess the viability and gestational age of the fetus," Chandra said.
Kakfwi only received her first ultrasound 15 weeks into her pregnancy when she was in Calgary.
Left with bills
Kakfwi says she is feeling better but is now struggling to pay bills resulting from her health crisis in Edmonton. She says she received a $600 bill for the ambulance ride and had to pay to have her flights changed twice while she was in the hospital.
Kakfwi says she hopes health professionals in small N.W.T. communities will learn from her story.
"They should listen to their patients more," she says.