At five months pregnant, Claudia Wong knew it was normal to be uncomfortable some of the time. But she couldn’t shake the feeling something was wrong.
The Pickering, Ont., woman had already gained about 14 pounds, significant on her small frame. She’d become so swollen her legs were “like sausages” when she tried to put on pants. Her vision sometimes blurred.
Wong, who works in health care, mentioned everything to her obstetrician, but said she was told to “watch and wait.”
One night in October 2019, Wong had painful, fiery heartburn that no amount of antacid would dispel. She considered going to the hospital, but “it just felt like another thing that people would have brushed off,” she explained.
Instead, she and her husband, Denis Beaulne, checked into a float spa to relax. When Wong took a long time in the change room, the attendant unlocked the door and Beaulne found his wife passed out in the shower.
When she was five months pregnant in 2019, Claudia Wong became concerned about unusual weight gain, swelling and high blood pressure. (Submitted by Claudia Wong)
They went to a Durham-region hospital and waited several hours. Suddenly, as Beaulne watched in horror, his wife’s arm shot out violently. Then she began convulsing and foaming at the mouth.
Wong had eclampsia, one of the most common severe complications women experience during pregnancy. It’s a blood-pressure condition that ranges in severity and sometimes leads to death. Wong had many typical symptoms that had gone untreated for weeks.
“For someone else, my weight gain may not have been significant. For someone else, my blood pressure may not have been significant,” she recalled.
“But for me, I almost died.”
Wong later suffered a seizure due to the blood pressure disorder eclampsia. (Submitted by Claudia Wong)
Most maternal deaths preventable, experts say
Near misses like Wong’s happen in Canada every day, but maternal health experts say they don’t have to. Deaths of mothers are less common, but doctors are sounding the alarm that there are no consistent or reliable systems here to collect and share information on maternal deaths and close calls. It’s particularly tragic, they say, because most deaths and adverse outcomes are preventable. It also means mothers in Canada die from conditions like pre-eclampsia that no longer kill women in countries with better maternal health monitoring systems.
Dr. Jon Barrett, chair of McMaster University’s obstetrics department, has been advocating for such a system for two decades.
“It’s like having a near-miss aircraft crash at Pearson Airport, or one of the other major airports and not … trying to find out: What have we learned from it to avoid the next time?”
It’s like having a near-miss aircraft crash at Pearson Airport and not … trying to find out: What have we learned from it to avoid the next time?– Jon Barrett, chair of the department of obstetrics and gynecology at McMaster University
Patti Farnan doesn’t know if her daughter Kayla’s death was investigated, if anyone learned from it, or if it could have been prevented.
In January 2017, two and a half years before Wong’s seizure in a Toronto-area ER, 25-year-old Kayla Farnan had a seizure in a Niagara-region recovery ward.
She had just given birth to her first child by emergency C-section.
When her mother heard the code blue and saw medical staff running toward her daughter, she knew her worst fears had been confirmed.
Kayla Farnan had high blood pressure, headaches and nausea during her pregnancy, according to her mother. (Submitted by Patti Farnan)
Kayla’s pregnancy had been difficult, she said. Her daughter often complained she didn’t feel well and had frequent headaches, swelling and nausea.
“I was worried about her,” Farnan said. “I did have a gut feeling that things weren’t quite right.”
Kayla’s blood pressure was also high and she was told to monitor it, but was never put on medication, her mother said.
Like Wong, Kayla had been pre-eclamptic and undiagnosed. In her case, she developed HELLP Syndrome, one of the most severe forms of pre-eclampsia. HELLP stands for hemolysis — the destruction of red blood cells — elevated liver enzymes and low platelets. A blood clot the size of a baseball had formed in her brain.
The family only learned of Kayla’s diagnosis after she was sent to a trauma hospital for emergency brain surgery.
“And then we started doing research on HELLP and she checked every single box,” Farnan said. “I couldn’t believe it.”
Kayla never regained consciousness after the brain surgery. A week later, the family made the devastating decision to remove life support.
When Farnan looks back on it, she wishes she’d been more forceful in her demands that Kayla receive closer medical attention.
“Be vigilant for your daughters,” she said. “This needs to be taken seriously. Somebody died. And I’m sure she’s not the only one.”
Patti Farnan wonders if her daughter Kayla’s death could have been prevented. (Chelsea Gomez/CBC)
Some women’s deaths aren’t counted, doctors say
Kayla Farnan isn’t the only one. According to Statistics Canada, 523 women died from complications of pregnancy or childbirth between 2000 and 2020.
But Canada’s count of maternal deaths is so incomplete that Dr. Jocelynn Cook, the chief scientific officer of the Society of Obstetricians and Gynecologists of Canada (SOGC), says no one really knows how many mothers die during pregnancy or in the months after.
She says the true number is probably closer to 800, possibly higher.
She’s not alone in her suspicion that Canada undercounts the deaths of mothers.
This country’s data is so incomplete that an international report by the World Health Organization (WHO), UNICEF and others estimates Canada’s maternal mortality rate to be as much as 60 per cent higher than what is reported by StatsCan.
If those estimates are correct, Canada’s maternal mortality rate, while still low by global standards, was in the top third of countries in the Organization for Economic Co-operation and Development (OECD) in 2017 — and was double the rate of other high-income countries such as the Netherlands, Ireland and Japan.
The holes in Canada’s system
There are a number of reasons the death of a mother might slip through the cracks, Cook explains. Canada’s national maternal death count is calculated from death certificates. A death is considered maternal if it has been flagged as either a death of a pregnant woman or a woman in postpartum. But experts told CBC that these forms are routinely filled in incorrectly.
Even what counts as a maternal death is different depending on the province or territory where it happened.
Some provinces use WHO’s definition of up to 42 days after the end of pregnancy. Others count up to a year postpartum. Others may not count the postpartum period at all.
Only six provinces have mandated maternal death reviews, which means that if a woman dies in the other seven Canadian provinces or territories, her death will not be independently investigated.
“If we don’t capture information the same way across systems, if we don’t ask the same questions, we’re never going to be able to really understand what’s happening,” said Cook.
She has created a checklist to help provinces record consistent information when maternal deaths happen.
“We do know from the data from other countries that … a significant proportion of those cases are preventable,” Cook said. “And nobody wants anybody to die.”
Dr. Jocelynn Cook, chief scientific officer of the Society of Obstetricians and Gynecologists of Canada, is trying to standardize the information collected by provinces about maternal deaths. (Chelsea Gomez/CBC)
U.K. system a global model
In the U.K., maternal deaths have been tracked and investigated by the country’s MBRRACE monitoring program since 1952. Whenever a woman dies in her childbearing years, the team checks to see if she gave birth in the last year, says Dr. Marian Knight, a professor of maternal and child population health at the University of Oxford, and leader of the program.
“If we didn’t do that, we would potentially miss up to half of the maternal deaths that occur in the U.K. because … if you die by suicide, the fact that you have a six month old baby wouldn’t necessarily be written … on that death certificate.”
The law requires that maternal deaths to be reported to Knight’s team, and results from the confidential investigations are distributed widely.
Another U.K. program investigates near misses. One of its successes has been the virtual elimination of deaths related to pre-eclampsia, which killed Farnan and caused Wong to seizure. This is because recommendations around blood pressure control and fluid intake were written into national guidelines, Knight explains.
“It’s transformed the picture for women with pre-eclampsia,” she said.
Collecting lessons from close calls
After she had the seizure, Wong was airlifted to a Toronto hospital, where she had an emergency C-section.
Her daughter Sophie was born at just 750 grams and spent more than two months in intensive care.
Wong’s daughter, Sophie, was born weighing just 750 grams. (Submitted by Claudia Wong)
As someone who lives with the trauma of her daughter’s birth and the lasting impacts of eclampsia, which included a detached retina and changes to her brain, Wong wonders whether any of it could have been avoided.
“The worst part, I think, is the moral injury of seeing that there’s something that could work and then knowing that that doesn’t exist here,” she reflected. “Why doesn’t it exist here?”
Studying close-call cases like Wong’s is the life’s work of Dr. Rohan D’Souza, an associate professor of obstetrics and gynecology at McMaster University.
“They can tell you not only what factors resulted in these adverse outcomes, but also tell you what measures were put into place to prevent mortality and worse outcomes from happening.”
There is no point in having state-of-the-art review systems and keeping the knowledge to ourselves.– Dr. Rohan D’Souza, associate professor of obstetrics and gynecology at McMaster University
For D’Souza, surviving birth shouldn’t be the only goal.
He says women often suffer life-changing consequences including losing their babies, incontinence, pelvic trauma, emergency hysterectomies, and psychological trauma.
When a near miss happens, hospitals often do internal reviews, but that information isn’t made public.
“There is no point in having state-of-the-art review systems and keeping the knowledge to ourselves,” he said. “If it could happen in one institution, it can happen in another institution.”
D’Souza is working to establish a national surveillance system to determine what the most common complications of pregnancy are and collect lessons every doctor can learn from.
Dr. Rohan D’Souza studies serious pregnancy complications at McMaster University in Hamilton. (Chelsea Gomez/CBC )
‘Somebody else’s issue’
In Canada, health care is a provincial responsibility. This means the federal government has no authority to mandate independent investigations into maternal deaths and near misses in each province, according to the Public Health Agency of Canada.
The department declined an interview request, but said in an emailed statement that it’s working to improve its understanding of maternal health by linking datasets on hospitalizations, vital statistics and the census. This will help policy makers understand how factors such as ethnicity and income affect maternal health, the statement said.
“However, these initiatives do not involve medical practitioners confidentially sharing information on maternal deaths or near misses.”
Dr. Jon Barrett, a high-risk obstetrician at Hamilton’s McMaster University and the chair of the university’s obstetrics department, has been advocating for a better maternal health monitoring system in Canada for two decades. (Submitted by Jon Barrett)
Barrett, who trained in the U.K., says he recognizes the fact that health care in Canada is a provincial responsibility poses challenges for re-creating the U.K.’s top-down system here.
But he says a national problem requires a national solution.
“I think that’s part of the reason we haven’t really got our act together, is everyone saying it’s somebody else’s issue. I think women have not been prioritized,” said Barrett. “I really believe it is an equity issue in terms of the correct amount of emphasis given to maternal health.”
It was such a disgrace that we lost my daughter in such a way that it could have been salvageable. She could still be here.– Patti Farnan
For Patti Farnan, any changes will come too late.
“It was such a disgrace that we lost my daughter in such a way that it could have been salvageable,” she said. “She could still be here.”
“It needs to change, and my selfish reason is that Kayla’s death has to count for something.”
Patti Farnan meditates in a park in her hometown of Burlington, Ont. (Chelsea Gomez/CBC)
PHOENIX (AP) — Arizona voters have approved a constitutional amendment guaranteeing abortion access up to fetal viability, typically after 21 weeks — a major win for advocates of the measure in the presidential battleground state who have been seeking to expand access beyond the current 15-week limit.
Arizona was one of nine states with abortion on the ballot. Democrats have centered abortion rights in their campaigns since the U.S. Supreme Court overturned Roe v. Wade in 2022. Abortion-rights supporters prevailed in all seven abortion ballot questions in 2022 and 2023, including in conservative-leaning states.
Arizona for Abortion Access, the coalition leading the state campaign, gathered well over the 383,923 signatures required to put it on the ballot, and the secretary of state’s office verified that enough were valid. The coalition far outpaced the opposition campaign, It Goes Too Far, in fundraising. The opposing campaign argued the measure was too far-reaching and cited its own polling in saying a majority of Arizonans support the 15-week limit. The measure allows post-viability abortions if they are necessary to protect the life or physical or mental health of the mother.
Access to abortion has been a cloudy issue in Arizona. In April, the state Supreme Court cleared the way for the enforcement of a long-dormant 1864 law banning nearly all abortions. The state Legislature swiftly repealed it.
Voters in Arizona are divided on abortion. Maddy Pennell, a junior at Arizona State University, said the possibility of a near-total abortion ban made her “depressed” and strengthened her desire to vote for the abortion ballot measure.
“I feel very strongly about having access to abortion,” she said.
Kyle Lee, an independent Arizona voter, does not support the abortion ballot measure.
“All abortion is pretty much, in my opinion, murder from beginning to end,” Lee said.
The Civil War-era ban also shaped the contours of tight legislative races. State Sen. Shawnna Bolick and state Rep. Matt Gress are among the handful of vulnerable Republican incumbents in competitive districts who crossed party lines to give the repeal vote the final push — a vote that will be tested as both parties vie for control of the narrowly GOP-held state Legislature.
Both of the Phoenix-area lawmakers were rebuked by some of their Republican colleagues for siding with Democrats. Gress made a motion on the House floor to initiate the repeal of the 1864 law. Bolick, explaining her repeal vote to her Senate colleagues, gave a 20-minute floor speech describing her three difficult pregnancies.
While Gress was first elected to his seat in 2022, Bolick is facing voters for the first time. She was appointed by the Maricopa County Board of Supervisors to fill a seat vacancy in 2023. She has not emphasized her role in the repeal vote as she has campaigned, instead playing up traditional conservative issues — one of her signs reads “Bolick Backs the Blue.”
Voters rejected a measure to eliminate retention elections for state Superior Court judges and Supreme Court justices.
The measure was put on the ballot by Republican legislators hoping to protect two conservative justices up for a routine retention vote who favored allowing the Civil War-era ban to be enforced — Shawnna Bolick’s husband, Supreme Court Justice Clint Bolick, and Justice Kathryn Hackett King. Since the measure did not pass, both are still vulnerable to voter ouster, though those races hadn’t been decided by early Wednesday morning.
Under the existing system, voters decide every four to six years whether judges and justices should remain on the bench. The proposed measure would have allowed the judges and justices to stay on the bench without a popular vote unless one is triggered by felony convictions, crimes involving fraud and dishonesty, personal bankruptcy or mortgage foreclosure.
OMAHA, Neb. (AP) — Nebraska voters supported a measure Tuesday that enshrines the state’s current ban on abortions after the 12th week of pregnancy in the state constitution, and they rejected a competing measure that sought to expand abortion rights. Nebraska was the first state to have competing abortion amendments on the same ballot since the U.S. Supreme Court overturned Roe v. Wade in 2022, ending the nationwide right to abortion and allowing states to decide for themselves. The dueling measures were among a record number of petition-initiated measures on Nebraska’s ballot Tuesday.
What were the competing abortion measures?
A majority of voters supported a measure enshrining the state’s current ban on abortion after the first 12 weeks of pregnancy in the state constitution. The measure will also allow for further restrictions. Last year, the Legislature passed the 12-week ban, which includes exceptions for cases of rape and incest and to protect the life of the pregnant woman.
Voters rejected the other abortion measure. If they had passed it by a larger number of “for” votes than the 12-week measure, it would have amended the constitution to guarantee the right to have an abortion until viability — the standard under Roe that is the point at which a fetus might survive outside the womb. Some babies can survive with medical help after 21 weeks of gestation.
Abortion was on the ballot in several other states, as well. Coming into the election, voters in all seven states that had decided on abortion-related ballot measures since the reversal of Roe had favored abortion rights, including in some conservative states.
Who is behind the Nebraska abortion measures?
The 12-week ban measure was bankrolled by some of Nebraska’s wealthiest people, including Republican Sen. Pete Ricketts, who previously served as governor and donated more than $1.1 million. His mother, Marlene Ricketts, gave $4 million to the cause. Members of the Peed family, which owns publishing company Sandhills Global, also gave $1 million.
The effort was organized under the name Protect Women and Children and was heavily backed by religious organizations, including the Nebraska Catholic Conference, a lobbying group that has organized rallies, phone banks and community townhalls to drum up support for the measure.
The effort to enshrine viability as the standard was called Protect Our Rights Nebraska and had the backing of several medical, advocacy and social justice groups. Planned Parenthood donated nearly $1 million to the cause, with the American Civil Liberties Union, I Be Black Girl, Nebraska Appleseed and the Women’s Fund of Omaha also contributing significantly to the roughly $3.7 million raised by Protect Our Rights.
What other initiatives were on Nebraska’s ballot?
Nebraska voters approved two measures Tuesday that will create a system for the use and manufacture of medical marijuana, if the measures survive an ongoing legal challenge.
The measures legalize the possession and use of medical marijuana, and allow for the manufacture, distribution and delivery of the drug. One would let patients and caregivers possess up to 5 ounces (142 grams) of marijuana if recommended by a doctor. The other would create the Nebraska Medical Cannabis Commission, which would oversee the private groups that would manufacture and dispense the drug.
Those initiatives were challenged over allegations that the petition campaign that put them on the ballot broke election rules. Nebraska’s attorney general said supporters of the measures may have submitted several thousand invalid signatures, and one man has been charged in connection with 164 allegedly fraudulent signatures. That means a judge could still invalidate the measures.
Voters also opted Tuesday to repeal a new conservative-backed law that allocates millions of dollars in taxpayer money to fund private school tuition.
Finally, they approved a measure that will require all Nebraska employers to provide at least 40 hours of paid sick leave to their employees.
WASHINGTON (AP) — Voters in Missouri cleared the way to undo one of the nation’s most restrictive abortion bans in one of seven victories for abortion rights advocates, while Florida, Nebraska and South Dakota defeated similar constitutional amendments, leaving bans in place.
Abortion rights amendments also passed in Arizona, Colorado, Maryland and Montana. Nevada voters also approved an amendment, but they’ll need to pass it again it 2026 for it to take effect. Another that bans discrimination on the basis of “pregnancy outcomes” prevailed in New York.
The results include firsts for the abortion landscape, which underwent a seismic shift in 2022 when the U.S. Supreme Court overturned Roe v. Wade, a ruling that ended a nationwide right to abortion and cleared the way for bans to take effect in most Republican-controlled states.
They also came in the same election that Republican Donald Trump won the presidency. Among his inconsistent positions on abortion has been an insistence that it’s an issue best left to the states. Still, the president can have a major impact on abortion policy through executive action.
In the meantime, Missouri is positioned to be the first state where a vote will undo a ban on abortion at all stages of pregnancy, with an amendment that would allow lawmakers to restrict abortions only past the point of a fetus’ viability — usually considered after 21 weeks, although there’s no exact defined time frame.
But the ban, and other restrictive laws, are not automatically repealed. Advocates now have to ask courts to overturn laws to square with the new amendment.
“Today, Missourians made history and sent a clear message: decisions around pregnancy, including abortion, birth control, and miscarriage care are personal and private and should be left up to patients and their families, not politicians,” Rachel Sweet, campaign manager of Missourians for Constitutional Freedom, said in a statement.
Roughly half of Missouri’s voters said abortion should be legal in all or most cases, according to AP VoteCast, a survey of more than 2,200 of the state’s voters. But only about 1 in 10 said abortion should be illegal in all cases; nearly 4 in 10 said abortion should be illegal in most cases.
Bans remain in place in three states after votes
Florida, Nebraska and South Dakota became the first states since Roe was overturned where abortion opponents prevailed on a ballot measure. Most voters supported the Florida measure, but it fell short of the required 60% to pass constitutional amendments in the state. Most states require a simple majority.
The result was a political win for Gov. Ron DeSantis, a Republican with a national profile, who had steered state GOP funds to the cause. His administration has weighed in, too, with a campaign against the measure, investigators questioning people who signed petitions to add it to the ballot and threats to TV stations that aired one commercial supporting it.
Marjorie Dannenfelser, president of the national anti-abortion group SBA Pro-Life America, said in a statement that the result is “a momentous victory for life in Florida and for our entire country,” praising DeSantis for leading the charge against the measure.
The defeat makes permanent a shift in the Southern abortion landscape that began when the state’s six-week ban took effect in May. That removed Florida as a destination for abortion for many women from nearby states with deeper bans and also led to far more women from the state traveling to obtain abortion. The nearest states with looser restrictions are North Carolina and Virginia — hundreds of miles away.
“The reality is because of Florida’s constitution a minority of Florida voters have decided Amendment 4 will not be adopted,” said Lauren Brenzel, campaign director for the Yes on 4 Campaign said while wiping away tears. “The reality is a majority of Floridians just voted to end Florida’s abortion ban.”
In South Dakota, another state with a ban on abortion throughout pregnancy with some exceptions, the defeat of an abortion measure was more decisive. It would have allowed some regulations related to the health of the woman after 12 weeks. Because of that wrinkle, most national abortion-rights groups did not support it.
Voters in Nebraska adopted a measure that allows more abortion restrictions and enshrines the state’s current 12-week ban and rejected a competing measure that would have ensured abortion rights.
Other states guaranteed abortion rights
Arizona’s amendment will mean replacing the current law that bans abortion after the first 15 weeks of pregnancy. The new measure ensures abortion access until viability. A ballot measure there gained momentum after a state Supreme Court ruling in April found that the state could enforce a strict abortion ban adopted in 1864. Some GOP lawmakers joined with Democrats to repeal the law before it could be enforced.
In Maryland, the abortion rights amendment is a legal change that won’t make an immediate difference to abortion access in a state that already allows it.
It’s a similar situation in Montana, where abortion is already legal until viability.
The Colorado measure exceeded the 55% of support required to pass. Besides enshrining access, it also undoes an earlier amendment that barred using state and local government funding for abortion, opening the possibility of state Medicaid and government employee insurance plans covering care.
A New York equal rights law that abortion rights group say will bolster abortion rights also passed. It doesn’t contain the word “abortion” but rather bans discrimination on the basis of “pregnancy outcomes, and reproductive healthcare and autonomy.” Sasha Ahuja, campaign director of New Yorkers for Equal Rights, called the result “a monumental victory for all New Yorkers” and a vote against opponents who she says used misleading parental rights and anti-trans messages to thwart the measure.
The results end a win streak for abortion-rights advocates
Until Tuesday, abortion rights advocates had prevailed on all seven measures that have appeared on statewide ballots since the fall of Roe.
The abortion rights campaigns have a big fundraising advantage this year. Their opponents’ efforts are focused on portraying the amendments as too extreme rather than abortion as immoral.
Currently, 13 states are enforcing bans at all stages of pregnancy, with some exceptions. Four more bar abortion in most cases after about six weeks of pregnancy — before women often realize they’re pregnant. Despite the bans, the number of monthly abortions in the U.S. has risen slightly, because of the growing use of abortion pills and organized efforts to help women travel for abortion. Still, advocates say the bans have reduced access, especially for lower-income and minority residents of the states with bans.
The issue is resonating with voters. About one-fourth said abortion policy was the single most important factor for their vote, according to AP VoteCast, a sweeping survey of more than 110,000 voters nationwide. Close to half said it was an important factor, but not the most important. Just over 1 in 10 said it was a minor factor.
The outcomes of ballot initiatives that sought to overturn strict abortion bans in Florida and Missouri were very important to a majority of voters in the states. More than half of Florida voters identified the result of the amendment as very important, while roughly 6 in 10 of Missouri’s voters said the same, the survey found.
___
Associated Press reporters Hannah Fingerhut and Amanda Seitz contributed to this article.
___
This article has been corrected to reflect in the ‘other states’ section that Montana, not Missouri, currently allows abortion until viability.
