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Canada significantly undercounts maternal deaths, and doctors are sounding the alarm

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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.

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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.

An Asian woman holds a cellphone to take a photo of her pregnant belly.
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.”

An Asian woman sleeps in a hospital bed surrounded by monitors and IVs.
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.

A young blond woman uses a cellphone to take a photo of her pregnant form.
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.”

A woman wearing glasses and a tank top looks over the side of a bridge.
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.”

A woman with curly blond hair poses for a photo.
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.

An Asian woman wearing a hospital gown holds her newborn baby.
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.

An Indian man wearing a suit, tie and lab coat stands in front of a building.
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.”

A man wearing a yarmulke holds a newborn baby in a hospital setting.
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.”

A blond woman in glasses sits cross-legged under a tree with her eyes closed.
Patti Farnan meditates in a park in her hometown of Burlington, Ont. (Chelsea Gomez/CBC)

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Canadian military would be ‘challenged’ to launch a large scale operation: chief of the defence staff

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OTTAWA –

Canada’s military forces are “ready” to meet their commitments should Russia’s war in Ukraine spread to NATO countries, but it would be a “challenge” to launch a larger scale operation in the long term, with ongoing personnel and equipment shortages, according to Chief of the Defence Staff Gen. Wayne Eyre.

Eyre told Joyce Napier on CTV’s Question Period in an interview airing Sunday that while the forces in Europe are “ready for the tactical mission they’ve been assigned,” he has larger concerns about strategic readiness. He said there’s a lack of people and equipment, and further concern around the ability to sustain a larger scale mission in the longer term.

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The Canadian Armed Forces are still struggling to retain staff, with nearly 10,000 fewer trained personnel than they’d need to be at full force, and equipment stocks below what they require.

“We’ve got challenges in all of those,” Eyre said, adding the numbers reflect what’s been “let slip over decades, as we’ve focused on the more immediate (needs).”

Eyre said Canada’s military would be “hard pressed” to launch another large-scale operation like it had in Afghanistan, as an example, without having to redistribute its resources around the globe, as threats evolve.

“The military that we have now is going to be increasingly called upon to support Canada and to support Canadian interests, to support our allies overseas, but as well at home,” Eyre said, citing Russia’s invasion of Ukraine, climate change impacting the landscape in the Arctic, and an increase in digital and cybersecurity threats.

“It’s always a case of prioritization and balancing our deployments around the globe, not just with what, but when, and with who … and getting that balance right is something that that we’re working on,” he said. “Could we use more? Yeah, absolutely. But we operate with what we have.”

“We prioritize and balance based on what our allies need, and what the demand signals, just to make sure that we achieve the strategic effect the government wants us to achieve,” he also said.

Meanwhile Defence Minister Anita Anand said on CTV’s Question Period last week that Canada should “be able to walk and chew gum at the same time,” and balance its NATO commitments with securing the Arctic and promoting peace in the Indo-Pacific.

Eyre said his number one priority is getting Canada’s armed forces up to full strength, with an attrition rate of 9.3 per cent between both regular and reserve forces, up from 6.9 per cent last year. The Canadian Armed Forces Retention Strategy was released just last month.

“We are facing the same challenge that every other industry out there is facing in terms of a really tight labor market,” Eyre said. “Every other military in the West is facing the same challenge.”

He explained the organization is working on streamlining its recruitment process, among other changes, to meet the increasing need, with the goal to get numbers up “as quickly as possible.”

“Ideally, would have been yesterday,” he said. “We’re looking at where we can accelerate the recruiting, the training, and optimizing our training pipeline.”

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How soccer is evolving in Canada

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Soccer wasn’t really a thing when I was a kid. I grew up in the 1970s and ‘80s. Sure, we all had soccer balls. And we played a lot of what should be more accurately called, Kick and Run. But I – and all my friends – did not really know the rules, the teams or the players. We might’ve heard of Pelé, but not more than that.

We followed hockey, baseball, football (CFL and NFL) and basketball, in that order. I did occasionally watch soccer on TV, but that was because we didn’t have a lot of channels and the soothing English accents often lulled me to sleep.

Things are much different now. My 13-year-old son is a massive soccer fan. He plays on a team three or four times a week. His schoolmates include a lot of second-generation Canadians, whose parents came from soccer-obsessed nations. He watches Premier League and Championship League matches. He’s watches La Liga and Bundesliga. He watches World Cup qualifiers and could tell me the backstory on most of the players. In fact, he watches classic games on YouTube and plays FIFA22 on his PS4 and as a result, knows more about Pelé than I ever did. But, because of him, I now watch enough football to know a game is a match, a goalie is a keeper and I know which plays end up in corner kicks or throw-ins.

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I once asked him, “How well do you know the Germany national team?” and he said, “Not very well.” He then proceeded to name seven of their 11 starters. It’s a different world.

I still know almost nothing compared to the other soccer dads, but like millions of Canadians, I watched Canada’s qualifying matches and I know we have a great team, with some stellar players who are worth watching. The qualifying matches regularly beat both hockey games and CFL football when it comes to viewership.

But we should care about more than just the matches themselves. The World Cup is one of the biggest and most lucrative sports spectacles on Earth. This will be the first one hosted in the Middle East. And although Qatar may look shiny and new on TV, it’s mired in what many Western nations believe to be medieval and backwards policies on working conditions, LGBTQ2S+ and women’s rights.

Finding people to talk about it in Qatar is NOT easy. One of W5’s goals this week was to talk to migrant workers to describe how they were treated, their living conditions and their labour rights. Most were too afraid to talk to us.

And to confound things, there have been many stories of journalists being detained or arrested for reporting on migrant workers. Last week, a Danish reporter was live on TV from Qatar and when asked what things were like there, he directed his camera operator to pan left – revealing security officials in golf carts, who immediately tried to stop the live hit. The next day Qatari officials apologized, but the message was clear: we can stop you from reporting when we want. It’s a fascinating video that’s been viewed millions of times around the globe.

The Qatari government denies they’ve put any restrictions on media. In a tweet, the Supreme Committee for Delivery and Legacy says “several regional and international media outlets are based in Qatar, and thousands of journalists report from Qatar freely without interference each year.”

Not everyone is convinced. Qatar ranks 118 out of 180 countries in the 2022 Press Freedom index, published by Reporters Without Borders. Freedom House, which is a U.S.-based freedom watchdog, gives Qatar a 25 out of 100 score on Global Freedom, which includes freedom of expression. (Canada ranks 98 and the US ranks 83).

A Reuters Institute column from last week on press freedom in Qatar suggests authorities obscure press freedom laws, by hiding behind trespassing laws.

“One of the most common risks when doing journalistic work in Qatar is to be accused of trespassing. This is what Halvor Ekeland and Lokman Ghorbani of Norwegian state broadcaster NRK were accused of when they were arrested by officers of Qatar’s Criminal Investigations Department in November 2021, while covering World Cup preparations. The journalists were held for over 30 hours before being released without charge. They deny they were filming without permission,” says the article.

A little insider info: I have personally written, “we don’t want you to get arrested, but…” at least twice in correspondence with our team in Qatar. I’ve never encouraged anyone to break the law of course, but sometimes doing our jobs leads police or security into thinking they have a duty (or at least a right) to stop you.

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Don’t have a cow: Senator’s legen-dairy speech draws metaphor from bovine caper

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OTTAWA — Haven’t you herd? A dramatic tale of 20 escaped cows, nine cowboys and a drone recently unfolded in St-Sévère, Que., and it behooved a Canadian senator to milk it for all it was worth.

Prompting priceless reactions of surprise from her colleagues, Sen. Julie Miville-Dechêne recounted the story of the bovine fugitives in the Senate chamber this week — and attempted to make a moo-ving point about politics.

“Honourable senators, usually, when we do tributes here, it is to recognize the achievements of our fellow citizens,” Miville-Dechêne began in French, having chosen to wear a white blouse with black spots for the occasion.

“However, today, I want to express my amused admiration for a remarkably determined herd of cows.”

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On a day when senators paid tribute to a late Alberta pastor, the crash of a luxury steamer off the coast of Newfoundland in 1918 and environmental negotiators at the recent climate talks in Egypt, senators seated near Miville-Dechêne seemed udderly taken aback by the lighter fare — but there are no reports that they had beef with what she was saying.

Miville-Dechêne’s storytelling touched on the highlights of the cows’ evasion of authorities after a summer jailbreak — from their wont to jump fences like deer to a local official’s entreaty that she would not go running after cattle in a dress and high heels.

The climax of her narrative came as nine cowboys — eight on horseback, one with a drone — arrived from the western festival in nearby St-Tite, Que., north of Trois-Rivières, and nearly nabbed the vagabonds before they fled through a cornfield.

“They are still on the run, hiding in the woods by day and grazing by night,” said Miville-Dechêne, with a note of pride and perhaps a hint of fromage.

She neglected to mention the reported costs of the twilight vandalism, which locals say has cost at least $20,000.

But Miville-Dechêne did save some of her praise for the humans in the story, congratulating the municipal general manager, Marie-Andrée Cadorette, for her “dogged determination,” and commending the would-be wranglers for stepping up when every government department and police force in Quebec said there was nothing they could do.

“There is a political lesson in there somewhere,” said the former journalist.

Miville-Dechêne ended on what could perhaps be interpreted as a butchered metaphor about non-partisanship: “Finally, I would like to confess my unbridled admiration for these cows that have found freedom and are still out there, frolicking about. While we overcomplicate things, these cows are learning to jump fences.”

This report by The Canadian Press was first published Nov. 26, 2022.

 

Marie-Danielle Smith, The Canadian Press

 

 

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