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)
HAMILTON – It remains faint but Bo Levi Mitchell and the Hamilton Tiger-Cats still have a playoff pulse.
Mitchell threw two touchdown passes as Hamilton defeated the Ottawa Redblacks 37-21 in the CFL’s annual Hall of Fame game Saturday afternoon. The Ticats (4-9) earned a second straight win to move to within six points of the third-place Toronto Argonauts (7-6) in the East Division.
Hamilton visits Toronto on Friday night.
“Obviously they’re (wins) huge now,” Mitchell said. “We didn’t do ourselves any favours by getting into this position and not being able to really control our own destiny.
“But right now, we need certain people to win at certain times. Our job is to go out there and try to win the next five, then the next three after that.”
Mitchell finished 20-of-27 passing for 299 yards and an interception. He entered weekend action leading the CFL in passing yards (3,383) and TD strikes (21).
Greg Bell’s 15-yard TD run at 11:30 of the fourth and two-point convert put Hamilton up 36-21 after backup Jeremiah Masoli led Ottawa on two scoring drives. Following a 13-yard TD strike to Andre Miller at 2:53, Masoli found Dominique Rhymes on a 10-yard touchdown pass at 7:43 before Khalan Laborn’s two-point convert cut Hamilton’s lead to 29-21.
“When you’re scoring from (15) yards out on a run play, that makes offence easy,” Mitchell said. “It’s one of those things when you get down there as a quarterback, it takes you sometimes five, eight, 10 plays and now it’s ‘OK, now we have to create some stuff and find something.’
“When you hand the ball off and you’re scoring from (15) yards, it makes the offence really easy.”
Ottawa (8-4-1) would have clinched a playoff spot with a victory.
Ottawa committed six turnovers (three interceptions, two fumbles, once on downs) before an announced Tim Hortons Field gathering of 22,119. Lawrence Woods III also returned a punt 83 yards for a touchdown at 11:51 of the first quarter that put Hamilton ahead 10-3.
“You’ve got to bring your best every single week and this wasn’t our best, all of us, from coaches to the players,” said Ottawa head coach Bob Dyce. “If you don’t play great for four quarters, I don’t care who you’re playing you’re not going to have a successful day.
“We should’ve made the tackle (on Woods), we had him wrapped up it’s that simple. Even though we didn’t make the play on that, there should’ve been extra bodies there to clean it up when he did break the tackle.”
Hamilton also tied the season series with Ottawa 1-1. The teams meet again at TD Place on Oct. 25.
“If we didn’t turn it over today I would’ve said we played really well offensively and that to me is what the biggest difference is,” said Hamilton head coach Scott Milanovich. “Even the turnovers today (interception, fumble), at least they were in their end and we weren’t giving them a short field.
“The biggest play of the game was Woodsie’s return. It got us jump-started, gave us the lead and we were kind of off after that.”
Ottawa starter Dru Brown was 17-of-27 passing for 164 yards and an interception. Masoli entered late in the third and finished 13-of-19 passing for 183 yards with two TDs and two interceptions, but Dyce said Brown will start next weekend against Montreal (10-2-1), which earned a 19-19 tie Saturday night with Calgary (4-8-1).
The Canadian Football Hall of Fame’s ’24 class of S.J. Green, Chad Owens, Weston Dressler, Vince Goldsmith and Vince Coleman, along with builders Ray Jauch and Ed Laverty (posthumously), was honoured at halftime. All were enshrined Friday night.
Steven Dunbar Jr. and Ante Litre had Hamilton’s other touchdowns. Marc Liegghio kicked two field goals, three converts and two singles.
Ottawa’s Lewis Ward booted two field goals and a convert.
Mitchell culminated a five-play, 96-yard march with a 20-yard TD pass to Litre at 13:34 of the third. It followed Jonathan Moxey’s interception.
Liegghio’s single at 7:05 of the third put Hamilton up 22-6.
Mitchell’s 54-yard TD strike to Dunbar at 14:18 of the second staked Hamilton to its 21-6 halftime lead. The advantage was well-deserved as the Ticats had more first downs (12-six), net offensive yards (260-144) and scored on both offence and special teams.
Mitchell was 14-of-20 passing for 210 yards and a TD, but his interception cost Hamilton at least a field-goal attempt. Dunbar had five receptions for 113 yards and the touchdown.
Brown completed 13-of-21 passes for 127 yards.
Liegghio’s missed 47-yard attempt went for the single at 12:45 to put Hamilton ahead 14-6. It followed a Kiondre Smith catch that was ruled incomplete and at the very least cost the Ticats a first down that would’ve kept the drive alive.
Ward’s 30-yard kick at 9:15 had pulled Ottawa to within 13-6.
Liegghio’s 19-yard field goal at 5:13 pushed Hamilton’s lead to 13-3. It followed the defence stopping Ottawa’s Dustin Crum on third-and-one, giving the Ticats possession at the Redblacks 40.
Liegghio’s 47-yard field goal opened the scoring at 2:42 before Ward tied in with a 24-yard boot at 8:44.
UP NEXT
Redblacks: Host the Montreal Alouettes (10-2-1) next Saturday, Sept. 21.
Tiger-Cats: Visit the Toronto Argonauts (7-6) on Friday.
This report by The Canadian Press was first published Sept. 14, 2024.
TORONTO – Needing three points to keep their playoff push alive, Toronto FC’s Jonathan Osorio and Deandre Kerr stepped up with first-half goals against Austin FC on Saturday with goalkeeper Sean Johnson doing his bit at the other end.
A 76th-minute goal by Austin’s Owen Wolff made for a nervy ending but TFC hung on for a 2-1 win.
While Toronto (11-15-3) remains on the Major League Soccer playoff bubble in eighth place in the Eastern Conference (the eighth- and ninth-place teams in each conference square off in a wild-card playoff with the winner facing the top seed in the conference), other results went their way.
Seventh-place Charlotte, 10th-place Atlanta and 11th-place Philadelphia all lost while ninth-place D.C. United tied.
Toronto midfielder Alonso Coello called it “a game we had to win.”
“It’s a big win … To see that fight tonight was important,” added coach John Herdman.
Austin (9-12-7) came into the game in 11th place in the West, two points below ninth-place Minnesota. The Texas side has won just one of its last six league games (1-4-1).
Austin outshot Toronto 7-6 (6-2 edge in shots on target) in the first half but found itself trailing 2-0 at the break as Toronto took advantage of its chances and the visitors didn’t in their first-ever visit to BMO Field, before an announced crowd of 25,538.
Toronto had a dream start, catching Austin on the counterattack in the seventh minute. A sliding Austin player dispossessed an onrushing Kerr, who had been set free by a long ball from Coello, but the ball bounced to Osorio, who beat goalkeeper Brad Stuver with a rising shot.
It was the Toronto captain’s second goal of the season in league play and his 65th for TFC in all competitions. Only Sebastian Giovinco (83) and Jozy Altidore (79) scored more in Toronto colours.
TFC went ahead on another counterattack in the 30th minute after an Austin giveaway. Osorio found Richie Laryea outpacing his marker and the wingback unselfishly sent a perfect low cross across goal for Kerr to knock home for his third of the season.
Wolff, the son of Austin head coach Josh Wolff, made it interesting with his late strike. The 19-year-old U.S. youth international, controlling a long ball, beat defender Raoul Petretta and then waited out Johnson before slotting it home for his first of the season.
Toronto survived a nervy six minutes of stoppage time as Austin pressed for the equalizer. Austin outshot Toronto 14-9 (8-3 in shots on target) and had 52.5 per cent possession.
The win evened Toronto’s home record at 7-7-0, while Austin slipped to 3-8-3 on the road.
It was a costly evening for Austin with defender Brendan Hines-Ike, midfielder Jhojan Valencia and star attacker Sebastian Driussi allpicking up cautions to miss Wednesday’s game with Los Angeles FC due to yellow-card accumulation.
Toronto defender Shane O’Neill will miss Wednesday’s game against visiting Columbus for the same reason. Toronto could be short mid-week, too. The hope is veteran centre back Kevin Long, who missed Saturday’s game after tweaking his hamstring in training, will be good to go.
Toronto has five games remaining, including three more at home as it looks to return to the post-season for the first time since 2020 when it lost to Nashville after extra time at the first hurdle.
It is a challenging road.
TFC hosts Columbus, the New York Red Bulls and Inter Miami while playing away at the Colorado Rapids and Chicago Fire. All but Chicago are in playoff positions.
The only previous meeting between Toronto and Austin was in May 2023, when Zardes scored a 91st-minute winner to give Austin a 1-0 win over visiting Toronto, which was then mired at the bottom of the Eastern Conference. That loss prompted a post-game outburst from Italian star Federico Bernardeschi about TFC’s drab play.
Then-coach Bob Bradley benched Bernardeschi for the next game.
Current coach John Herdman made four changes to his starting 11 with Bernardeschi and Osorio returning from suspension and Coello and Kerr also slotting in. Coello, who had missed the last eight league games with a hamstring injury, was impressive in his 59-minute return.
Both Toronto and Austin suffered home losses last time out going into the international break. Toronto was beaten 3-1 by D.C. United while Austin lost 1-0 to Vancouver.
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This report by The Canadian Press was first published Sept. 14, 2024.
MONTREAL – CF Montreal is back in the win column after securing a 2-1 Major League Soccer win over Charlotte FC on Saturday night at Stade Saputo.
Montreal’s form had suffered of late, with just one win in MLS since July, but Laurent Courtois’ squad showed a level of poise and control over the tempo of the game that had not been seen since the beginning of the season.
“What we’ve changed in the last few weeks or months in terms of our methodology or coaching, is nothing. We did the exact thing, We had the exact same words, and we expressed them the exact same way,” said Courtois. “Today, everything just clicked.”
Caden Clark scored for the first time as a Montreal (7-12-9) player in the 23rd minute, in addition to Bryce Duke’s goal three minutes later that ended up being the winner, while Tim Ream found the back of the net for Charlotte (10-10-8).
Montreal had the first major scoring chance of the match after 15 minutes of play. With a free kick roughly 25 metres away from goal, Gabriele Corbo sent a near-perfect shot smashing off the crossbar.
Montreal would continue to dictate the tempo in the opening phase, finding first blood just seven minutes later.
Following a phenomenal triple-save from Charlotte goalkeeper Kristijan Kahlina, the ball fell to Clark who volleyed the ball into the wide-open net, picking up his first goal for the club.
“I think you don’t lose the feeling (of scoring), everything happens for a reason, you just can’t lose yourself in the chaos,” said Clark, who had missed a full season due to injury and was briefly without a club, but was grateful for Courtois’ confidence in him.
“(To have a coach’s confidence) is huge and is something I’ve had both ends of so you just can’t take advantage of that in the wrong way. I’m going to keep my discipline with the game plan and keep my head right.”
With momentum completely on their side, the home side doubled the lead just three minutes later. Montreal continued to build up play on the left flank and found a streaking Raheem Edwards in behind the defence who cut the ball back to Duke, sending the Stade Saputo crowd into a frenzy.
Just after the half-hour mark, Charlotte pulled one back through a set piece — something Montreal has struggled defending all season — as Ream rose above everyone at the back post to score his first with his new club.
The second half began in a similar fashion to the end of the first, with Charlotte pressing high up the pitch and forcing several turnovers in dangerous areas. After surviving the pressure, Montreal began to regain control of the game near the hour mark, enjoying the lion’s share of the possession while Charlotte looked to hit back on the counterattack.
“I think when we conceded that goal we were like ‘here we go again.’ 2-1 is a tough lead before halftime … and at the beginning of the half we kind of shot ourselves in the foot and they pressed a bit more, they moved a bit more forward and that opened some gaps,” said captain Samuel Piette.
“I was happy with that, it shows character. At the end of the day, we just wanted the three points and that’s what we got.”
As the game progressed, Charlotte pushed harder to find an equalizer but to no avail. With only one shot on target conceded, the second-worst defence in the league put up an impressive front and confidently rebuffed every single Charlotte attack.
“I’m a big fan of the back five’s performance in their discipline, competitiveness, and synchronization with balls in behind,” said Courtois.
“We can’t explain sometimes in a game it’s not there, they’re capable and today they showed it. Let’s see tomorrow.”
UP NEXT
Both teams are back in action on Sept. 18 away from home as Montreal will look to avenge a 5-0 rout against the New England Revolution while Charlotte visits Orlando City SC.
This report by The Canadian Press was first published Sept. 14, 2024.
