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Rana Van Tuyl was about 12 weeks pregnant when she got devastating news at her ultrasound appointment in December 2020.

Her fetus’s heartbeat had stopped.

“We were both shattered,” says Van Tuyl, who lives in Nanaimo, B.C., with her partner. Her doctor said she could surgically or medically pass the pregnancy and she chose the medical option, a combination of two drugs taken at home.

“That was the last I heard from our maternity physician, with no further followup,” she says.

But complications followed. She bled for a month and required a surgical procedure to remove pregnancy tissue her body had retained.

Looking back, Van Tuyl says she wishes she had followup care and mental health support as the couple grieved.

Her story is not an anomaly. Miscarriages affect one in five pregnancies in Canada, yet there is often a disconnect between the medical view of early pregnancy loss as something that is easily managed and the reality of the patients’ own traumatizing experiences, according to a paper published Tuesday in the Canadian Medical Association Journal.

An accompanying editorial says it’s time to invest in early pregnancy assessment clinics that can provide proper care during and after a miscarriage, which can have devastating effects.

The editorial and a review of medical literature on early pregnancy loss say patients seeking help in emergency departments often receive “suboptimal” care. Non-critical miscarriage cases drop to the bottom of the triage list, resulting in longer wait times that make patients feel like they are “wasting” health-care providers’ time. Many of those patients are discharged without a followup plan, the editorial says.

But not all miscarriages need to be treated in the emergency room, says Dr. Modupe Tunde-Byass, one of the authors of the literature review and an obstetrician/gynecologist at Toronto’s North York General Hospital.

She says patients should be referred to early pregnancy assessment clinics, which provide compassionate care that accounts for the psychological impact of pregnancy loss – including grief, guilt, anxiety and post-traumatic stress.

But while North York General Hospital and a patchwork of other health-care providers in the country have clinics dedicated to miscarriage care, Tunde-Byass says that’s not widely adopted – and it should be.

She’s been thinking about this gap in the Canadian health-care system for a long time, ever since her medical training almost four decades ago in the United Kingdom, where she says early pregnancy assessment centres are common.

“One of the things that we did at North York was to have a clinic to provide care for our patients, and also to try to bridge that gap,” says Tunde-Byass.

Provincial agency Health Quality Ontario acknowledged in 2019 the need for these services in a list of ways to better manage early pregnancy complications and loss.

“Five years on, little if any progress has been made toward achieving this goal,” Dr. Catherine Varner, an emergency physician, wrote in the CMAJ editorial. “Early pregnancy assessment services remain a pipe dream for many, especially in rural Canada.”

The quality standard released in Ontario did, however, prompt a registered nurse to apply for funding to open an early pregnancy assessment clinic at St. Joseph’s Healthcare Hamilton in 2021.

Jessica Desjardins says that after taking patient referrals from the hospital’s emergency room, the team quickly realized that they would need a bigger space and more people to provide care. The clinic now operates five days a week.

“We’ve been often hearing from our patients that early pregnancy loss and experiencing early pregnancy complications is a really confusing, overwhelming, isolating time for them, and (it) often felt really difficult to know where to go for care and where to get comprehensive, well-rounded care,” she says.

At the Hamilton clinic, Desjardins says patients are brought into a quiet area to talk and make decisions with providers – “not only (from) a physical perspective, but also keeping in mind the psychosocial piece that comes along with loss and the grief that’s a piece of that.”

Ashley Hilliard says attending an early pregnancy assessment clinic at The Ottawa Hospital was the “best case scenario” after the worst case scenario.

In 2020, she was about eight weeks pregnant when her fetus died and she hemorrhaged after taking medication to pass the pregnancy at home.

Shortly after Hilliard was rushed to the emergency room, she was assigned an OB-GYN at an early pregnancy assessment clinic who directed and monitored her care, calling her with blood test results and sending her for ultrasounds when bleeding and cramping persisted.

“That was super helpful to have somebody to go through just that, somebody who does this all the time,” says Hilliard.

“It was really validating.”

This report by The Canadian Press was first published Oct. 15, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

PEACE RIVER, Alta. – The operator of a pulp mill in northwestern Alberta has been fined $1 million for letting almost 31 million litres of toxic wastewater flow into the Peace River.

Environment and Climate Change Canada says the effluent released in April 2021 was “acutely lethal” to fish.

Mercer Peace River Pulp Ltd. pleaded guilty last month to a section of the Fisheries Act.

The conviction means the company’s name will be added to the Environmental Offenders Registry.

The federal government says the pulp mill was shut down for maintenance and waste was directed to a spill pond, where it was to be stored until it could be gradually treated and released into the river.

But the investigation found there wasn’t enough room in the pond for that additional effluent, something Mercer has since taken steps to fix.

The fine is to go into Ottawa’s Environmental Damages Fund.

This report by The Canadian Press was first published Oct. 15, 2024.

The Canadian Press. All rights reserved.

The diplomatic row between Canada and India could derail a trading relationship that already underperforms its potential, experts warn.

Relations between the two countries have hit a new low with Canada’s decision to expel New Delhi’s top envoy and five other diplomats on bombshell allegations Monday from the RCMP, who said that Indian government agents have been linked to murder, extortion and coercion in Canada.

International Trade Minister Mary Ng tried to reassure Canadian businesses, issuing a statement Tuesday acknowledging the “uncertainty” the situation creates for exporters and investors. She said the federal government will continue to support commercial and economic ties between the countries.

But analysts say there is no way the trading relationship between Canada and the world’s fastest-growing economy can escape unscathed from this latest escalation in tensions — at least not in the immediate future.

“In the short term, I think certainly this will have a negative impact … if you’re a Canadian business who’s trying to get a foothold into India or if you’re an Indian business trying to do something in Canada,” said Partha Mohanran, director of the India Innovation Institute at the University of Toronto.

“Or if you’re talking about any kind of free trade agreements, whether it’s at the provincial level or at the federal level. All that stuff is obviously going to be on the back burner, to say the least.”

In particular, the latest developments suggest there won’t be any imminent progress towards the India-Canada Comprehensive Economic Partnership Agreement (CEPA), a proposed bilateral trade deal that the two countries have been negotiating in fits and starts since 2010.

After a five-year hiatus, talks began again in earnest in 2022, but Canada paused the process last year — a move that was met with dismay by some business groups.

Mohanran said the deterioration of relations between India and China is problematic because the amount of trade currently being done between the two countries is already far smaller than it should be.

In 2022, Canada exported $5.3 billion worth of goods to that country, or just 0.7 per cent of global exports, according to Statistics Canada. Imports from India amounted to $8.3 billion, around 1.1 per cent of total global imports.

By comparison, Canadian exports to China in 2022 were $28.7 billion, even though India’s population has grown so rapidly that it surpassed China’s for the first time last year.

“(Canada-India) is a relationship which has woefully underperformed its potential,” Mohanran said.

“If you look at bilateral trade, both countries barely register on each other’s radar. India is much more focused on the U.S., for instance, and Canada is much more focused on China than it is on India. I think both countries have ignored each other in terms of potential.”

Among the top products Canada exports to India are coal, potash fertilizers and lentils.

In her statement Tuesday, Ng said Canada stands firmly by its businesses, and will work closely with all Canadian enterprises engaged with India.

But she added Canada will not tolerate any foreign government threatening, extorting or harming Canadian citizens on its soil.

“We must consider our economic interests with the need to protect Canadians and uphold the rule of law,” she said.

This report by The Canadian Press was first published Oct. 15, 2024.

The Canadian Press. All rights reserved.