Awareness of tragic loss is only a start

Meaningful improvements needed to both obstetric and neonatal care, Deborah Ostrovsky says.

This crisis … leads to errors and a lack of compassion.

We’re nearing the end of Pregnancy and Infant Loss Awareness month, and while it has only received modest attention, for those of us who have suffered a miscarriage, stillbirth, had a newborn die, or lost a baby to SIDS, any public awareness about what frequently remains a matter of private grieving is comforting beyond measure.

According to the Pregnancy and Infant Loss Network, one in five pregnancies end in miscarriage and there are approximately six stillbirths per 1,000 births in Canada. While the stigma felt by parents who find their lives altered by these statistics can be devastating, breaking the silence is healing.

Yet for some of us, “awareness” can feel symbolic at best. Awareness-raising only highlights the growing disconnect between recognizing the psychosocial needs of bereaved mothers and families on the one hand, and the decades-long crisis in maternity and neonatal care on the other. The latter arguably makes at least some of these tragedies preventable.

In Canada, the shortage of maternity and newborn care personnel has been documented extensively. Almost two decades ago, the Maternity Care Crisis in Canada conference (2000) presented unsettling data about the insufficient number of obstetricians, putting both mothers and babies at risk. In 2008, a report from the Society of Obstetricians and Gynaecologists of Canada also sounded an alarm about the critical shortage of OB/GYNS that would get worse in the years ahead. This year, the last obstetrician left the town of Antigonish, N.S., Scotia, and smaller cities like Chilliwack have grappled with obstetrician staffing issues. The president of the St. Boniface Hospital in Winnipeg has publicly decried that overcapacity is putting newborns in danger. The Canadian Medical

Association Journal argues that doctor burnout from overwork is also at an all-time high, further increasing the risk of substandard care.

This crisis affects education and research, and leads to errors and a lack of compassion. In Montreal, a 2009 incident where a stillborn baby was taken out with the morgue’s laundry resulted in a badly needed overhaul of hospital procedures. In 2014 a Toronto couple discovered they were not informed about their newborn son’s dangerous infection that could have potentially prevented his death. A Cree woman who was medevaced from her community in Whapmagoostui in northern Quebec and in severe pain after 10 days of bleeding from a miscarriage, was treated like a “second-class citizen” in a Val d’or hospital where she overheard insulting remarks from staff and told to stay in a hotel.

Pregnant women of colour still confront discrimination in the health care system, which poses risks to health before and during pregnancy. First Nations and Inuit women have higher rates of stillbirth, and infant mortality in these populations is higher than the rest of the Canadian population.

Awareness certainly combats stigma; but more systemic changes are needed to reduce these injustices leading to disaster.

Regional inequities are also troubling. Ontario’s Bill 141, the Pregnancy and Infant Loss Awareness, Research and Care Act, has a research component, making Ontario the first and only province to create a strategy to combat pregnancy loss and stillbirth.

Private companies and entrepreneurs are offering a variety of products and services, including the Cuddle Cot for families who have lost a baby. At the federal level, MP Blake Richards brought a motion (M-110) to improve compassionate care and support for parents, although it was shut down last June.

Such efforts represent a taboo-breaking paradigm shift in public discourse on matters of life and death. But whatever the value of combating silence, such efforts mean little if they are not accompanied by meaningful improvements to obstetric and neonatal care.

Before another October rolls around, let’s prevent tragedies before they happen, and reduce error and trauma when they do.

Deborah Ostrovsky was recently chosen as one of the Writers’ Trust of Canada’s Rising Stars and is a former peer support with MISS (Mothers in Support and Sympathy) in Montreal.