Visit the BC Women's Hospital Early Pregnancy Assessment Clinic.
Pregnancy is an emotionally charged time for an expectant mom - equal parts joy and stress. There's a lot to think about - Am I eating enough? Too much? Should I stop exercising? And then there are the periodic nausea, mood swings and insomnia. On top of this, about 30 percent of pregnant women experience complications such as bleeding and cramping during the first half of pregnancy - complications that while common, are sometimes an indication that something is wrong. In fact, 10 - 20 per cent of women miscarry in the first trimester.
Women with these symptoms typically go to their ER, sometimes waiting hours to be seen. Some are referred elsewhere for test to wait for what could be the worst - or best - news of their lives. Dr. Stephanie Rhone, Medical Director of the Reproductive Medicine program at BC Women’s Hospital (pictured above) knew there had to be a better way to support these women. The answer came in 2007 with the opening of BC Women’s Early Pregnancy Assessment Clinic (EPAC).
Based on a best-practices model in the UK and offered only at BC Women’s Hospital in British Columbia, EPAC is an inter-disciplinary clinic devoted entirely to providing medical and emotional care to women in the first trimester of pregnancy who are experiencing complications. Everything these women need is under one roof: assessment, diagnosis and management of complications and pregnancy loss, as well as supportive counselling.
“With specialized nurse clinicians on staff, as well as obstetrician-gynecologists who are ultrasound certified, patients don’t have to wait for answers,” says Rhone. “We share what we see on an ultrasound as we see it.”
One of the keys to the success and importance of the clinic is the speed at which it able to deliver healthcare to women experiencing miscarriage. Where women often wait up to 10 days to resolve a failed pregnancy through an ER, the clinic is able to provide compassionate medical care and closure quickly – often on the same day.
If the news is not good and a miscarriage is imminent, they have nurses on staff who help patients decide how they would like to resolve the pregnancy. If medical or surgical interventions are required, they’re done right on the premises.
Counselling is a key part of the process, says Dr. Rhone, who adds that there’s generally a real lack of acknowledgement of the emotional impact of miscarriages: “People tend to say, ‘Oh, it’s early on and you’ll get pregnant again.’
“They minimize it. That’s why we’ve made sure the care here is emotionally, as well as physically, supportive.”
“If I’d been in an ER, it would have been treated as an unfortunate medical issue,” says one young woman, who was referred to the clinic after an ultrasound and blood tests revealed that her six-week pregnancy was no longer viable. “But the EPAC staff acknowledge how disappointing a miscarriage is, how heartbreaking. They support you through part of your life story. It certainly had an effect on how I was able to move on.”
The care provided doesn’t stop once the patient leaves the clinic.
“We touch bases with all our patients at regular intervals after they leave to make sure they’re okay,” says Marie Rose McDonnell, a long-time nurse clinician at the Clinic with post-RN certification in prenatal nursing. “Our focus is TLC.”
The response from patients confirms that the supportive approach to helping women deal with miscarriage is meeting a very real need.
“All of our patients tell us that we’ve made a bad situation better,” says McDonnell. “Now we have women coming from as far away as Chilliwack and Squamish.”
Over the past five years, the Clinic has evolved into a top referral centre for women from throughout the entire region.
“The Early Pregnancy Assessment Clinic is a fantastic resource for us,” says Dr. Lyne Filiatrault, an ER physician at Vancouver General Hospital. “We regularly refer women there, and we know they’ll get the care that a fast-paced ER can’t give them.”
Ruth Comfort, a midwife at BC Women’s, has also referred women to the Clinic: “I know my clients will get all the answers and attention they need from an incredibly caring team of professionals.”
Today, after five years in operation, they’re operating at capacity. Open Monday to Friday, from 8 am to 4 pm, it averages between 30 and 40 patients a week. Dr. Rhone’s vision now is to expand the clinic’s hours.
“Ideally, we should be providing care seven days a week, into the evening hours,” she says. “In the UK, these clinics operate like mini emergency departments.”
Meanwhile, in keeping with BC Women’s leadership role in developing women’s health programs that can be replicated elsewhere, Dr. Rhone is currently sharing the EPAC model with other hospitals. Ultimately, she’d like to see clinics like this become the standard of care throughout BC, meeting the needs and greatly reducing the stress of early pregnancy for women everywhere.
More information about the Early Pregnancy Assessment Clinic at BC Women's.
Originally published in the Spring 2013 issue of Women's Magazine. Free subscription here.
Written by: Helena Bryan
Photography of Dr. Stephanie Rhone by: Brian Howell