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Spotlight 3/3

Emerging concerns with obstetrical and gynecological care

In 2023/24, Patient Ombudsman began tracking an increasing number of complaints related to obstetrical and gynecological care issues, including complaints about insensitivity, poor communication and lack of responsive care for pregnancy complications, miscarriages, difficult births and sexual assaults.

Some of the complaints were about serious incidents in which patients’ severe pain was ignored or dismissed or a failure to carry out fetal monitoring leading to tragic outcomes.

While the clinical nature of the complaints meant that they often fell within the scope of health professions regulatory colleges, Patient Ombudsman also identified broader organizational issues, including a lack of trauma-informed care approaches that, if addressed, could improve the experiences of patients and their families.

Patient experience

The complainant was referred for an urgent ultrasound at a community surgical and diagnostic centre after experiencing the symptoms of a miscarriage including abdominal pain and heavy bleeding. When the complainant arrived at the centre, she told the sonographer this would be a difficult appointment for her. The complainant shared that the sonographer showed no compassion and did not explain what the procedure would involve. After the procedure, the complainant attempted to discuss her concerns about the sonographer’s lack of compassion and communication. The sonographer responded that they were not allowed to show compassion and focused on their inability to share the results of the scan, which was not the patient’s primary concern.

What we did

The Patient Ombudsman Early Resolution Specialist made a courtesy call to the centre so ensure that it was aware of the patient’s concerns and was following up. The patient was encouraged to return to Patient Ombudsman if she was not satisfied with the centre’s response.

In 2023/24, Patient Ombudsman identified 130 such complaints. The majority of the complaints were about public hospitals (100) and community surgical and diagnostic centres (nine), as well as 26 non-jurisdictional complaints about medical care (14 about primary care providers and 12 about obstetrician/gynecologist specialists).

The terms “obstetrical violence” and “obstetric and gynecological violence” have been used by researchers and the media to describe a range of negative patient experiences including disrespectful, inadequate, non-consensual or abusive gynecological and obstetrical care.^1,2 While the terms are somewhat controversial,³ there is ample evidence globally and in Canada that many women report experiences with gynecological and obstetrical care that is at the least insensitive and at worst results in serious harm or leaves lasting trauma.^4,5

Patient Ombudsman will continue to monitor this trend and has launched an investigation into a case involving an emergency department’s response to a patient with a pregnancy complication that will be reported in 2024/25.

Patient experience

A patient contacted Patient Ombudsman with concerns about the quality of care and communication she received in a hospital emergency department. The patient was worried that her unborn child wasn’t moving. A cursory initial examination by a physician failed to reveal that the baby was in distress. A follow-up examination pursued by a nurse showed that the baby was, in fact, experiencing distress and at risk. The patient was admitted, and the baby was delivered prematurely shortly afterwards. The patient described inconsistent, insensitive communication from the care team and difficulty getting answers to her questions about what was happening.

What we did

After Patient Ombudsman contacted the hospital, senior leadership met with the patient and apologized for her experience. They advised the patient that they had provided feedback to the clinical team and had used the patient’s experience as a learning opportunity.