‘Frustrated beyond belief,’ pregnant evacuees face unique challenges

Warning: This report contains details of pregnancy loss that may be distressing to read.

For many NWT wildfire evacuees this summer, the experience hasn’t been easy. People carrying an extra passenger have faced added challenges.

Several pregnant evacuees described a range of experiences as they fled their homes, tried to access medical care in new circumstances and, eventually, prepared to return.

In some cases, they described a lack of communication from NWT health officials and a sense that they were largely on their own to arrange and advocate for their care.

Dr Claudia Kraft, territorial medical director for the territory’s health authority, said there were challenges, particularly in the early days of the evacuation from Yellowknife, which had not been anticipated by health officials.

“We’ve tried really, really hard to have direct communication with each of the people that we knew about and felt responsible for looking after,” she said.

“We know it’s not been easy or seamless by any means, and we’ve had to really adapt often to the feedback that we’ve received.”

‘I was very stressed’

When Yellowknife’s evacuation order was first issued, Nancy Belanger, who is now 26 weeks pregnant, headed to Edmonton with her partner. She then went on to Quebec, where she has family.

Belanger said trying to see a doctor outside the territory was a challenge. Once she was able to do so, she had to pay for routine testing out of pocket.

“I was very stressed,” she said.

“It’s not normal. You live in Canada. Why, in this situation, can’t we have the service in every province?”

Belanger said she feels “lucky” because she received a text from the nurse in her prenatal class – asking the group if they were OK – and she was able to get information quickly.

She is also grateful that since returning to Yellowknife, she has been able to see her doctor.

Like many residents, Jessie Wilson said she was confused about the best thing to do when ordered to leave Yellowknife late on August 16.

Wilson was 28 weeks pregnant at the time and described experiencing brain fog, which made it difficult to process information about the evacuation.

“That was incredibly stressful,” she said. “I felt stupid for following the direction of my government up until then.”

Before the evacuation order was issued, an evacuation alert had only been in place for three areas on the western edge of Yellowknife. The city started the week saying its plan was for residents to shelter within the municipality. If anyone left Yellowknife, multiple levels of government stated before the city-wide evacuation order, they would be on their own.

Wilson and her partner evacuated to Alberta. Shortly afterward, she said, she was contacted by the NWT’s health authority about how to access her medical records. After that, she said, most of her information came from a group chat with other pregnant Yellowknifers.

“We shouldn’t have had to do that,” she said. “We should have been getting the information and the support directly from the health and social services department.”

Wilson did say she was able to access her medical records and the prenatal care she needed in Alberta. “They were really great,” she said.

But when she went to get an ultrasound, Wilson said she was told information was missing from the requisition. Her texts and phone calls went unanswered, and only because she had a personal contact number for the referring doctor was she able to address the issue.

Wilson said the way in which residents were informed about the evacuation order’s end was also problematic. The city and Yellowknives Dene First Nation made the announcement only on social media, on the Friday night before a long weekend.

“Having the rug pulled under you that quickly was, I think for me, just as stressful as the confusion and chaos of evacuating,” she said.

The day before the evacuation order was downgraded to an alert on September 6, health officials said anyone who was 33 weeks pregnant or later, or had a high-risk pregnancy, should not immediately return. The territory’s health authority said the obstetrics unit at Stanton Territorial Hospital was at zero capacity at the time, and only urgent services would be provided through the emergency department for some time to come.

Wilson said she was uncertain about what to do: there was no clear definition of a high-risk pregnancy, for example, and a potential issue had been flagged in her ultrasound.

She also worried about expenses, as her insurance coverage would now end on September 6. Her emails to the Department of Health and Social Services with questions went unanswered.

“I was just completely distraught,” she said. “I didn’t get any information back from any government source about what I should be doing. I was completely on my own for coordinating all of my healthcare.”

Wilson decided to return to Yellowknife, but said she has “survivor’s guilt” as some other pregnant evacuees have had to stay down south. She said hearing from others who weren’t able to get answers in the days leading up to their due dates, particularly about medical travel coverage, was “shocking and horrifying.”

“It makes me feel like our healthcare system here just isn’t conducive to being a safe environment for people to give birth,” she said.

“The actual medical professionals that I’ve dealt with are great … I have confidence in them,” she clarified. “But the actual administration themselves, and the logistics and the communication, is dangerously incompetent.”

Wilson pointed out that many families from the NWT and Nunavut were sent south to give birth when Yellowknife’s obstetrics unit was closed for more than two months in late 2021 and early 2022. The health authority said at the time there were not enough staff to safely operate the unit beyond emergency services.

“Watching how this is unfolding, it feels like a pattern,” Wilson said. “For someone who’s about to give birth here, that’s kind-of horrifying.”

The NWT’s health authority announced on Wednesday that the Stanton Territorial Hospital’s obstetrics unit would return to full capacity as of Thursday.

People who had been 33 weeks pregnant when the evacuation order ended would be contacted directly by Friday, the authority stated. Evacuees at least 37 weeks pregnant as of Wednesday were told to speak to a physician where they were located about whether or not they could travel.

Dr Kraft said accommodation for people on medical travel is now available in Yellowknife.

Previously, pregnant people from communities that had not evacuated – and who would normally be sent to Yellowknife to give birth – were being sent to Edmonton.

‘A lot of damage done’

One evacuee who was 33 weeks pregnant when the evacuation order lifted, who asked Cabin Radio that she not be identified so as to speak freely about her experience, said she struggled to navigate and access appropriate care in Alberta.

“Nothing was arranged or easily accessible to the pregnant evacuees,” she said.

“You just get scared that you’re going to slip through the cracks, you know? You need care because it’s not just your life.”

While she asked several times to see a doctor in Alberta, the woman said she was refused and told she would only be able to see one once she was 36 weeks pregnant.

According to an NWT prenatal guide published in 2021, initial prenatal visits should take place between six and 12 weeks’ gestation. The guide states regular visits should be scheduled every four weeks until 28 weeks’ gestation, then every two weeks until 36 weeks’ gestation, and from there every week until birth.

The woman said she was able to see a nurse practitioner at a pop-up clinic to get an ultrasound that had been ordered. Within an hour of that visit, she received a phone call telling her to immediately head to the hospital as her baby wasn’t “practice breathing,” when babies begin to develop patterns similar to breathing while in the womb.

“It is my first pregnancy … I had no idea what that means,” the woman said, adding little was explained over the phone and she didn’t know what to ask.

Once at the hospital, she said she was monitored and told she would be able to speak to a doctor about the ultrasound results. Shortly afterward, however, a nurse told her everything was fine and denied her request to see a doctor.

The woman said she was told to contact the nurse practitioner at the clinic about a follow-up visit. The following day, when she did so, she was told to call back in two weeks if she felt she still needed to be seen.

“I was frustrated beyond belief,” she said.

The woman said she decided to go home to Yellowknife as soon as she was able, against the NWT government’s advice, because of her experience in the south.

“I was done,” she said.

Upon voicing that to NWT healthcare professionals, however, she said she received phone calls discouraging her from taking that step, telling her, in her words: “If you come back, you’ll be forced to labour in emergency and your newborn will receive no care.”

Kimberly Riles, the health authority’s chief executive, said on Monday that people with advanced pregnancies who had returned to Yellowknife “despite the advice for them to stay away” could still access services “to support their ongoing care needs.”

After telling a nurse by phone that something had to give, the woman said she was connected with a doctor for the first time in more than a month.

Against her wishes, the woman said physicians “pushed” her to connect with medical travel about staying in Alberta. She then received a call from a travel agent, who she said had been given her contact information without her knowledge, about booking a hotel.

Despite what she had been told, the woman said after returning to Yellowknife, she got a call from the hospital to book a 36-week ultrasound. Her prenatal pregnancy program was also back on schedule.

“I feel like there’s been a lot of damage done,” she said.

“If people are worried about the future of the Northwest Territories, maybe they should be considering pregnant folks a little bit better.”

‘Consistent, clear messaging’

Riles said at a Monday press conference that the health authority’s website had offered the “most consistent, clear, messaging” available.

The health authority launched a health services updates page on August 25, including information from Alberta Health Services for pregnant people.

“We have been in touch with as many pregnant patients as we’ve been able to reach to discuss their specific scenarios, their specific care needs, and to give them advice that’s suited to their situations,” Riles added.

The health authority also evacuated late-term pregnant people from Yellowknife hospital on a charter flight, she said, and had been “pretty involved in setting them up along the way.”

Riles acknowledged “there were a few pregnant patients” the authority was unable to reach as of last week.

Dr Kraft said the initial focus was evacuating inpatients from the Yellowknife hospital, as well people with special health care needs, such as those with late-term pregnancies, and coordinating their care in Alberta.

She said NWT health officials then worked with the province to determine “pathways of care” for pregnant people who were able to safely evacuate on their own, including the pop-up clinic in Edmonton.

Kraft said while coordinating communication early in the evacuation was difficult, and people struggled to navigate logistics, the government has since put in place pathfinders – staff whose job is to help connect people with resources.

She added that the territory’s current system of medical travel benefits does not address the supports needed once an evacuation ends. While officials say people should use private insurance or employer benefits where they can, Kraft said staff have worked to fill gaps for pregnant evacuees staying where they are, or who are now able to travel home. That has included working with travel agents to book hotels.

Kraft said while she is still working to get services back up and running, the health authority will learn many lessons from the evacuation.

“The impacts were incredibly challenging,” she said. “I hope we never face quite that degree of disruption again.”

‘We’re really OK’

Another pregnant evacuee, who asked that she not be identified because of her job, described a less challenging experience.

“I have a really, really normal pregnancy, like a textbook pregnancy,” she said. “I might be in a totally different situation than other people who are struggling in their pregnancies for whatever reasons.”

The woman, who is due in two weeks, said she and her husband first evacuated to Alberta, then to Ontario, where her family lives, once she suspected she may have to give birth outside the territory.

Before the evacuation order was issued, she said she had the forethought to request her prenatal records in case anything happened.

She said she was able to access medical care in Calgary by contacting a clinic where a friend had recently given birth. In Toronto, she said she had friends who work in the medical field who were able to connect her with care.

Like other evacuees Cabin Radio spoke with, the woman said communication from NWT health officials could have been better. By the time she was contacted and told to remain down south, she said, she had already travelled to Toronto.

“We had already had to make arrangements,” she said. “I had already found a doctor in Toronto.”

She said giving birth in Ontario would mean she wouldn’t get a baby bundle, postnatal time at the hospital, and a private room to recover as she would in the NWT.

“I think in the grand scheme, we’re really OK,” she said.

“I’m sympathetic to people who maybe don’t have that family support, or maybe have a high-risk pregnancy, because I think it would be scary.”

The woman said earlier this week she still did not know whether she would get medical travel coverage. On Wednesday, she said she was told she was allowed to return to Yellowknife, but has yet to determine the logistics of that.

‘A uniquely devastating experience’

One woman, who asked Cabin Radio that she not be identified to protect her privacy, shared her story of experiencing a miscarriage while evacuating.

“Dealing with the chaos and all the uncertainties of everything, on top of the grief and all of the emotions that go into loss, this has been a uniquely devastating experience,” she said.

When ordered to evacuate, the woman said she joined her partner, who was working in an NWT community outside Yellowknife.

“It was all still very new, maybe five or six weeks at the most, when I came there pregnant and scared,” she said.

Through contacting the Northern Birthwork Collective, the woman said she was able to get an ultrasound in Inuvik that had previously been scheduled to take place in Yellowknife.

“It was quite the ordeal, trying to get medical travel,” she said.

At her appointment, the woman said she was told by a technician that there was not yet any fetal pole – one of the initial stages of a pregnancy – nor a heartbeat, but they needed more information before making a diagnosis.

“I had a bunch of question-marks in my head going back,” she said.

The next day, she had blood work done for testing. She received the results the following week, indicating her level of hCG – a hormone produced during pregnancy – had dropped, which shouldn’t happen in a healthy pregnancy.

She said she accessed care at the clinic where she was staying, describing the nurse practitioner as “amazing.”

Once her miscarriage was confirmed, she said she asked about mental health supports and resources, but was informed only limited online supports were available.

“With so many miscarriages, especially early on, there’s a feeling of isolation that goes with it,” she said. “Not being able to talk about it, and then the healthcare stuff about being in an isolated place, it was just a pretty scary experience.”

While accessing healthcare would likely have been easier and faster in the south, the woman said she feels “lucky” she was able to stay in the NWT with her partner and had space to grieve. She said they were able to find a special spot in the community for a burial.

“I’m really thankful that we were held and supported in such a beautiful community,” she said.