The lead author of Canada’s national guidelines on drug-induced abortion says Nova Scotia should drop the practice of insisting on an ultrasound when it results in delays in providing the procedure.
The issue was raised this week after The Globe and Mail reported that Nova Scotia’s only abortion clinic is not allowed to perform ultrasounds to determine how far along a pregnancy is, leaving women to wait days or weeks for an appointment at the hospital’s diagnostic imaging unit. In an essay published Saturday, reporter Jessica Leeder outlined the challenges she faced earlier this year in obtaining a medical abortion. Ms. Leeder was told she would need to wait about two weeks for an ultrasound before a doctor could prescribe the abortion drug Mifegymiso. She eventually travelled out of province and paid out of pocket to have a timelier abortion.
Women in many other provinces, especially large urban centres, can obtain same-day ultrasounds and abortions. Health advocates say timely access is important to help women avoid unwanted pregnancy symptoms, such as nausea.
Nova Scotia cites the prescribing information for Mifegymiso published by Health Canada in applying its practice to insist on ultrasounds. However, Canada’s guidelines for medical professionals state that ultrasounds are recommended, but if scans are not readily accessible, providers should use other methods.
Dustin Costescu, a family planning specialist who helped write the national guidelines, said in an interview that abortions using the drug Mifegymiso are safely and effectively performed in many countries without routine ultrasound. In France, about 70 per cent of medical abortions are performed without dating ultrasounds, he said.
Ultrasounds are used to determine how long a woman has been pregnant and to rule out ectopic pregnancies − those growing outside the uterus. Mifegymiso can be used in only the first nine weeks of pregnancy. Another drug would be used for ectopic pregnancies.
Dr. Costescu is calling on Health Canada to update the product monograph for Mifegymiso to reflect the fact ultrasounds are not necessary before the pill can be prescribed. Product monographs are documents that contain detailed information on how to safely prescribe drugs and are written by drug manufacturers and approved by Health Canada. While not binding, many health professionals adhere to them. Currently, the product monograph for Mifegysmo says ultrasounds are required. That means women in areas where ultrasounds are not readily available, such as Nova Scotia and some remote and rural parts of Canada, may be facing unnecessary delays.
“These regulations are being used in a scapegoating manner to justify practice restrictions,” Dr. Costescu said. “It behooves the regulator to use the best available evidence to help us to do our job safely and effectively.”
Dr. Costescu said other reliable methods to date pregnancies include pelvic exams and blood tests. To ensure women aren’t experiencing an ectopic pregnancy, health professionals would do blood tests in the days after the medical abortion to see whether levels of the pregnancy hormone are decreasing.
Wendy Norman, associate professor in the department of family practice at the University of British Columbia, said health-care providers that are mandating ultrasounds before every drug-induced abortion are “falling down on their duty” to deliver good care.
“If there is a health system policy requiring an ultrasound in every case … this falls short of our best available evidence.”
Dr. Costescu said Mifegymiso is new to the Canadian market and many health professionals may feel uncomfortable prescribing outside the scope of the product monograph.
A spokeswoman for Health Canada said that to alter the product monograph, the drug manufacturer would have to submit new evidence demonstrating that the change is evidence-based and safe.