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Canada Nova Scotia says week-long wait acceptable for dating ultrasound before abortion, but experts disagree

The Nova Scotia Health Authority says it’s acceptable for women to wait a week for an ultrasound before a pregnancy termination but experts maintain such a delay can have serious repercussions on a woman’s health and is not the medical standard in other parts of Canada.

Kim Munroe, the NSHA’s director of ambulatory care, said there’s no need for Nova Scotia’s only abortion clinic, located at the QEII Health Sciences Centre in Halifax, to conduct its own on-site dating ultrasounds because the hospital’s department of diagnostic imaging can accommodate all the women who want to end their pregnancies. While some women in urgent situations can be seen within a day or two, the average wait time for an ultrasound is a week, Ms. Munroe said in an interview.

But the medical directors of the abortion clinic and other abortion experts say that conducting on-site dating ultrasounds would speed access to timely abortions.

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Abortion access wait times are not tracked across Canada. But experts say that in urban centres, women can often receive same-day or next-day appointments at abortion clinics. They say it is onerous if women have to make separate trips to a doctor’s office or clinic, wait days or weeks for a scan, and then make another appointment for the actual abortion.

Experts say delaying care can affect the type of procedure women can have. A week-long delay could push a woman past the standard nine-week limit for the abortion pill, a safe alternative that allows women to terminate their pregnancy at home and avoid surgery. Delaying treatment beyond a few days also exposes women to potential nausea, vomiting and other difficult pregnancy symptoms, which can be traumatizing.

The Nova Scotia Women’s Choice Clinic recently raised funds for its own ultrasound machine, which is expected to arrive within two weeks. Once it does, however, the clinic is only authorized to use it during surgical procedures, not to perform dating scans before an abortion. Dating scans – which are recommended but not mandatory, according to Canada’s national guidelines for medical abortions using the drug Mifegymiso – are done to determine the gestational age of the fetus and rule out ectopic pregnancies (those growing outside the uterus).

Dustin Costescu, lead author of the guidelines, said the the NSHA policies are making the process of obtaining an abortion in Nova Scotia unnecessarily lengthy and onerous. By not allowing the abortion clinic to conduct on-site dating ultrasounds, it means women have to make at least two separate appointments; this can, in some cases, push them beyond the gestational age for medical abortion eligibility.

“It’s a vulnerable and time-sensitive phase,” Dr. Costescu said. “It’s a bit harsh to tell a woman who has an unintended pregnancy she’s not a priority.”

Lianne Yoshida, co-medical director of the abortion clinic, said the new machine could eliminate wait times for abortion ultrasounds and would also relieve pressure on the hospital’s department of diagnostic imaging. Doing on-site dating ultrasounds would also bring the Nova Scotia Women’s Choice Clinic up to the same standard of care that’s available in most other abortion clinics across Canada, she said.

While Ms. Munroe acknowledged that on-site dating ultrasounds are a standard part of good abortion care, she said it’s “certainly not the priority issue at this point.”

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“We’re not saying that dating on the unit is not best practice. What we’re saying is we’re not there yet,” she said.

The Nova Scotia Department of Health and Wellness says it’s up to the NSHA, which oversees day-to-day health-care delivery, to make any recommendations for changes to abortion services, including ultrasounds.

The province has come under fire this week after The Globe and Mail reported women often have to wait days or weeks for an ultrasound, which the health authority says is necessary before an abortion. In an essay published Saturday, reporter Jessica Leeder outlined her attempt to receive a medical abortion in Halifax earlier this year and explained how she eventually had to fly to Toronto and pay out of pocket rather than wait two weeks or more for an ultrasound in Nova Scotia.

According to Ms. Munroe, all patients have to wait for ultrasounds and they can’t make exceptions for every hospital department that has a need.

“Just because 90 per cent of the [orthopedic] patients require an X-ray doesn’t mean we’re going to put an X-ray in the orthopedics department,” she said.

She noted that currently, no one at the clinic is trained to do ultrasounds before an abortion. Once the machine is there, hospital officials can meet to discuss future priorities, whether dating ultrasounds should be performed at the clinic and staff training needs, she said.

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Dr. Yoshida said she will receive abortion ultrasound training at a session held by the National Abortion Federation in Toronto on Friday. She is paying for the training out of pocket. She has opted not to get trained on conducting dating scans because it’s not a skill she will be able to use for the foreseeable future.

The department of diagnostic imaging can see up to six women seeking abortions a day. They are squeezed in between other patients, Ms. Munroe said. On some days, most or all of the spots go unused, she said.

But Melissa Brooks, co-director of the abortion clinic, said in an e-mail they regularly do eight abortions a day, meaning there are usually not enough ultrasounds available to accommodate everyone.

“There certainly are weeks where our triage nurse is scrambling to find spots to fit people in,” Dr. Brooks wrote.

Dr. Yoshida said the debate isn’t about how long women have to wait. It’s about the fact the clinic will now have a way to eliminate the wait altogether and provide seamless care in one place. She’s hopeful that can happen one day.​​

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