The waiting room was quiet except for the occasional shuffle of papers and the muted ping of text messages. Sarah, a 32-year-old teacher from Victoria, had been bleeding for three days before she could get an appointment. “I knew what was happening,” she told me, her voice steady but her hands fidgeting with her phone case. “But I didn’t know what to expect medically, emotionally, or even what questions to ask.”
Sarah’s experience reflects a reality faced by thousands of Canadians each year. Miscarriage affects approximately 15-20% of known pregnancies, touching the lives of about 100,000 families annually across the country. Yet until recently, there has been no standardized approach to care.
This gap is what the Society of Obstetricians and Gynaecologists of Canada (SOGC) aimed to address with their first-ever national clinical practice guidelines for miscarriage care, released last month. The comprehensive framework offers healthcare providers evidence-based recommendations for supporting patients through pregnancy loss—a milestone that advocates have sought for decades.
“These guidelines represent a significant shift in how we approach early pregnancy loss in our healthcare system,” explains Dr. Dustin Costescu, an obstetrician-gynecologist at McMaster University and chair of the SOGC’s Clinical Practice Gynaecology Committee. “We’re moving away from viewing miscarriage as simply a medical event and recognizing it as a profound life experience that requires compassionate, informed care.”
When I visited clinics across British Columbia last year, I encountered healthcare providers who described feeling unprepared to offer consistent emotional support alongside medical intervention. Many relied on personal instinct rather than formalized training for the delicate conversations that follow pregnancy loss.
The new guidelines address this by emphasizing psychological care alongside medical management. They outline specific approaches for healthcare practitioners to discuss loss sensitively, provide appropriate follow-up, and recognize when additional mental health support might be necessary.
For Indigenous communities, the guidelines acknowledge the importance of culturally safe care and traditional practices around pregnancy and loss. This recognition comes after years of advocacy from Indigenous health organizations who have highlighted gaps in culturally appropriate reproductive healthcare.
“When we lose a pregnancy, we’re not just losing a medical outcome—we’re losing dreams, plans, and a piece of our future,” says Melissa Jenkins, who founded the support network Pregnancy After Loss following her own experiences with recurrent miscarriage. “These guidelines signal that our healthcare system is beginning to understand the emotional magnitude of this experience.”
The recommendations also address practical concerns. They outline multiple management options—expectant (waiting for natural completion), medical (using medications), or surgical interventions—empowering patients to choose approaches aligned with their circumstances and preferences.
Statistics Canada data indicates that approximately 40% of women who experience miscarriage develop symptoms of depression, while 20-40% experience anxiety in the months following loss. The guidelines aim to reduce these numbers through improved initial care and appropriate referrals.
Healthcare inequities also feature prominently in the SOGC’s approach. Rural and remote communities, where access to specialized care is limited, receive specific consideration. The guidelines suggest telemedicine options and protocols that can be implemented in settings with fewer resources.
“We see patients traveling four or five hours just to receive basic follow-up care after a miscarriage,” a nurse practitioner from northern British Columbia told me. “These guidelines create a roadmap for consistent care regardless of location.”
The development process itself reflected a commitment to diverse perspectives. The SOGC consulted patient advocacy groups, mental health specialists, and healthcare providers across disciplines to ensure the guidelines would address the full spectrum of needs.
Implementation remains the next challenge. While the guidelines provide a framework, healthcare institutions must now integrate these recommendations into their systems and training. This transition may take time, particularly in regions already struggling with resource constraints.
For Sarah, whose experience predated these guidelines, the changes come with mixed emotions. “I’m grateful future patients might have a better experience,” she reflected as we spoke in a coffee shop near her home. “But it’s hard not to wonder how different my journey might have been with these supports in place.”
As Canada moves forward with these new standards of care, the SOGC emphasizes that the guidelines will evolve based on emerging research and feedback from both healthcare providers and patients. The Public Health Agency of Canada has expressed support for the initiative, noting its alignment with broader efforts to improve reproductive healthcare nationwide.
For the thousands of Canadians who will experience miscarriage this year, these guidelines represent more than clinical recommendations—they signal recognition of an often-invisible loss and commitment to care that honors both physical and emotional healing.
“The most important thing,” Dr. Costescu notes, “is that patients know they’re not alone, their experience matters, and our healthcare system is working to better support them through one of life’s most difficult transitions.”
