Numaira Siddiqui and her son Alyan (9) at their home in Surrey, B.C. While pregnant with him, Ms. Siddiqui survived a medical emergency, with doctors at Vancouver General Hospital performing life-saving surgery and delivering her son at the same time.Isabella Falsetti/The Globe and Mail
Numaira Siddiqui arrived at the hospital unconscious, eight months pregnant. The Metro Vancouver resident had been at a prenatal ultrasound appointment when she developed a severe headache and collapsed, prompting panicked staff at the radiology clinic to call 911.
At Vancouver General Hospital, a CT scan revealed a brainstem hemorrhage – a life-threatening condition. She was immediately placed face-down on a specialized operating table, her pregnant belly suspended, as surgeons performed an emergency procedure to open her skull and relieve dangerous pressure on her brain.
Throughout the four-hour procedure, an obstetrician lay on his back under the operating table, monitoring Ms. Siddiqui’s fetus with a hand-held ultrasound. As it neared completion, he observed fetal distress and signalled the baby would have to be delivered immediately.
Gordon Finlayson, the attending intensive care physician overseeing Ms. Siddiqui’s care that day in November, 2016, said her case immediately came to mind when he learned in late February that VGH, B.C.’s largest hospital, would be diverting patients who are 20 weeks or more pregnant with complex medical and surgical conditions to other hospitals. VGH has temporarily lost obstetrical services in the wake of a specialist shortage and unsuccessful pay negotiations.
Dr. Finlayson was one of two medical leads to write to B.C. Health Minister Josie Osborne and local MLAs saying the disruption creates inequitable patient care and “will become a matter of life and death.”
VGH is not a maternity hospital and does not typically deliver babies. However, as an adult Level 1 trauma centre – a designation indicating that the most advanced care is available – it has until now contracted with maternal-fetal medicine specialists at BC Women’s Hospital, who are trained for high-risk pregnancies, to provide obstetrical care in complex cases involving pregnant patients.
Ms. Siddiqui says it was fortunate to have the full team of doctors available that day. ‘They were doing two operations at that time.’Isabella Falsetti/The Globe and Mail
The maternal-fetal medicine specialists gave notice as early as November, 2024, that they would be ending their contract with VGH as their practice shifted toward more specialized care. That gave the province 15 months to plan, Dr. Finlayson and Phil Dawe, the hospital’s medical director of trauma services, wrote in their letter.
Complex pregnancy cases are rare and Vancouver Coastal Health, the local health authority, says contingency plans are in place as it works toward a solution. Doctors and trauma specialists say these patients should never be diverted from a top-tier hospital, and note the disruption is part of a provincewide shortage of obstetrician-gynecologists affecting women’s health.
Chelsea Elwood, vice-president of the Society of Obstetrics and Gynecology of British Columbia, said a group of obstetricians worked with the health authority on short- and long-term planning options, including securing pay rates, while the specialists continued providing care.
The groups did not ultimately secure an agreement and the maternal-fetal medicine specialists gave 24-hour notice on Feb. 28.
Doctor pay in B.C. is governed by the Physician Master Agreement, or PMA, negotiated between the province and the provincial doctors association.
Vancouver General diverts pregnant patients with complex cases because of OB-GYN shortage
The Ministry of Health says the obstetrician group is seeking an on-call rate three times higher than the one offered in the agreement – $2,000 per day compared to $678 per day – and that it would risk destabilizing services offered at the PMA rate if the ministry agreed.
However, Dr. Elwood called this an apples-to-oranges comparison, saying the PMA on-call rate does not include fee-for-service payments, such as $653 for an emergency C-section under B.C.’s Medical Services Plan, as an example. The $2,000 would have been a flat day rate and was initially agreed upon, she said.
Dr. Finlayson recalled the distress he felt that day in 2016 treating Ms. Siddiqui before an obstetrician arrived.
“That sense of being absolutely helpless in the depths of an emergency is an awful feeling as a physician,” he said in an interview. “And forget how I feel as a physician; think about the patients and their families.”
Vancouver Coastal Health says about two pregnant patients a week attend VGH for emergency care. For now, they will be transferred to other hospitals such as Royal Columbian in New Westminster, St. Paul’s in Vancouver or Lions Gate in North Vancouver.
Dr. Finlayson said while such cases are rare, they often involve catastrophic emergencies where minutes matter and a transfer to Royal Columbian, B.C.’s other adult Level 1 trauma centre, 20 kilometres away, may not be feasible. In other cases, a pregnant patient may have a complex medical condition, such as a blood cancer requiring a marrow transplant, that can’t be treated at any other hospital in B.C.
“These are all rare events, which is why I think there’s a perception of catastrophizing the situation,” Dr. Finlayson said. “But as an intensivist, I’m certainly much more comfortable having an obstetrician partner with us whenever we have a patient that’s obviously pregnant, or even postpartum.”
Trauma specialists have noted that VGH’s loss of obstetrical care is at odds with Level 1 trauma centre requirements outlined by both the Trauma Association of Canada and the American College of Surgeons, or ACS.
Ms. Siddiqui with her husban Arsalan Rasool (left) and their two boys, Alyan and Azaan (4). She spent years in rehabilitation after her surgery, relearning how to walk, speak and breathe.Isabella Falsetti/The Globe and Mail
Canada has about 16 adult Level 1 trauma centres, though only two – Sunnybrook Health Sciences Centre and St. Michael’s Hospital, both in Toronto – are formally verified by the ACS, which runs an international trauma centre verification program. The rest are designated by provincial or regional health authorities. ACS verification is not required.
Avery Nathens, the Toronto-based medical director of trauma quality programs at the ACS, said verification carries strict standards, including staffing and resource requirements, and participation in benchmarking programs.
A hospital without 24-hour obstetrics and gynecology would not pass verification, he said.
“For something time-sensitive like obstetrics, it’s difficult to have a contingency plan where your plan is to transfer a patient,” Dr. Nathens said.
Arsalan Rasool, Ms. Siddiqui’s husband, said that day in 2016 was the worst of his life. He was consumed with guilt for missing his wife’s ultrasound appointment – he had just started a new job and was on probation – and panicked when he arrived at the hospital to learn her chances of survival were slim.
He praised the team of doctors, whom he said remain in his prayers today.
Ms. Siddiqui spent years in rehabilitation after her surgery, relearning how to walk, speak and even breathe. The baby she carried then, Alyan, is now nine and big brother to four-year-old Azaan.
She said it was fortunate to have the full team of doctors available that day.
“They were doing two operations at that time,” Ms. Siddiqui said. “If there was no obstetrician, no doctor for the baby, then that time would be very difficult. At that time, that I was so critical, every minute counts.”