How this St. Joseph’s clinic helps patients in the early stages of pregnancy and lowers ED visits

Dr. Shawna Irons, a physician in the Family and Community Department, and Clinical Nurse Specialist, Gizelle Barsoum are part of the team at the Early Pregnancy Management Clinic (EPMC) at St. Joseph’s Health Centre.
Founded in 2021, the clinic was developed as a Women and Children’s Health program in collaboration with the Emergency Department (ED) and the Family Medicine OB team to better support patients experiencing complications during the first trimester of pregnancy.
Sign up for the Unity Health Toronto newsletter, a monthly update on the latest news, stories, patient voices and research emailed directly to subscribers. If you haven’t subscribed yet, you can do that by clicking here.

Care in early pregnancy is often provided in the ED, and patients can be impacted by wait times and a less than ideal setting at a vulnerable time. The EPMC provides urgent and individualized care to patients in a comfortable outpatient setting, for women who are experiencing complications in the first 13 weeks of pregnancy, such as threatened early pregnancy loss, a non-viable pregnancy, confirmed pregnancy loss or ectopic pregnancy.
Patients are referred from St. Joseph’s staff in the ED, obstetricians (OB), Family Medicine and community midwives and the program is actively decreasing the amount of ED visits by allowing care to be managed in a space solely dedicated to early pregnancy.
“To be able to work with a program that provides the right resources and the right supports at the right time for patients is really important to me,” Dr. Irons says. “We are helping to fill a significant gap for these patients, and provide good care that we feel proud of. We are really supporting patients.”
Barsoum has a lead role in running the clinic by being the constant care provider, connecting patients with the resources they need during the early stages of pregnancy. In her role, the day-to-day includes triaging referrals, contacting patients to gather more information about their history, providing counselling, education and support, and arranging follow-up visits and procedures the care team.
She helps to provide both the important continuity of care and ensures the team is informed of patient needs. This essential communication with all providers involved is part of what makes the clinic successful in providing the compassionate care they strive for.
“I have found lots of value in this clinic and the quality of care we can provide to our patients” says Barsoum.

Barsoum, in her Clinical Nurse Specialist role works closely with the family medicine obstetrical provider on call while the obstetrical team is available for surgical or complex consults if a procedure is required, the OB on call is able to book them directly in reserved time slots which decreases patient wait times. The EPMC also helps provide services for those experiencing pregnancy complications after an initial visit to their provider or the ED. These cases can sometimes end in loss, which the team also provides support with.
Pregnancy loss is experienced differently by everyone, and the interprofessional team including social work, psychiatry and spiritual care is available through the EPMC clinic based on a patient’s individual assessment of need.
Despite outcomes often being difficult, patients take comfort in knowing their options and appreciate the care they’ve been provided.
While “it can be an extremely difficult time for the patients and a time of uncertainty,” Dr. Irons believes the ability to provide appropriate and compassionate care to patients is the most important aspect of the EPMC.
By Caitie Lehman
Photos by Katie Cooper