EARLY DISCHARGE PROGRAM REDUCES RISK FOR MOMS AND BABIES
MSH’s innovative midwifery-run birthing unit collaborates with obstetrical staff to provide quality patient-centred care during COVID-19
Agroundbreaking program introduced by Markham Stouffville Hospital (MSH) last spring — as the pandemic forced everyone and everything to pivot to new protocols — has redefined the birthing experience for women at the hospital. And, everyone hopes, for other hospitals too.
The early discharge program at MSH was inspired by a group of midwives in Ottawa and was adapted to meet the needs of MSH’s community. And though it was launched at a time of great stress and anxiety due to COVID-19, the results for hundreds of women and families to date have been exactly the opposite.
The program allows for the discharge of healthy moms and babies within six hours of giving birth at the hospital in the obstetrical birthing unit and provides them with follow-up care in the comfort of their own home. It is the result of a partnership and collaboration among several of the hospital’s teams, encompassing obstetrics, paediatricians, family physicians and MSH’s forward-thinking team of midwives in the Alongside Midwifery Unit (AMU).
For Francesca Hume, who was one of the first mothers to give birth at MSH’s The Stollery Family Centre for Childbirth & Children under the early discharge program in April, the pandemic added a high level of anxiety to her birthing experience.
“The pandemic was really ramping up when I was nine months pregnant and all of the unknowns created a lot of anxiety regarding my own birth experience,” says Francesca, who started her maternity leave from MSH — where she is an obstetrical nurse — early in order to avoid exposure.
Francesca’s mother lives with her and is undergoing chemotherapy for pancreatic cancer. So, limiting exposure to the possibility of infection of COVID-19 was top of mind.
As well, not having her husband in the room with her to share the experience added another level of stress. (During the time of Francesca’s labour and delivery, partners were allowed to attend the birth, but had to depart shortly afterward. At the time of publishing, this latter restriction was no longer in effect but subject to change based on hospital policy and procedures.)
Francesca was offered the opportunity to participate in the early discharge program and she was immediately relieved.
“First, it meant my exposure to patients and staff in hospital would be decreased, which was important both for me and baby — as well as for my mom. And it also meant my husband wouldn’t miss the key early moments.”
Francesca gave birth at 4:45 p.m. and was back home first thing the next morning.
“The program allows even more patient-centred choices and breaks down the silos between disciplines, which is something we’ve always been good at in the childbirth centre at MSH. And this is taking it all even further,” says Francesca.
Soon after her return home, she had her first visit from midwife Stephanie Zaheer.
“Stephanie took the time to review any issues we were having in caring for our son and talk to me about how I was feeling physically and emotionally. She asked questions about things that even I didn’t think of,” says Francesca.
“I also really appreciated the many ways Stephanie delivered safe care while in my home, including wearing a mask, washing her hands frequently and thoroughly cleaning anything she would be using during her examinations.”
Stephanie, who leads the early discharge program, says that mothers can call to speak with a midwife or request a visit anytime in the six weeks following their birth.
“We provide the first home visit and we do all the same assessments — from bloodwork to breastfeeding support, or whatever mom needs.”
Stephanie was instrumental in bringing the various expertise and departments at MSH together in order to design the early discharge program. And she would love to see it rolled out across the province.
Acknowledging that it might take a change of mindset for some people to embrace the program, she believes the long-term benefits should make it a no-brainer. Given that midwives work in 79 of about 100 hospitals in Ontario that provide maternity services, “this should definitely be the standard,” says Stephanie.
MSH is home to Canada’s first midwifery-run birthing unit within a hospital’s walls. The AMU opened in 2018. MSH was also the first Ontario hospital to grant midwife privileges upon provincial legislation of midwifery as a health profession in 1994.
Each year, more than 3,200 babies are born at MSH.
The early discharge program was an integral part of the midwifery services of the AMU at the outset, and it’s now available to anyone giving birth at the hospital in the obstetrical birthing unit.
Dr. Deepa Grewal, chief of paediatrics, gives full credit to the midwifery unit for making all of this possible.
“On the obstetrical side of the hospital, we weren’t doing early discharges. But then came COVID-19. So with the concern about surge volumes and optimizing flow and bed utilization, we asked ourselves: ‘For women who have had uncomplicated vaginal births, could we get them home sooner with the proper supports in place?’”
The leadership and collaborative efforts of the AMU, says Dr. Grewal, is what made this possible. “This is a successful endeavour because of the collaboration with the midwives,” she says. “This is simply an extension of what the midwives normally do for their patients, so it made sense.”
“The survey response [from patients who have been through the program] has been amazing,” says Carol Cameron, executive director of the AMU. “142 people have responded so far and 99 per cent say they are very satisfied and would do it again.”
“The AMU is the result of a commitment to innovation here at MSH. And this new program is yet another example of that,” says Carol. “I am really proud to work for an organization that is not afraid to think outside the box to meet our ever changing patient needs.”
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