New collaborative program at London, Ont., hospital helps ease tensions of high-risk pregnancies
When 41-year-old Allison Zi‐ etsma of London, Ont., learned she was pregnant with her son Sawyer just a few months after giving birth to her daughter, she was riddled with anxiety because of how difficult her experience was the first time around.
Both of Zietsma's pregnan‐ cies classified as high risk due to medical challenges, includ‐ ing high blood pressure and a risk of hemorrhaging, as she experienced during her first delivery.
"Our biggest concern was pregnancy loss," Zietsma told CBC News. "Having two preg‐ nancies close together can al‐ so increase risks for both the baby and myself, so I was concerned for my own safety and health as well."
That fear was put to ease when she was referred to the Interprofessional Mid‐ wifery/Maternal-Fetal Medi‐ cine Expanded (TIME) pro‐ gram at the London Health
Sciences Centre (LHSC).
The collaborative program pairs midwives and maternalfetal medicine (MFM) special‐ ists, who deal with high-risk pregnancies together to pro‐ vide extra care and support for patients and their new‐ borns.
This includes extra time at their prenatal visits, mental health supports, breastfeed‐ ing supplies, and six weeks of postpartum care for moms and their babies at their homes in London.
Easing strain on healthcare system
A key pillar for TIME is the additional supports available to patients, while also keeping them out of hospital for nonurgent matters at a time when staffing challenges and burnout are plaguing the health-care system, said MFM specialist Dr. Harrison Banner.
"We saw a lot of people coming back to hospital who could've probably been served in their own communi‐ ty, so this allows us to keep that care in the community and keep people out of the emergency department," he said.
"Allowing patients to con‐ tact the midwife by pager and having somebody available to answer their questions is a form of proactive [preventive] medicine as well, which is something our system should have a lot more of."
Dr. R Douglas Wilson, pres‐ ident of the Society of Obste‐ tricians and Gynaecologists of Canada, says programs like TIME that combine different skill sets are an absolute ne‐ cessity, given potential risks that can come with any preg‐ nancy.
The COVID-19 pandemic highlighted many areas of weakness within the healthcare system, which now re‐ quires a revamping of old models of care, using team‐ work and being patient fo‐ cused, the Calgary-based doc‐ tor said.
"There's no greater gift at the end of obstetrical processes that you have a healthy mother and baby, and the best way for that to happen is to have the healthcare systems recognize the priority that maternity care requires so that appropriate funding and human resources are put into the beginning of life."
MFM specialist Dr. Barbra de Vrijer said factors con‐ tributing to high-risk pregnan‐ cies include:
Birthing twins or triplets. Placenta issues. Babies who are smaller than average. Ba‐ bies with birth defects. Moms having high blood pressure, or heart and kidney disease, requiring them to be moni‐ tored more closely.
"The hospital always needs to discharge patients within 24 to 72 hours [after birth] so there might be a gap for patients who have needs that exceed a family physician's ability, and this is where the program truly comes in," de Vrijer said. Best of both worlds
TIME received funding from Ontario's Ministry of Health, and is open to Lon‐ don residents. But there are similar programs in Canada, such as the South Communi‐ ty Birth Program in Vancou‐ ver and the Humber River Hospital in Toronto.
Since launching in Octo‐ ber, TIME has served about 60 high-risk patients and has re‐ ceived overwhelmingly posi‐ tive response so far, said mid‐ wife Lauren Columbus.
"Many patients felt like they were getting the best of both worlds where they had these very skilled doctors tak‐ ing care of them, but they al‐ so benefited from their mid‐ wives who can bridge the gap between the hospital and the community, and provide that holistic care," she said.
"We're seeing a patient population that is not our typical wheelhouse and doc‐ tors have really seen value in the care that we provide, so it's been a really wonderful experience."
Zietsma credits the TIME staff in helping her navigate the past six weeks since Sawyer was born, along with combatting her postpartum depression, she said.
"They were really proactive at giving me resources to deal with issues that we anticipat‐ ed, and the midwives really helped to debrief me on [pre‐ ventive] measures to take and how things might affect me," she said.
Zietsma and Sawyer are now ready to be discharged from TIME. The now six-weekold, who was born on Dec. 15, is physically thriving, his mom says.
Zietsma hopes programs like this can be expanded and help other parents make in‐ formed choices, she said.
"It's so easy for new par‐ ents to feel alone and over‐ whelmed with the amount of noise and information that's out there, so seek out what‐ ever supports are available to you and ask questions."