Maison Bleue delivers ray of hope
PARC-EXTENSION PREGNANCY CENTRE provides crucial medical and social support for mothers-to-be in dire straits and their families
For pregnant women in vulnerable situations, La Maison Bleue delivers multiple health and social services under one roof, including resources for babies and small children.
A very pregnant 22-yearold Marriam Naseeb walks to the centre each week from her home in Park-Extension. She’s the sole income earner for her family — mother, father and two younger brothers — and she hasn’t seen her husband since June.
She smiled as she talked about La Maison Bleue’s integrated team of specialists, including a family doctor, midwife, nurse and social worker, that has followed her pregnancy.
“Whoever I’ve met here, I’ve found a sister, a mother and a friend,” Naseeb said. She’s one of 90 pregnant clients that the multi-disciplinary pregnancy centre — part of the Centre de santé et de services sociaux (CSSS) de la Montagne — accepts each year in the Park-Extension neighbourhood.
Like Naseeb, pregnant women who come to La Maison Bleue might be from low-income households with any number of dependent family members. Many clients, including teenagers, might also be facing other challenges, including conjugal violence, precarious immigration status, living alone without contacts in the city, having children who are being followed by youth protection services and mental health issues. Or they might be carrying a baby that is the outcome of rape.
Like Naseeb, each of these women visits La Maison Bleue on a voluntary basis, often walking from nearby homes for access to medical attention, group classes on subjects like breastfeeding and applying for unemployment insurance, as well as other social and medical resources.
The sunny waiting room of La Maison Bleue includes a crib, a kitchenette, plants, children’s books and an ExerSaucer. A bulletin board promotes a workshop called “Get your family ready for winter.”
Personalized kids’ toothbrushes hang on a board in a big playroom, where each weekday a specialized educator hosts age-specific groups for young children to play games, sing songs and do crafts — often with parents — in order to develop language and motor skills, and to socialize.
“It’s one-stop shopping,” said Dr. Vania Jimenez, who with her daughter, Amélie Sigouin, co-founded the first La Maison Bleue in Côte-desNeiges in 2007. The centre in Park-Extension opened its doors in 2011 and a third centre is being planned for downtown, near Cabot Square, affiliated with the same CSSS, Jimenez said.
Having practised family medicine and obstetrics in Montreal for more than 25 years, Jimenez said she became frustrated in the past when she and other doctors weren’t able to meet the real health needs of pregnant women and young families in vulnerable situations — needs like social support, education and postpartum nutrition.
“We were doing these deliveries and feeling pretty powerless,” Jimenez said. She could write a referral for a social worker, but appointments often would be missed, or never made at all, because the woman in question didn’t trust a social worker she’d never met.
“We weren’t very successful in creating the social nest that these families need in order to make a good life for their babies,” Jimenez said.
Adding to her frustration was knowing that the most efficient time to prevent problems for children is during pregnancy — knowledge that was supported by the research of Jimenez’s colleague, Montreal social pediatrician Gilles Julien. His approaches to healthy child development were among several inspirations for La Maison Bleue.
Jimenez is one of five family doctors who work from La Maison Bleue in Park-Extension as little as a half-day per week. Each doctor then spends the other part of the workweek in a private practice or at a Centre local de services communautaires (CLSC).
“Physicians tend to take a lot of space,” Jimenez explained, adding that it was better for the women to see more of the centre’s social worker and midwife, who work exclusively at La Maison Bleue.
Hannah Shenker is another family doctor at the centre. Like the other doctors, she follows the babies she’s helped deliver until age 5 at La Maison Bleue. To ensure continuity of care, parents can then choose to have their child transferred to Shenker’s practice at a CLSC.
Each of the family doctors at La Maison Bleue begins the day by meeting around a table with the other professionals involved in each family’s care.
“I don’t feel like the women that I see here are my individual patients,” Shenker said. “I feel like I’m part of a team that’s following them, and accompanying them through their pregnancy and birth, and afterward.”
“Pregnancy is a really good porte d’entrée to make an impact on families,” said Dominique Arsenault, a Maison Bleue spokesperson. With trust established during pregnancy, Arsenault said, mothers and fathers are more likely to return to La Maison Bleue following their babies’ births.
Fostering a healthy bond between parents and children is a key goal at La Maison Bleue, Arsenault added, noting that a psycho-educator is part of the team that works with parents and kids for the first five years after a birth — or longer if they have younger siblings.
“Mothers who have had trauma in their own childhoods — for example, because of violence or neglect or abuse — will sometimes reproduce that,” she said. “We can help the mother and child try to establish a strong relationship, so the child has a good sense of psychological and emotional security.”
“And one of our goals here is to break the social isolation of families,” Arsenault said, describing some of the group classes pregnant women and their families are invited to.
During prenatal classes led by her midwife, Naseeb said she’s learned what to expect during her labour and breastfeeding. Through classes led by the centre’s nurse, Naseeb said she’s learned what solid foods her baby can eat after six months, like boiled vegetables and mashed potatoes. And the centre’s social worker has helped her arrange for maternity leave from her job at a Tim Hortons outlet, Naseeb said, and has organized group trips to the nearby Jean Talon Market and to a neighbourhood swimming pool.
“Some of the women here, it’s their second baby, or their third baby, so they share their experiences also,” Naseeb said. She has exchanged phone numbers with other clients at La Maison Bleue, she said, as well as tips about local food banks and a local women’s centre, and where to get the best prices on groceries.
Naseeb discovered La Maison Bleue through a friend who’d also been a client there. Word of mouth, Arsenault said, is the main source of referrals. Professionals through the CSSS de la Mon- tagne make about one-third of referrals, she added, and others find La Maison Bleue through child protection services, community groups and schools.
After an initial meeting with a nurse, Naseeb was accepted as a client, and soon met her social worker, doctor, and midwife.
“The first time I heard the heartbeat of my baby, the midwife told me: ‘You can call your husband, and he can also hear the heart,’ ” Naseeb said. “He was in heaven.”
In fact, her husband remains in Pakistan and is in the process of being sponsored to live in Canada, which means he can’t get a visitor’s visa to attend their daughter’s birth this month, she said. Naseeb’s mother, likewise, will not be at the birth because she will stay home to take care of Naseeb’s 8-yearold brother.
Naseeb and all the pregnant women at La Maison Bleue who would otherwise be alone during their births are also given the option of having a doula, or birth assistant. The doula works on a voluntary basis from one of two services — Montreal Birth Companions and Mother Wit. Naseeb said her doula has helped her plan for special comforts during her birth, like music, perfume and being able to talk to family members in Montreal and Pakistan by phone.
La Maison Bleue clients also choose between birthing at home or at a hospital.
“I chose the Jewish (General Hospital) because it’s better than a home birth,” Naseeb said, adding that having doctors and ultrasound machines nearby was safer. Arsenault said most clients at La Maison Bleue opt for hospital births for similar reasons.
Rivka Cymbalist is the founder of Montreal Birth Companions and has been providing doula services to vulnerable families since 2003. The women at La Maison Bleue, she said, have a continuity of care that even women who aren’t in vulnerable situations have a hard time finding. This continuity, she said, helps prevent negative outcomes, like sick mothers and babies, and unnecessary hospital interventions like caesarean births.
“The model should probably be copied across Canada,” Cymbalist said. “It’s a great model.”
La Maison Bleue is a nonprofit organization partnered with the CSSS de la Montagne. Its professionals are paid through the public health care system, but other expenses — administrative staff and maintenance, for example — are covered through private donations and public grants.
“With that, we buy our freedom from bureaucracy,” Jimenez said, noting that if La Maison Bleue needs a new fridge, for example, they don’t have to fill out government paperwork.
Jimenez was careful not to make declarations about how La Maison Bleue is improv- ing health outcomes. “We are hoping to prevent future attachment problems, developmental problems. We are being evaluated for that,” she said. A team, including researchers from the Université de Montréal and the École nationale d’administration publique is doing the evaluation, which is funded by the nonprofit group Avenir d’enfants and is expected to be finished in summer 2014.
Jimenez is optimistic about the future of La Maison Bleue. “We think it’s a winning recipe for the future of children, their mothers,” she said. “And the health care model we have is, we believe, the model of the future for the Quebec health care system.”
Carol Clavier, an assistant professor in department of political science at Université du Québec à Montréal who studies public health policies, agreed with Jimenez.
“The literature on vulnerable families, child development and access to care quite strongly points to the relevance of multi-disciplinary, multi-dimensional interventions, like the type of intervention La Maison Bleue is trying to put together,” she said.
“The Quebec government has followed this track of developing these kinds of services for vulnerable families for a very long time,” Clavier added, listing three public programs launched since 1991 with roughly the same objectives as La Maison Bleue. One of those programs, SIPPE (Services integrés en périnatalité et petit enfance) which was launched in 2004, is still operating in Quebec.
“(SIPPE) does sort of the same thing as what La Maison Bleue does,” Clavier said.
While Arsenault explained that SIPPE was one of the programs that inspired La Maison Bleue, she said the two programs are complementary. Criteria for each program are slightly different, she said, and once someone is in La Maison Bleue they do not use the SIPPE program, so there is no duplication.
“The plus that we have here is the medical followup,” she said, emphasizing that La Maison Bleue offers midwives and doctors, while SIPPE doesn’t.
“Our organization model works. We have great impacts on the babies and families,” Arsenault added.