New collaborative program at London, Ontario hospital helps ease rigidity in high-risk pregnancies

New collaborative program at London, Ontario hospital helps ease rigidity in high-risk pregnancies

When Allison Zietsma, 41, of London, Ontario, learned she was pregnant with her son Sawyer just months after giving birth to her daughter, she was terrified because her first experience was so difficult.

Both of Zietsma’s pregnancies were classified as high risk due to medical challenges, including high blood pressure and risk of bleeding, as she had experienced with her first delivery.

“Our biggest concern was pregnancy loss,” Zietsma told CBC News. “Having two pregnancies close together can also increase the risks for both the baby and myself, so I was also concerned for my own safety and health.”

That fear was allayed when she was referred to the London Health Sciences Center’s (LHSC) Interprofessional Midwifery/Maternal-Fetal Medicine Expanded (TIME) programme.

The collaborative program brings together midwives and maternal-fetal medicine (MFM) specialists who work together to address high-risk pregnancies to provide additional care and support to patients and their newborns.

This includes extra time during their prenatal visits, mental health support, breastfeeding supplies and six weeks of postnatal care for mothers and their babies at their homes in London.

Midwife-of-entry Annie Latham, right, examines six-week-old Sawyer Zietsma, shown with his mother, Allison. (Submitted by the London Health Sciences Centre)

Relief of the health system

A key pillar for TIME is the additional support available to patients while keeping them away from the hospital for non-urgent matters at a time when staffing issues and burnout are plaguing the healthcare system, said MFM specialist Dr. Harrison Banners.

“We have seen many people come back to hospital who probably could have been cared for in their own community. That way we can keep that care going in the community and keep people away from the ER,” he said.

“Giving patients the opportunity to page the midwife and have someone available to answer their questions is a form of empowerment [preventive] medicine too, which our system should have a lot more of.”

dr R. Douglas Wilson, President of the Society of Obstetricians and Gynecologists of Canada, says that given the potential risks that can accompany any pregnancy, programs like TIME that combine different skills are an absolute necessity.

The COVID-19 pandemic has exposed many vulnerabilities within the healthcare system, which now requires an overhaul of old models of care through teamwork and patient focus, the Calgary-based doctor said.

“There is no greater gift at the end of midwifery when you have a healthy mother and baby, and the best way to achieve that is for health systems to recognize the priority that maternity care requires, so that appropriate resources and resources are available.” Human resources are provided at the beginning of life.”

MFM specialist Dr. Barbra de Vrijer said factors that contribute to high-risk pregnancies include:

  • Birth of twins or triplets.
  • problems with the placenta.
  • Babies who are smaller than average.
  • babies with birth defects.
  • Mothers with high blood pressure or heart and kidney disease that require closer monitoring.

“The hospital must always discharge patients within 24 to 72 hours [after birth] So there could be a gap for patients whose needs are beyond the capabilities of a general practitioner, and that’s where the program really comes in,” said de Vrijer.

Best of both worlds

Funded by the Ontario Department of Health, TIME is open to London residents. But there are similar programs in Canada, like the South Community Birth Program in Vancouver and the Humber River Hospital in Toronto.

Since launching in October, TIME has treated about 60 high-risk patients and has received an overwhelmingly positive response so far, midwife Lauren Columbus said.

“Many patients felt they got the best of both worlds having these very experienced doctors taking care of them, but they also benefited from their midwives who are able to bridge the gap between the hospital and the community and provide this holistic care. ” She said.

“We’re seeing a patient population that isn’t our typical wheelhouse, and the doctors really recognized the value of the care we provided, so it’s been a really wonderful experience.”

Zietsma credits TIME staff with helping her navigate the last six weeks since Sawyer’s birth, along with battling her postpartum depression, she said.

Allison wears a pink t-shirt and holds baby Sawyer in a gray romper.Allison Zietsma is grateful to the TIME staff for helping her identify the potential risks and how to avoid them. (Isha Bhargava/CBC)

“They were really proactive in providing me with resources to address issues that we anticipated and the midwives really helped with the debriefing [preventive] actions to take and how things might affect me,” she said.

Zietsma and Sawyer are now ready to be fired from TIME. The now six-week-old, who was born on December 15, is doing well physically, his mother says.

Zietsma hopes programs like this can be scaled up and help other parents make informed choices, she said.

“It’s so easy for new parents to feel alone and overwhelmed by the amount of noise and information that’s out there, so seek out the support you have available and ask questions.”