Objectives

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Objectives

• To describe the setting and background for South
  Community Birth Program
• To outline the program and describe unique
  features of SCBP including Collaborative
  Practice, Centering Pregnancy group prenatal and
  Doula care
• To describe the Evaluation outlined for SCBP
• To discuss challenges

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Participants

• Pat Agon Chen, RN Jag Gill, RN
  Sue Harris, MD
  Carolyn Iker, MSN Linda Knox RM Julie
  Bertelli Jalana Grant, Doula
  Co-ordinator

• Valerie Perrault, RM Sabrina Purewal,
  RN Joan Robillard, MD
  Lilah Rossi, MD Lee Saxell, RM
  Amy Braunstein
• Penelope Hutchison, Project Manager

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Setting

• South Vancouver Diverse
• 50 of residents speak a language other than
  English at home

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Setting

• 1,313 births in 1999
• Limited number of primary maternity care
  providers in the area
• 64.5 of deliveries by OB/GYN prior to SCBP

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Setting

• Higher incidence of Low Birth Weight
• Increasing rates of C/S in the last 5 years
• Lower rates of breastfeeding
• Focus Groups Women unhappy with their care
• I would have questions but I would not get a
  chance to ask them
• There was never any time to explain anything to
  my doctor it was always too rushed,

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Partners

• Granted Primary Health Care Transition Funds from
  PHSA and VCH
• Also supported by BC Womens Hospital

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Project Features

• Program to provide Maternity Care for women in
  this community through pregnancy, birth and early
  postpartum
• Multidisciplinary Collaborative Care
• Centering Pregnancy Group Prenatal
• Doula Support

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SCBP

• Prenatal care and CP Groups take place at South
  Community Health Centre
• Large meeting room with adjacent
• clinic rooms adjacent
• All births take place at BC Womens Hospital

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Collaborative Practice

• Multidisciplinary team midwives, family
  physicians, community heath nurses and doulas
• Registered midwives and family physicians share
  prenatal care and call for the birth

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Collaborative Practice

• Community Health Nurses (CHNs) provide prenatal
  care with the physician/midwife
• CHNs provide postpartum and breastfeeding support
  in the womans home
• Obstetrical back-up provided through the Resident
  clinic at the South Community Health Centre
• CHNs link women with community resources

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Collaborative Practice

• Doulas are assigned during the prenatal care and
  meet women at least once during the pregnancy
• Midwives and family physicians share care
  including call
• Team meets regularly to discuss cases and issues
  arising for the program

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Collaborative Practice Labour Birth

• The doula attends the woman at home in early
  labour and maintains contact with FP/RM
• FP/RM may do home visit for assessment
• Goal to admit to hospital in active labour
• FP/RM and doula attend the woman at the birth
• Early discharge is supported (lt24hours)

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Collaborative Practice Postpartum

• The woman is visited at home within 24 hours
  after discharge by either CHN/FP/RM
• CHN and FP/RM are in contact if problems
• CHNs continue to visit as needed
• Follow up visit with baby to South Community
  Health Centre
• Reunion of CP Group takes place within a month

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Centering Pregnancy

• CENTERINGPREGNANCY

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Centering Pregnancy

• One intake clinic visit
• Group prenatal care
• 8-12 women/group
• Similar due month
• 10 sessions in total (4 visits q4 weeks then 6
  visits q2 weeks)

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Centering Pregnancy

• Self Care activities BP, Weight, Urine, GA
• THREE minute belly check
• Info shared between woman and care provider
• Discussion of topics of interest co- facilitated
  by CHN and Midwife or FP
• Guest speakers (PT, Nutritionist), Video

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Centering Pregnancy

• Sessions last 2 hours, consistent time day
• Women receive Moms Notebook
• Self-assessment sheets
• Multips highly valued in the group

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Moms Notebook

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Doula Care

• A trained lay person who provides continuous
  one-to-one care during labor and birth
• Doulas recruited within the community
• 18 languages
• Attend a four day DONA approved Doula
  Certification Training
• Mentorship program (with DONA Certified Doulas)

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Collaborative Practice

• Belief that quality maternity care is achieved by
  the contribution of all care providers
• Established shared values, goals and vision
• Establish SCBP protocols

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Collaborative Practice

• Regular care provider meetings retreats
• Regular communication through message board in
  OSCAR, handover
• Mutual trust and respect all caregivers
  participate in the discussions around care( CHNs,
  midwives, doctors, support staff, doula
  co-ordinator)

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Collaborative Practice

• Providing mutual support
• Valuing each others style scope of practice
• Shared responsibility accountability
• Willingness to devote time and energy to building
  the relationship
• Willingness to openly discuss differences

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Fee/pay structure

• Open and frank discussion of financial issues
• All physician and midwife billings are pooled and
  distributed evenly
• Currently billing is under current MD/RM MSP
  billing structures
• Goal is to move to alternative pay model (case
  based)

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Fee/pay structure

• CHNs salary is provided through the CHC
• Doulas currently paid by project money ( payment
  less than the going rate)
• Sustainability for doulas through commitments if
  savings with length of stay, interventions etc
  are achieved

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EMR

• OSCAR ( Open Source Clinical Application
  Resource)
• All forms (Antenatal, LD, Newborn) look like the
  BC Provincial forms (BCRCP)
• Ability to access most up-to-date record at point
  of care.
• Facilitates research and data collection

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OSCAR
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Evaluation

• Study Outcomes
• Perinatal
• Birth Weight/Apgars
• Method of delivery
• Medical interventions in labour and
• birth
• Length of Stay
• Breastfeeding duration

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Evaluation

• Study Outcomes
• Maternal depression
• Maternal satisfaction participation in
  antenatal care
• Maternal satisfaction with birth experience
• Maternal confidence in breastfeeding
• Maternal confidence in newborn care
• Provider satisfaction

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Control Group

• Funded by the BC Medical Research Services Fund
• Cohort matched group of women delivering at BC
  Womens Hospital

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Enrollment

• Community physician referrals
• Community referrals women in program
• Goal 300 women per year
• 110 women enrolled
• 80 in program
• 40 transferred out-primarily moving or SA
• To date 35 deliveries

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Challenges

• Enrollment Patterns of practice, politics,
  beliefs
• Time commitment
• System development

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• For more information
• www.scbp.ca