New collaborative program at London, Ont., hospital helps ease tensions of high-risk pregnancies

When 41-year-old Allison Zietsma 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 pregnancies classified as high risk due to medical challenges, including 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 pregnancies close together can also 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 Midwifery/Maternal-Fetal Medicine Expanded (TIME) program at the London Health Sciences Centre (LHSC).

The collaborative program pairs midwives and maternal-fetal medicine (MFM) specialists, who deal with high-risk pregnancies together to provide extra care and support for patients and their newborns.

This includes extra time at their prenatal visits, mental health supports, breastfeeding supplies, and six weeks of postpartum care for moms and their babies at their homes in London.

Easing strain on health-care system

A key pillar for TIME is the additional supports available to patients, while also keeping them out of hospital for non-urgent 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 community, so this allows us to keep that care in the community and keep people out of the emergency department," he said. 

"Allowing patients to contact 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, president of the Society of Obstetricians and Gynaecologists of Canada, says programs like TIME that combine different skill sets are an absolute necessity, given potential risks that can come with any pregnancy. 

The COVID-19 pandemic highlighted many areas of weakness within the health-care system, which now requires a revamping of old models of care, using teamwork and being patient focused, the Calgary-based doctor 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 health-care 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 contributing to high-risk pregnancies include:

• Birthing twins or triplets.
• Placenta issues.
• Babies who are smaller than average.
• Babies with birth defects.
• Moms having high blood pressure, or heart and kidney disease, requiring them to be monitored 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 London residents. But there are similar programs in Canada, such as the South Community Birth Program in Vancouver and the Humber River Hospital in Toronto. 

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

"Many patients felt like they were getting the best of both worlds where they had these very skilled doctors taking care of them, but they also benefited from their midwives 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 doctors 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 anticipated, and the midwives really helped to debrief me on [preventive] 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-week-old, 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 informed choices, she said. 

"It's so easy for new parents to feel alone and overwhelmed with the amount of noise and information that's out there, so seek out whatever supports are available to you and ask questions."