Research team seeks to strengthen perinatal health care system in Canada

Approximately 400,000 births occur in Canada each year. While most pregnancies result in the delivery of a healthy baby, 1 in 9 ends in complications that require the baby to receive treatment in a neonatal intensive care unit. The mother may also experience complications that require special treatment or care.

Although Canada has an excellent system of perinatal care overall, some gaps exist that have led to suboptimal processes and disparities. These problems create challenges for health care professionals and prevent the delivery of high quality of care to mothers and their babies.

"The regionalization of perinatal health care in Canada began in the 1970's and attempted to match the pregnant woman’s level of risk to the services available in the delivery hospital. However, the closing of hospitals in rural areas in recent years has led to a situation where pregnant women have to travel long distances to access the level of care appropriate for their risk level. The Greater Toronto Area also faces a serious mismatch between levels of pregnancy risk and the hospital’s tier of service” says Dr. K.S. Joseph, a perinatal researcher at the University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia.

Currently, women with low-risk pregnancies living in rural areas who travel long distances for prenatal care or childbirth may have their medical risks addressed but can encounter social risks. Social risks are especially problematic for high-risk women from rural areas. Problems include challenges associated with relocation for extended period and isolation, and can be extremely taxing for women with small children. Women with high-risk pregnancies residing in urban centres are also disadvantaged if they are unable to access a specialist centre because of a lack of capacity. Delivery in a hospital without the special expertise or equipment needed to manage possible complications leads to post-delivery emergency transport to a higher level hospital but such situations sometimes result in less than optimal outcomes.

Dr. Joseph is leading a CIHR-funded research team that seeks to correct this mismatch between pregnancy or infant risk and the level of care. Over the next year, the team will carry out analyses of the perinatal health system across the country to identify what’s working well and where improvement is need.

Using data from the Canadian Institute for Health Information as well as provincial and territorial heath systems data, the team will produce a ground level map of the levels of perinatal care available across the country – from small hospitals in rural areas to the most advanced specialist hospitals. The project will include a focus on rural and remote regions of the country and the system of emergency transport available, such as land and air ambulances.

”Our overall objective is to ensure that mothers and babies receive a level of care that is appropriate to level of risk they face,” says Dr. Joseph.

The team has support and collaboration from the Society of Obstetricians and Gynaecologists of Canada, the Public Health Agency of Canada, the Canadian Perinatal Programs Coalition, the Canadian Paediatric Society, and other professional organizations. On the basis of their analysis, the team will make recommendations and implement them in collaboration with perinatal care programs in all regions of the country as well as provincial and territorial Ministries of Health. ‎The recommendations will assist provinces and territories better organize and deliver health services for pregnant women and newborns.

The team's work is being funded under the CIHR Institute of Human Development, Child and Youth Health's Preterm Birth Initiative.

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