ON THE FRONTLINES: BIRTH EDITION

July 10, 2020

 

Laurence Tsorba, Erin Chartrand and Martha Sroggie are midwives employed by the Montfort’s Postpartum Care-at-Home Program, integrated into the Family Birthing Centre’s (FBC) care team since 2018.

Armed with a deep love for newborns and a concern for the well-being of new mothers, they work closely together and pass the torch - 24 hours a day, seven days a week - to meet the needs of more than 250 families each year.

Laurence and Erin tell us about their work and how the pandemic has changed the way they do their jobs to ensure the health and safety of the newest members of our community.

“ It is truly an honour and a privilege to be part of the Postpartum Care-at-Home Program! Montfort is the only hospital in Canada and the United States that offers this type of innovative program, allowing new mothers to return home within the first 6 to 14 hours after a vaginal delivery or 24 to 28 hours following a C-section.

According to a survey conducted by the Champlain Maternal Regional Program in 2017, several hospitals in the region are seeing a decrease in the length of postpartum stay as many families wish to return home and settle into their family environment as soon as possible after birth. This program therefore meets the needs of families by offering a close follow-up for mothers and babies. 

This initiative would not have been possible without the close interprofessional collaboration among delivery physicians, obstetricians, midwives, pediatricians and the FBC nurses, for which we are grateful. 

Any family residing in Ontario with a low risk factor and/or no complications can apply for this service. Following the birth, an assessment is done to ensure that mother and baby meet the eligibility criteria for the program and that they are still good candidates to return home.

The program is promoted during pregnancy through prenatal follow-ups and prenatal information sessions. And of course, the service is becoming increasingly known through word of mouth.

We serve a vast geographical area, a perimeter of 35 km from Rockland to Kanata and as far as Limoges. We offer one week of postpartum care with a visit the day after delivery as well as visits throughout the week. In some cases, for example if breastfeeding is more difficult, we visit mothers every other day or even daily. We want to make sure that the baby maintains the weight criteria and we watch for any possible signs of jaundice. The hospital stay is then shorter, and mothers have access to a midwife on call at all times. 

Before the pandemic, in-person prenatal information sessions were offered twice a month. At that time, we had groups of 80 participants. Since the restrictions associated with COVID-19, we have had to convert our in-person sessions to virtual sessions on Microsoft Teams, which now take place every two weeks.

Since the beginning of the pandemic, we have been receiving many requests for the program because women prefer to return home as quickly as possible. Since we are conducting home visits, we have had to quickly adjust our practices to provide the safest care to families.

Coronavirus has really changed the way we do things. We have received excellent support and training from Montfort in order to respect the recommendations and protocols related to the pandemic. We had to acquire personal protective equipment (PPE) such as hats, goggles, masks, gloves and gowns, which must be worn during our visits in order to prevent the transmission of the infection to our clients. All our equipment must be disinfected between visits.

We call each patient to announce our arrival and let them know that we will be coming in with the PPE. We ask all the screening questions before entering their home. They must not have had any visitors between the time they leave the hospital and the time of the visit. 

Photo: Erin Chartrand and Laurence Tsorba, midwives, Montfort

Usually, a few days after the delivery, a consultation with a family doctor should take place to assess the baby's weight. The evaluation of the mother and baby is now done at home, as well as the blood tests that would normally be done at Montfort. All support groups organized by public health and community centres are no longer taking place, so we are also available to support these new mothers. 

Some clinics closed during the pandemic, leaving mothers without a family doctor to provide the necessary follow-up. A few family doctors at Montfort have agreed to take over and see clients from these clinics. We also offer the telemedicine service, something we did very little before, allowing patients to discuss with one of us remotely. 

With the support of the ministry, we have increased our internal capacity and purchased additional equipment to meet the needs of families. Our visits, which last 60 to 90 minutes, allow families to limit travel to a doctor's office and receive care at home. This also allows family doctors to follow-up by telephone or teleconference, knowing that their patients are receiving our care.

Everything has been done keeping in mind that we must maintain excellent care for the family, the mother and the newborn despite the pandemic. Our hope is that the program will continue to expand post-COVID. We understand that it is a huge transition to have a newborn and the importance of being at home, especially in these times when there are many restrictions.  

For us, it is truly an extraordinary program and one that is starting to shine at the provincial level. Furthermore, our leadership team recently submitted a preliminary evaluation of our program to the World Health Organization at their request. Our preliminary results show a very high level of client satisfaction and the breastfeeding rate is also very positive. Families report that they are better prepared for their transition from hospital to home. In addition to providing care and sharing our knowledge, we are fortunate to be able to take some of the burden off families at such an important time in their lives. 

We are grateful that this program was established before COVID-19. We are even more delighted that we were able to adapt to the many changes fairly quickly and continue to provide this essential support for new moms and their babies. 

If you have contributed to Montfort’s COVID-19 emergency fund, thank you! We are profoundly grateful for your generosity. Otherwise, you can always make a donation to support the hospital's priority needs.

Our goal is to keep taking you to our frontlines regularly. Please check our website periodically for other testimonials from Montfort’s dedicated guardian angels.