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.

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:

"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.