Science & Research

Healthy mom, healthy baby

Prenatal care program makes a difference in the Inner City

Vanessa Boyer, pictured here with son Jaxyn, appreciates the prenatal care she was able to receive through the PIIPC project.
Vanessa Boyer, pictured here with son Jaxyn, appreciates the prenatal care she was able to receive through the PIIPC project.

Winnipeg Health Region
Wave, Summer 2015

First-time mom Vanessa Boyer's voice brims with pride and love as she speaks about her one-and-a-half-year-old son, Jaxyn. That pride and love turn to extreme gratitude when she speaks about the midwives who helped her bring Jaxyn into the world.

The midwives work at Mount Carmel Clinic, where Boyer was a client of the Partners in Inner-City Integrated Prenatal Care project, better known as PIIPC.

"It was a wonderful experience for me," Boyer says candidly. "The midwives showed me so much kindness."

PIIPC is a collaborative project focused on reducing inequities in access to and use of prenatal care in Winnipeg's inner city. The project, which began in September 2012, was funded by the Canadian Institutes of Health Research (CIHR) and Research Manitoba through the Partnerships for Health System Improvement program (PHSI). The Winnipeg Health Region and Healthy Child Manitoba also helped fund the project.

The study's principal investigator is Maureen Heaman, a CIHR Chair in Gender and Health and a professor in the College of Nursing in the Faculty of Health Sciences at the University of Manitoba. She has devoted her career to the enhancement of maternal and child health.

"The research project was built on previous research and a few years of different projects, starting out with one that looked at regional variations in use of prenatal care across the province," Heaman explains. "What I found in that project was that there were high rates of inadequate prenatal care in Winnipeg's inner city. Many of the women who had inadequate prenatal care living in these neighbourhoods identified as Aboriginal or of First Nation descent."

Prenatal care is critical for a healthy pregnancy and birth, as it gives health-care providers the opportunity to identify and monitor risks that can affect both mother and child. Among other benefits, prenatal care can help decrease incidences of preterm birth and low birth weight.

Heaman determined that in order to improve the rates of prenatal care in three inner city communities - Downtown, Inkster and Point Douglas - it was necessary to first find out what women living in those areas saw as the barriers, motivators and facilitators to prenatal care. Her team spent the next three years conducting that research, and then invited 70 stakeholders to a workshop to consider ways to reduce those barriers and make it easier and more desirable for inner city women to access prenatal care. Following that workshop, an inter-disciplinary steering committee was formed and the PIIPC project was born. Its mandate included four major initiatives that were designed to:

  • Add midwifery care to some of the inner city Healthy Baby/Healthy Start community support programs;
  • Strengthen the link for pregnant women who access the Street Connections mobile van service with care providers (obstetricians, family physicians, nurses, social workers) at the out-patient department of Health Sciences Centre's Women's Hospital or with the midwives at Mount Carmel Clinic;
  • Develop a flexible program of access to prenatal care at Women's Hospital and Mount Carmel Clinic for women referred from a variety of sources including Sage House, HIV clinic, Mothering Project, public health nurses and community physicians;
  • Launch a social media marketing campaign called "This Way to a Healthy Baby" to increase awareness about the importance of prenatal care and where to obtain it.

The shared intent of these initiatives - all of which have been implemented - was to integrate prenatal care services in the inner city and develop a collaborative approach towards providing that care among frontline health providers, clinics and Women's Hospital. This approach, in turn, would make it easier and more likely for at-risk pregnant women to get the care they needed.

Lisa Merrill, a clinical nurse specialist at Women's Hospital, which is a key partner in PIIPC, says the project has created positive changes in the health-care system: "It has brought our teams together to work more collaboratively. The team at Women's Hospital included social workers, nurses, obstetricians, family physicians and support staff. The development of close inter-professional partnerships between programs and sites has been another successful outcome of the project."

Kelly Klick, who co-chaired the PIIPC community-based working group and coordinated the involvement of Mount Carmel Clinic's midwives in the project, says PIIPC focuses on women who face barriers to care, such as living in a hotel and having no income, or who are at high risk for having unhealthy and/or apprehended babies.

"Women who did not have a provider for their prenatal care were offered services," explains Klick, who was also one of the midwives involved with Boyer's care. "If they lived in the target postal codes and were at risk of inadequate care, we invited them to be in the study."

A total of 281 women have enrolled in the program, including 219 who have consented to participate in the research component. Merrill says many of the women had risk factors such as poverty, addictions, smoking, family violence, Child and Family Services involvement, and homelessness, and many of them mistrusted the healthcare system. "The women were identified as PIIPC clients," explains Heaman, "which helped get them access." Clinics and care providers knew to be a little more flexible about trying to see them when they showed up and getting them additional services.

Boyer became involved in the PIIPC study after a friend told her about the midwives at Mount Carmel Clinic who had helped her when she gave birth. She approached the clinic in the first few weeks of her pregnancy and, because she lived downtown and was at risk for inadequate care, was invited to join the program.

Boyer admits to being nervous throughout her pregnancy and worried about the health of her unborn child, but says that the midwives were always accessible, kind, supportive and reassuring. "I would go to the clinic maybe every two weeks and sometimes they would come and see me at my residence," Boyer says.

In addition to monitoring a woman's pregnancy, the prenatal care also involves providing information about health and nutrition, healthy life choices, preparing for birth, and the importance of breastfeeding. Women in the program are also connected to resources, including housing, financial support, and food banks to assist with their needs as required. Women also receive extra emotional support to help reduce barriers and empower them to reach their goals.

Heaman stresses that PIIPC came about through the work of a lot of people. "It's been a very big community-based initiative and a lot of people have been devoted to the project and spending time on it," she says. "The project is unique in involving a wide range of decision-makers and care providers from the Winnipeg Health Region, Healthy Child Manitoba, Manitoba Health, and First Nations Health and Social Secretariat of Manitoba working together with researchers from the University of Manitoba."

Lynda Tjaden, Director of Public Health with the Region, says the project underscores the value of enhancing health equity efforts throughout the health-care system. "Maureen's previous research shows that despite having a universal health-care system, gaps exist and some women are not accessing prenatal care," she says. "The PIIPC project is an example of how we can address the inequitable social factors that are experienced by women as barriers in accessing prenatal care. This initiative promotes conditions in which mothers and babies can achieve their best possible outcomes."

Heaman's research team is now evaluating the program by reviewing hospital charts and analyzing interviews and questionnaires completed by PIIPC clients. Although the results are still preliminary, they appear to be very positive. "We compared the women in our study to the women in the previous study who had had inadequate prenatal care . . . and we are able to show that among similar types of women we have improved their access to and use of prenatal care," says Heaman.

As a result of PIIPC, women are initiating their prenatal care earlier in their pregnancies and having more prenatal visits than similar women in similar circumstances have in the past. As well, the results indicate that women who have had previous pregnancies received more prenatal care through PIIPC for their recent pregnancies and this has been associated with a reduction in pre-term births.

The next step for the team is to visit the Manitoba Centre for Health Policy to review data on rates of inadequate prenatal care in the inner city, and see if those rates have been reduced on a population health level because of PIIPC.

Heaman is hopeful that will prove to be the case, but the reality is that neither Heaman nor the many dedicated people on her team need to see the data to know that PIIPC has made a difference in Winnipeg's inner city. They already know that, because of PIIPC, 281 women who would not have received adequate or even any prenatal care, received compassionate and supportive care throughout their pregnancies and, as a result, had healthy pregnancies and healthy deliveries.

Vanessa Boyer knows it too. She just needs to look at her son Jaxyn to appreciate the impact that the PIIPC program has made.

Wave: March / April 2015

About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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