Keeping Maternity Care Close to Home

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Imagine developing a complication in pregnancy, and not know where you were going to be treated and who would be looking after you.  Imagine that you would be travelling two to three hours away from home, without family support to an unfamiliar city.  Where do you imagine this scenario?  Would it surprise you that this occurs right here in South Western Ontario?

32 week infant girl (private photo)

Maternity care reform is a priority for the provincial government of Ontario.  Their goal is to promote the best care possible as close to home as possible.  In the Local Health Integration Networks (LHINs)1 and 2 (see map), maternity care is centralized with a single tertiary care centre.  It is supported in the community by five level II centres and many small level I centres.  In recent years, many of the smaller level I centres have closed their doors to maternity services due to increasing cost and decrease numbers of physicians doing deliveries.

The single tertiary centre is located at the University of Western Ontario’s teaching facility, London Health Sciences Centre.  In the spring of this year, it was created from the merger of two local maternity centres into a single unit serving more than 7,000 women a year.  Many of these women are referred in to the city for high-risk pregnancies, many more from the surrounding communities travel into the city for the presumed benefits of delivering at the newest centre in the province.

However, many patients and even a number of physicians do not understand that a high level of maternity care is offered in our community centres, and this inappropriate influx of low-risk patients is distribution the regional flow of patients.  Recently, after trying to transfer a patient to London, I learned that my patient, a single mother, with limited social support, would be travelling out of our region, because the delivery room in London was full.  It was not full of high-risk patients, but those from community centres who chose to delivery in London.  This resulted in seven patients being transferred out of our region in a single region due to bed shortages in London.

The solution to this problem is to improve the relationship between the high-risk specialists and the regional communities they serve.  There is a very strong perinatal outreach program in this region; it is time for this to be a clinical outreach program as well.  When high-risk specialists understand the services in community centres, they will be better able to triage which patients need only to be seen in clinic and still delivery in their local hospitals.  When communities see patients with complicated pregnancies referred back to delivery in their community hospitals, it will build confidence in the local maternity care services, returning care closer to home.  Finally, due to the number of patients traveling to London on a regular basis for assessment, it is time to consider the development of satellite assessment units, to further enhance the care in the community centres.  This will allow the system room to accommodate those who need to be in London, and encourage the rest to want to be in their communities.

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4 Responses to “Keeping Maternity Care Close to Home”

  1. caroberts7 Says:

    Ontario’s effort to make access to maternal health services a priority is commendable. The link to the map gives a good picture of where the various health facilities are located and how many communities must commute to receive services. Assuming this is a rural community and that access to health care requires a long commute, expecting mothers would greatly benefit from knowing they can be taken care of closer to home. Both the specialists and the local health facilities should join in the campaign to raise awareness among expecting mothers of the services that are available to them. As you mentioned, such a campaign would need to start with improved communication between the specialists and the local health facilities so that they know where mothers can be referred to closer to home.

  2. abrown88 Says:

    It appears that patient’s are flocking to the London center because of the apparent perception that this site offers better maternity care than a local maternity center. I agree that this needs to change so that patients will feel comfortable delivering where they are located. There perhaps needs to be an upgrade in the local maternity systems so people will have confidence in delivering at those sites.

  3. robertmartenjhsph Says:

    I think this posting should win an award for including the cutest photo.

    • hbbos Says:

      Its actually my oldest daughter at four weeks old – she was premature and delivered in London. She is now a healthy six-year old with no complications thanks to the wonderful care we both received!! (Ironically posted on her birthday)

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