North Island Blog: Updates from the Field

1A Community Symposium: Establishing building blocks to sustain rural maternity care

Written by Regina Chan, Project Assistant

On Friday, June 15th, the Centre for Rural Health Research held the 1A Community Symposium. This day-long symposium brought together the five rural communities in British Columbia who provide local maternity care in the absence of local C-section services. These communities are Port McNeill, Hazelton, Haida Gwaii, Salt Spring, and Invermere. With funding from the Joint Standing Committee on rural issues through the Rural Coordination Center of BC, we invited a midwife, physician, nurse and administrator from each of the five communities. Representatives from The Ministry of Health and other key stakeholders also attended. The objective for the day was to identify and consolidate system supports needed across all five communities to support sustainable rural maternity care.

As we are studying the North of Vancouver Island and establishing Building Blocks to sustain local maternity services, we heard from four other communities in BC also offering maternity services without access to local c-section. We conducted pre-symposium interviews with each of the five communities’ care providers and administrators to understand their model of care and common challenges. With this new shared understanding, the symposium focused on solutions for sustainability for the five sites.

The next steps to move towards the goal of sustaining maternity services is to bring the prioritized requirements for sustainable care as identified by the communities to discussion with the Ministry of Health, Health Authorities and relevant professional associations. This work is built on the foundation of over 15 years of primary research in BC which has found the safety of low-resource rural maternity services without access to local cesarean section and strong community desire for local maternity care. Another blog post will be coming next week to discuss how all the communities connected together to instill hope in each other to strive for change in the future.

Supporting Normal Birth

Written by Kira Barwich , Research Coordinator

Over 30 community members, care providers and moms attended a session around considerations for supporting birth in small communities led by Dr Kotaska, OBGYN Yellowknife as part of our Building Blocks for Sustainable Rural Maternity Care: The North Island Project. If you missed it, you can watch the session here.

Supporting Normal Birth

Dr. Andrew Kotaska, OBGYN Yellowknife

Presentation in Port Hardy April 23rd, 2018

What are the ethical, medical legal, and pragmatic considerations when supporting birth in small communities? Drawing on his extensive experience with family practice and obstetrics on the North Coast of B.C. and in the Northwest Territories, Dr. Kotaska discusses risk, decision making, consent, and outcomes in low-resource maternity settings.

Building Nursing Confidence in the North Island

Written by Kira Barwich, Research Co-ordinator

One of the ‘building blocks’ to sustain rural maternity care in the North Island that emerged through engaging community members and care providers was the need for increased confidence and competence in maternity care for the nurses on the North Island. We heard from many nurses in both Port Hardy and Port McNeill of feelings of low confidence in nursing maternity skills and their reluctance to be a part of deliveries in Port Hardy and Port McNeill. We heard this trepidation is due to several factors including a very low volume of births leading to a lack of experience and a lack of training and education opportunities due, in part, to high nursing staff turnover.  We heard from several nurses that they have never been at a ‘normal vaginal birth’. We also heard from the North Island physicians of the crucial role of nurses in the delivery team.

In response to what we heard from North Island care providers, the Building Blocks team along with support from First Nations Health Authority and Island health, facilitated a nursing education session for Port Hardy and Port McNeill nurses.

Dr. Kotaska led a session on birth in small communities April 23rd, Port Hardy   

  Port Hardy CNE session April 23rd

Celina Laursen, RM from Haida Gwaii and Kim Campbell, RN, RM, MN led the 2 full day sessions. Dr. Kotaska, OBGYN from Yellowknife led a session on supporting birth in low-resource maternity communities.

6 nurses attended the Port Hardy CNE session April 23rd, 8am – 3:00pm

3 nurses attended the Port McNeill CNE session April 24th, 8am – 3:00pm

Over 30 nurses, community members, care providers and moms attended a session around  considerations in supporting birth in small communities, led by Dr. Kotaska.

Click here to read the CNE summary report!

 Talking about Risk

Written by Kira Barwich, Research Coordinator 
CME session on birth with Dr. Kostaka attended by over 30 North Island care providers

Following a year of intensive fieldwork to understand the challenges faced by rural moms, community members and care providers in North Vancouver Island, we are now looking at how to action each of the proposed building blocks for sustainable rural maternity care.

Jude and Kira travelled up to the North Island with Dr. Andrew Kostaka, an Obstetrician from Yellowknife for focused discussions on the “Expanded Inclusion Criteria for Low-risk Deliveries” building block. Dr. Kostaka led a Continuing Medical Education session, asking care providers “what is your greatest fear” and then worked to provide evidence-based strategies for challenging scenarios. This CME session was hosted in Port McNeill and attended by over 30 participants including paramedics, physicians, nursing staff, midwives and students both in-person, and by videoconference across four sites on the North Island.

 

Building Blocks discussion around appropriate inclusion criteria for low-risk deliveries

The following day, we hosted a discussion in Port Hardy with the North Island physician representative group to look at decision making and risk in low-resource settings. The discussion included Sheila Jager, a midwife from Campbell River and Celina Laursen, a midwife from Haida Gwaii. Dr. Kostaka led a fascinating discussion on respecting patient choice in rural maternity care and engaged with providers in a discussion around autonomy and beneficence. UBCO FLEX student, Krista Loewen, presented her findings from the literature review she conducted on appropriate exclusion criteria for low-risk deliveries in other low-resource communities.

UNBC FLEX student Hanna Chester led two focus group discussions with North Island nurses to hear more from them of what they would need to feel supported and sustainable in providing maternity care. In response to what we are hearing from care providers around a need for more education, our next ‘building block’ will be in April, when we will support a professional development session for North Island nurses on “normal physiological birth”.

Rural Maternity Services: 'We’re just not paying enough attention to them'

Written by Lisa Hodgson, Research Assistant

The CRHR has long been passionate about providing evidence to support needs-based planning for rural maternity care. This issue has recently caught the attention of the media, as well. Recently, our very own Dr. Jude Kornelsen was featured in a CBC investigation into the lack of birthing opportunities for women in rural communities:

Click to watch the news story here.

Since 2000, more than 20 communities have lost maternity care services in BC. While Dr. Kornelsen notes that nobody is intentionally shutting down these services, she suggests “we’re simply not paying enough attention to them.” Many rural women are required to travel long distances to birth in communities away from their families and support systems. The cost of traveling to birth in another community is not only financial, but has implications on health and well-being. Traveling long distances to birth has been correlated with higher infant mortality rates, higher rates of preterm birth, and lower birth weight.

Read more: Pregnant women in rural B.C. urged to leave town to deliver

Here at the CRHR, the Building Blocks Project has been busy working to better understand how we can support local birthing in rural communities on Northern Vancouver Island by working alongside health care providers, community members, and health authorities to create safe and sustainable solutions for women and their families in BC. To learn more, check out our video Where was I born Mama? and follow along with our blog posts.

Sharing What We Are Learning

Written by Kira Barwich, Research Coordinator

Jude and Kira presented progress and findings from Phase I of the Building Blocks for Sustainable Rural Maternity Care: The North Island Project at several conferences in this past February and March. These conferences were fantastic opportunities to share project progress and findings and connect with other researchers, policy makers and care providers around sustaining rural maternity care.

 Jude and Kira presenting at Perinatal Services BC Healthy Mothers and Healthy Babies Conference, March 2018

Jude at the Building Blocks to Sustainable Rural Maternity Care: The North island Project poster at Quality Forum, February 2018

We spent last week up in the North Island engaging with communities and continuing fieldwork for the project. Our purpose for this trip was two-fold: to continue our communication with the communities we had previously engaged with, and to further engage with healthcare providers and administration on the North Island to hear of their challenges and vision for sustainable maternity services in the North Island.

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Sunrise over Port Hardy [October 2017]

Click here to view the brochure we took back to share with North Island communities last week. The brochure provides project background and context, preliminary findings and next steps for Building Blocks for Sustainable Rural Maternity Care (The North Island Project). 

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Jude and Kira are looking forward to continued community engagement in the North Island for the Building Blocks for Sustainable Rural Maternity Care project talking with moms, community members, health care providers, BC Emergency Health Services and health administrators. Developing a framework for what sustainable rural maternity care in the North Island could look like is what we are working on now. With this aim, we are creating a plan by looking at the five community and provider-derived “building blocks for sustainable rural maternity care”. We will continue going back to the community over the course of the project to check back in. As we prepare to travel back up to the North Island for a week in early October, we have reflected on findings from the previous three trips to the community.

We have learned from communities (birthing women, families and elders as well as nurses, physicians and health administrators) what the experience of birth is for women on the North Island.

The North Island

Written by Kira Barwich, Research Coordinator
"They tell me skies this blue are not an everyday occurrence in the North Island, but I sure appreciated this view with all the shades of blue melding from sea, to mountains, to sky."

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Jude and I spent a week based in Port Hardy and area last month as part of the Building Blocks for Sustainable Maternity Care (The North Island Project).  The purpose of our trip was to listen to what the community had to say about birthing in the North Island. Many of our conversations were with mothers, community members, elders, health administrators and health care professionals. We found that the community had a lot to say on the topic of birth, and we are thrilled to have had the opportunity to engage with 44 individuals in conversation and discussion on the subject while we were there.

At the Port McNeill hospital, we were given a tour by one of the nurses which included a stop in at the maternity room. In 2015-2016, only 7 deliveries occurred in the Port McNeill hospital out of approximately 110 pregnancies in the population area. This current, low procedural volume in Port McNeill is not sustainable, due primarily to the lack of practice opportunities afforded to (primarily) nurses and this issue was one that arose frequently during our various conversations with health care providers and individuals in the community.

Continued time in the North Island also affirmed the distinct nature of the various communities in the North Island, for instance, marked differences between the Port McNeill and Port Hardy communities and the subsequent disparate challenges faced and priorities sought in terms of birthing services in each community. We had several very enlightening conversations with enthusiastic individuals who are passionate about, and committed to, supporting local maternity care in the North Island. We also had the opportunity to speak with several of the nurses serving the communities there and really appreciated hearing their concerns surrounding some of the vulnerability that is felt supporting birth in a low-resource setting such as Port McNeill.

Upon returning from the North Island, we are now working to transcribe and analyze the rich data that was collected over the course of many interviews and discussions there. I am looking forward to continue to see and hear the themes that emerge from what the communities are saying in regards to their birthing services and will work to reflect the community’s voice in subsequent action. Stay tuned as we continue to work and update you in supporting sustainable maternity care in the North Island!

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Celebrating National Indigenous People's Day in the North Island

KIRA'S EXPERIENCE IN THE FIELD
Written by Kira Barwich, Research Coordinator

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Jude and I were recently up in the North Island for fieldwork. Our time there coincided with celebrations for Indigenous Peoples Day and we were able to join the community of Port Hardy and the surrounding area for some of the celebrations. Indigenous Peoples Day was celebrated nation-wide on June 21st to celebrate the heritage, diverse culture and outstanding achievements of First Nations, Inuit and Metis.

The rain cleared shortly after the celebrations began making the bright blue sky, deep blue sea, and vivid colors of those in attendance a striking backdrop for the celebrations. Following the unveiling ceremony for the Ǥa̱lǥa̱poła murals, several of the elders spoke on the occasion and the Kwakiutl, Gwa’sala-‘Nakwaxda’xw and Quatsino Nations hosted performances of traditional music and dance . Several of the performances encouraged participation so we all had the chance to join in the dance circle and sway to the beat. Around lunchtime, we then made our way over to a feast held at the Kwakiutl Big House in Fort Rupert where there was delicious seafood chowder and fresh bannock a few of the many dishes served in abundance!