Eileen Hutton TALMOR Do we drive faster in canada

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  • Area of Netherlands is 41,000 sq km. Canada is 214 times larger.
  • We have many similarities; large cities
  • But then we have some differences
  • Total fertility rate: This entry gives a figure for the average number of children that would be born per woman if all women lived to the end of their childbearing years and bore children according to a given fertility rate at each age. The total fertility rate (TFR) is a more direct measure of the level of fertility than the crude birth rate, since it refers to births per woman. This indicator shows the potential for population change in the country. A rate of two children per woman is considered the replacement rate for a population, resulting in relative stability in terms of total numbers
  • Total fertility rate: This entry gives a figure for the average number of children that would be born per woman if all women lived to the end of their childbearing years and bore children according to a given fertility rate at each age. The total fertility rate (TFR) is a more direct measure of the level of fertility than the crude birth rate, since it refers to births per woman. This indicator shows the potential for population change in the country. A rate of two children per woman is considered the replacement rate for a population, resulting in relative stability in terms of total numbers
  • Midwifery is built around the principles of ….like the Netherlands we are: autonomous care providers, entrepreneurs providing prenatal post partum etc.
  • Midwifery is built around the principles of ….like the Netherlands we are: autonomous care providers, entrepreneurs providing prenatal post partum etc.
  • For the so called grey areas Pharmacopeiaeg. Treatment of bladder infection; IV antibiotic for GBS prophylaxis
  • For the so called grey areas Pharmacopeiaeg. Treatment of bladder infection; IV antibiotic for GBS prophylaxis
  • For the so called grey areas Pharmacopeiaeg. Treatment of bladder infection; IV antibiotic for GBS prophylaxis
  • For the so called grey areas Pharmacopeiaeg. Treatment of bladder infection; IV antibiotic for GBS prophylaxis
  • Primary Outcome: Composite measure of neonatal/perinatal mortality or serious morbidity:Any stillbirth or neonatal death (≤ 28 days)The presence of any one of the following complications:Apgar < 4 at 5 minutesNeonatal resuscitation (PPV + compressions)Birth weight < 2500gNICU stay of > 4 days
  • Primary Outcome: Composite measure of neonatal/perinatal mortality or serious morbidity:Any stillbirth or neonatal death (≤ 28 days)The presence of any one of the following complications:Apgar < 4 at 5 minutesNeonatal resuscitation (PPV + compressions)Birth weight < 2500gNICU stay of > 4 days
  • Secondary Outcome: Composite measure of maternal mortality or serious morbidityAny direct obstetrical cause maternal deathThe presence of any one of the following complications:Blood loss >1000 ml or consultation for bleedingAny infection requiring consultationAny 3rd or 4th degree lacerationAny postpartum transfer of care to a physician
  • Secondary Outcome: Composite measure of maternal mortality or serious morbidityAny direct obstetrical cause maternal deathThe presence of any one of the following complications:Blood loss >1000 ml or consultation for bleedingAny infection requiring consultationAny 3rd or 4th degree lacerationAny postpartum transfer of care to a physician
  • Secondary Outcome: Composite measure of maternal mortality or serious morbidityAny direct obstetrical cause maternal deathThe presence of any one of the following complications:Blood loss >1000 ml or consultation for bleedingAny infection requiring consultationAny 3rd or 4th degree lacerationAny postpartum transfer of care to a physician
  • With collaboration and interprofessional approach we can make a difference to women around the world.
  • Advances in labour and Risk Management; management of risk effectively for OB;
  • Advances in labour and Risk Management; management of risk effectively for OB;
  • Eileen Hutton TALMOR Do we drive faster in canada

    1. 1. Do we drive faster in Canada? Eileen K. Hutton RM, PhD McMaster University VU Amsterdam
    2. 2. Size: 9 M km2
    3. 3. Country Information Canada Netherlands• Population: 33.8 16.7 million• Median age: 41 41 years• Annual births: 368 185 thousand
    4. 4. Birthing Information Canada Netherlands• Fertility rate: 1.6 1.7 per 1000 women• Birth Rate: 10.3 10.3 per 1000• Infant mortality: 5 4.7 per 1000 births
    5. 5. Maternity care in Canada• Increasingly obstetricians doing primary care obstetrics – 1996: 56% Vaginal Births by OB – 2000: 61% Vaginal Births by OB• Large shift of GP physicians out of obstetrics – 1989  31% – 1999  19%
    6. 6. Midwifery care in Canada• More midwives educated and registered – First regulated midwifery 1994 – Education 4 year BHSc (Midwifery)• Now 1,000 midwives in country
    7. 7. The Midwifery Model of Care• Built on principles of: – woman-centred care – informed choice – evidence based practice – continuity of care provider – choice of birth place. Source: Canadian Association of Midwives
    8. 8. Like the NL:– A primary care model of midwifery– Autonomous care providers– Care during pregnancy, birth to 6 weeks post partum– Community-based; hospital privledges– Self employed– Collaborative with specialists– List of required consultations and transfers of care
    9. 9. Unlike the NL• All midwives must provide care in all settings• Midwives provide care after consultation and supportive care after transfer of care in labour – Enhances continuity of care
    10. 10. Continuity of Care• is an important tenant of midwifery care – Same midwife or small group (<4) midwives provide care: • during all trimesters of pregnancy • Labour & birth and the postpartum period • 24-hour coverage Source: College of Midwives of British Columbia
    11. 11. Continuity of CareAllows midwife to: – Develop a relationship during pregnancy – Supportive care in labour and birth – Provide comprehensive care throughout the postpartum period – Enhance safe, individualised care Source: College of Midwives of British Columbia
    12. 12. Continuity of Care• Midwifery care includes: – Family planning services – Education – Counseling – Advocacy and – Emotional support Source: College of Midwives of British Columbia
    13. 13. Unlike the NL• Prenatal care visits 30-45 minutes long• Case load? Hard to compare• 2 midwives at the birth – No kraamverzorgster
    14. 14. Unlike the NL• Many midwives travel longer distances to attend births• 30 minute general rule, but…• Rural births registered with EMS
    15. 15. Changes in practice patterns• Research evidence has led to changes in care protocols• Populations of women are different – Many more first time mothers – More over weight women – Older birthing population
    16. 16. But are they normal?• Resulting in changes in : – Management of PROM – Rates of induction for post dates – More slow to progress labours – GBS management protocols
    17. 17. Canadian midwives provide care in “grey areas”– Broader scope of screening tests;– Broader pharmacopeia;– Labour Induction and augmentation;– Women with epidural analgesia;– Electronic fetal heart monitoring
    18. 18. Canadian midwives provide care in “grey areas”– Resulting in greater continuity of care provider for women
    19. 19. Benefits of Midwifery Care• Cochrane review of continuity of care models shown to decrease CS• Vaginal deliveries are associated with a lower risk of maternal morbidity and infection and shorter hospital stays. Hodnett E. Cochrane Systematic Review 2006:1
    20. 20. Canadian outcomes at home
    21. 21. Ontario• 130,000 births per year in Ontario• Midwives attended 10% of these births• Home births accounted for 2% of the provincial total
    22. 22. Typical home birth set up
    23. 23. Ontario Sample Selection 25, 720 birthsPlanned at the onset of labour 6692 homebirth 6692 hospital birth
    24. 24. Ontario• Of all planned homebirths: – 78% actually delivered at home • (60% nullip; 89% multip) – 5% transported by ambulance to hospital during or immediately following birth
    25. 25. OntarioPrimary outcome - composite of neonatal/perinatal mortality or serious morbidity: – no difference between the home and hospital 2.4% vs. 2.9% RR 0.83 [ 0.67, 1.02 ] – Both groups reported a perinatal / neonatal mortality rate of 1:1000
    26. 26. OntarioPrimary outcome - composite of neonatal/perinatal mortality or serious morbidity: – no difference between the home and hospital 2.4% vs. 2.9% RR 0.83 [ 0.67, 1.02 ] – Both groups reported a perinatal / neonatal mortality rate of 1:1000
    27. 27. Ontario– There were no cases of maternal mortality– Planned homebirth associated with: • less serious morbidity 5.5% vs. 7.1%; RR 0.77 [ 0.67, 0.87 ]
    28. 28. Ontario– There were no cases of maternal mortality– Planned homebirth associated with: • less serious morbidity 5.5% vs. 7.1%; RR 0.77 [ 0.67, 0.87 ]
    29. 29. Ontario– There were no cases of maternal mortality– Planned homebirth associated with: • less serious morbidity 5.5% vs. 7.1%; RR 0.77 [ 0.67, 0.87 ] • fewer Caesarean section 5% vs. 8% RR 0.64 [ 0.56, 0.73 ]
    30. 30. OntarioWomen planning home birth were less likely to experience:• Labour augmentation – 28% vs. 36%; RR 0.76 [ 0.72, 0.80 ]• Pharmaceutical pain relief – 17% vs. 45% RR: 0.37 [ 0.35, 0.39 ]
    31. 31. Ontario• Episiotomy – 4% vs. 6%; RR: 0.73 [ 0.63; 0.84 ]• Assisted vaginal delivery – 3% vs. 4%; RR 0.67 [ 0.56; 0.80 ]• Caesarean section – 5% vs. 8%; RR 0.64 [ 0.56, 0.73 ]
    32. 32. IPE – in education programs•ALARM for residentsand MW students•Consultationworkshop•Introduction to OB formedical students andMW students•Placement with OB,Nursing
    33. 33. IPE – for practitioners•ALARM Course•MOREob•M&M rounds•Coroner’s review•Perinatal outreach
    34. 34. Do we drive faster in Canada?
    35. 35. Do we drive faster in Canada?Only sometimes!

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