Fostering Collaboration in Maternity Care

"You can't just order people to collaborate"

In some BC communities, pregnant women can face fragmented and siloed perinatal care, split between family doctors, registered midwives and obstetricians — who may not communicate, collaborate, or even trust each other.

A new Shared Care initiative, called the Maternity Network, aims to foster better interprofessional collaborative maternity care. Research shows that effective interprofessional collaborative maternity care increases  access and quality of care for pregnant women, and enhances the satisfaction and retention of care providers.

However, "you can't just order people to collaborate" says Lee Yeates, a registered midwife and Collaborative Practice Consultant for the new Maternity Network initiative. "It comes from the process of getting maternity providers together to gather information, identify challenges, and brainstorm solutions for better care. Once relationships are built, then you can cooperate more effectively."

The initiative fosters a series of activities that has maternity providers getting to know each other, clarifying scopes of practice and roles, dispelling myths and misperceptions, and learning about needs of patients and each maternity care provider in their regions.

Three communities pilot engagement

In the last five years, several communities — Comox, Penticton/South Okanagan and Kootenay Boundary — have led the way in piloting process-driven forms of engagement, which included needs-assessment surveys of both providers and patients, patient journey-mapping, as well as meetings and events to promote dialogue, relationship-building, and solution-finding. Each community developed solutions tailored to local needs.

Comox

In Comox, solutions included the creation of a well-defined, easy to navigate patient pathway, as well as a group prenatal care pilot, bringing midwifery and family practice patients together for medical care, education and peer support. Providers have clearly defined the various roles and now regularly communicate and cooperate. "From the provider perspective, there’s a big difference in tone and collaboration, " said Comox GP, Dr Sara Sandwith. "We feel like a team now, and we did not feel like that before."

South Okanagan

In the South Okanagan, the process of engagement has encompassed all providers, and established a new pilot perinatal clinic on a floor of the Penticton Regional Hospital, including four maternity GPs and a registered midwife. Weekly meetings to discuss cases, as well as the creation of standardized protocols have fostered rewarding collaborative relationships and clarified patient pathways among all local maternity providers, not only those who work at the clinic. The process has increased trust among maternity care providers by 60%, and contributed to the more sustainable delivery of local maternity services.

"It is now immensely collaborative," said Dr. Jennifer Begin, a Penticton maternity GP. "This new model has made maternity care more sustainable for the providers. Plus, we are providing better care to a wider variety of patients."

Kootenay Boundary

In Kootenay Boundary, collaboration has resulted in the development of tele-maternity technology, meaning that patients’ can now meet with both their GP and maternity provider through a virtual visit in their GP’s office. Jamie Colby, a young mom from Grand Forks, was able to use tele-maternity to connect from her doctor’s office with her midwife in Trail during her last pregnancy. Reflecting on the visit, Colby said, “It was awesome. The visit was stress free, and my doctor and midwife also seemed to really enjoy it.” Additionally, Kootenay Boundary used a collaborative approach to develop a successful perinatal mental health program for women at risk of depression or anxiety.

More funding available

Seven other communities —Thompson, Sea-to-Sky, Nanaimo, Chilliwack, Surrey/North Delta, Vancouver, and the East Kootenays — have embarked on similar engagement processes with seed funding from Shared Care. The majority are now in the action phase of their projects, with providers working together to bring local needs-based solutions to fruition.