Monday, May 5, 2008

Article: "Canada's U.S. baby boom"

This story was on the front page of this morning's Globe & Mail. Scary stuff, & scarier still when you realize many of the couples facing this scenario have already been through the wringer with infertility & high-risk pregnancies.

Follow the link & have a gander at the comments (it will be active for about a week). Of course there are posters saying it's all the fault of women waiting too long to have babies, grrr....!!

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Canada's U.S. baby boom
With neonatal resources stretched thin, more and more high-risk infants are sent south to find a bed
From Monday's Globe and Mail
May 5, 2008 at 3:49 AM EDT

More than 100 Canadian women with high-risk pregnancies have been sent to United States hospitals over the past year – in what a doctors' group attributes to the lack of a national birthing plan.

The problem has peaked, with British Columbia and Ontario each sending a record number of women to U.S. neonatal intensive care units (NICUs). Specifically, 80 B.C. women have been sent to U.S. hospitals since April 1, 2007; in Ontario, 28 have been sent since January of 2007, according to figures from the respective health ministries.

André Lalonde, executive vice-president of the Society of Obstetricians and Gynaecologists of Canada, said the problem is due to bed closings that took place almost a decade ago, the absence of a national birthing initiative and too few staff.

“Neonatologists are very stretched right now,” Dr. Lalonde said in a telephone interview from Ottawa. “We're so stretched, it's kind of dangerous.”

A national birthing initiative, he said, is urgently required to ensure services are planned, guidelines on the best way to care for these patients are implemented, and a stronger focus is placed on maternity patient safety.

Canada, once able to boast about its high rank in the world for low infant-mortality rate – sixth place in 1990 – saw its rank plummet to 25th place in 2005, according to figures published this year by the Organization for Economic Co-operation and Development.

Specifically, Canada's infant mortality rate of 5.4 deaths per 1,000 live births is tied with Estonia's and more than double Sweden's rate of 2.4.

The inability for Canada to care for all of its sick and premature babies has caught the attention of renowned pediatrics professor Shoo Lee, who is studying the health outcomes of infants sent abroad, in addition to those who remain here, often under stretched staffing conditions.

“If you have insufficient resources in the province, what does that mean for those kept in the system?” Dr. Lee, director of the Canadian Neonatal Network, said from Edmonton. “Are they being admitted to the NICU only when they are very sick? Are they being pushed out too early to make room for others?”

Philippe Chessex, division head of neonatology for B.C. Women's Hospital & Health Centre, said every effort is made to avoid out-of-province transfers. Even sick babies who aren't sent to the U.S. can still face several moves while at home.

“We're transferring babies across the province, in all directions, to try to find an extra bed for the next potential birth or for any baby already born,” Dr. Chessex said in a telephone interview from Vancouver. “We now have babies who have been transferred up to six times after leaving here before reaching home.”

For parents, the devastating news that their baby is sick due to a malformation, illness or being born prematurely is compounded by the reality that there simply is not a bed available for their infant close to home.

“Whenever a sick baby is born, it's really a disaster for these families because it was unexpected. And it just puts a terrible stress on them,” Dr. Chessex said. “If they are sent out of country at that moment, it is just unbelievable the kind of pressure that they must go under.”

No one knows that better than Jade Pascoe, of Cranbrook, B.C., who went into labour 15 weeks earlier than her due date. She gave birth on March 29, to Nevin James William Moore, who came into this world weighing 1 pound 10 ounces. “They tried to get me somewhere in Canada,” said Ms. Pascoe, 19. “But there was nowhere to send me.” The hospital where she gave birth does not have a NICU. And when no NICU bed could be located in B.C. or Alberta, her son was sent to a hospital in Spokane, located in eastern Washington.

During that time, doctors, nurses and others took turns using a manual respirator for six hours on the boy, until he arrived by air ambulance at Deaconess Medical Center. He is expected to stay there until July.

Of her son, born at 25 weeks gestation, Ms. Pascoe said: “I didn't know they came that small.” Though he is not yet stable enough for her to kiss or cuddle, she can touch him. Patrice Sweeny, assistant neonatal intensive-care unit manager at Deaconess Medical Center, said Nevin is on a ventilator and requires a lot of support but he is improving.

“Jade comes in every day and is very devoted and does everything that she can,” Ms. Sweeny said in a telephone interview. “She takes his temperature, changes the diaper. She is as involved with her baby as possible.”

Ms. Pascoe's grandmother, Sydenia Cumming, said while the B.C. government pays for all the care costs in the U.S., there are other expenses the family must absorb, such as food, lodging and transportation.

“There are a lot of expenses; it's pretty hard,” said Ms. Cumming, 70, who was visiting Nevin in Spokane. “The hospital is wonderful, the staff is wonderful. Nothing could be better that way; it would just be more convenient to be home.”

In a telephone interview, B.C. Health Minister George Abbott said the province experienced “quite an extraordinary spike” in the number of premature and sick infants who required transfer in fiscal 2007-08. In 2007, 3,269 babies were born prematurely, up from 3,137 in 2006, according to the B.C. Vital Statistics Agency. By comparison, he said in fiscal 2004-05, no high-risk pregnancies in that province were sent to the U.S.

Though the province is adding NICU beds, he said that in itself is not the answer. For example, when extra NICU beds were added in Victoria, it took about a year before they were operational due to the difficulty in recruiting a neonatologist.

“You need a highly skilled nurse and you need a neonatologist to help manage the ward and that's proven challenging,” said Mr. Abbott. He said the province is working with others to find a solution.

Further east, Ontario is planning to add more NICU beds, said Laurel Ostfield, press secretary to Health Minister George Smitherman.

Since January of 2006, 39 women with high-risk pregnancies in Ontario have been sent to U.S. hospitals. Ms. Ostfield stressed that figure represents a tiny fraction of cases; there were 36,525 high-risk pregnancies in 2006 alone, the most recent year for which there are figures.
The bottom line, Ms. Ostfield said, is that the mothers and babies are “getting the care that they need … It's important that Ontarians know the province is still going to take care of them, which is why we do pay to send [them] out of country.”

But the key to looking after future mothers and babies, according to Dr. Lalonde, of the Society of Obstetricians and Gynaecologists of Canada, is having a plan, in the form of a national birthing initiative.

A 28-page report, released in January by SOGC, said such a plan is estimated to cost about $43.5-million from April, 2007, to March 31, 2012, including $24-million for an aboriginal birthing initiative.

That report, called A National Birthing Initiative for Canada, recommends federal leadership in seven key areas, including a mechanism to accurately gather data, implementation of national standardized practice guidelines, a focus on maternity patient safety, and a coalition that would create a model of sustainable maternity and newborn care.

“The reality is that maternity care disparities and deficiencies in this country have been obscured [by] dedicated doctors, midwives and nurses who deliver miracles every day,” said the report, which is the work of obstetricians, family physicians, midwives, neonatal nurses and rural physicians. “However, these dedicated professionals are telling us that cracks in the system are reaching a breaking point and that the current situation is potentially dangerous and cannot be sustained.”

The Public Health Agency of Canada said in a prepared statement that it has reviewed the initiative and it has been co-operating on key elements of federal interest, such as the promotion of healthy pregnancies.

“We continue to discuss further opportunities for collaboration within federal jurisdiction,” according to the statement, provided Sunday by spokeswoman Patti Robson.

$11.6-million: Amount, in U.S. dollars, British Columbia has spent on prenatal care in the States since April, 2006

$1,700: Average cost per day for a Level III neonatal intensive care bed in B.C.

$5,400: Average cost, in U.S. dollars, for a Level III bed in the States

39: Number of high-risk pregnancy cases Ontario has sent to the States since January, 2006

26.6 days: Average out-of-country stay for a high-risk pregnancy case

$170,000: Average out-of-country cost for a high-risk pregnancy case

Sources: British Columbia Ministry of Health, Ontario Ministry of Health


  1. Leave it to the media . . .

    Sometimes my need to know is greatly offset by the shock I feel knowing.

    Here in the US it is the litigious nature of our society that is running many OB's out of practice. They can't afford the malpractice premiums.

    The funny thing is - in the beginning, I wanted/needed all the shiny medical gadgets and protocol. In the end though - I wanted to just be left alone and would have had the baby at home if I could have. Though - I was fortunate on more than one occasion to have access to adequate and immediate prenatal care.

    Scary is right.

  2. very interesting. hey, are you a journalist in your spare time? you don't have to answer that. but you sure know your way around the facts.

  3. Luna -- I went to journalism school, but wound up working in corporate communications. I'm still a news junkie, though! ; ) & I always jump on anything I read that's infertility/pregnancy loss-related.

  4. Really interesting - here in Saskatchewan the stories are usually about people being transferred to other provinces (usually Alberta) when there aren't beds available, and that raises the same problems (people are away from their family and community support and have to incur daily costs just to live and have somewhere to live.) My two cents is that there should be a greater investment in midwifery and birthing centres or home birth for healthy, low risk preganancies to free up some resources for high-risk pregnancies. I hope any national birthing strategy would try to take this into account.

    Thanks for posting this - great to find someone who has their finger on the pulse of the Canadian issues.