Spirit of Giving

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Birthing at home

This article was written by Lezlie Lowe for the Fall 2014/Winter 2015 issue of Izaak Magazine – an in-depth, behind the scenes, all-access publication highlighting the incredible, everyday happenings at the IWK Health Centre. IWK Midwives make it possible for more families to welcome babies to the world safely at home. 

Home BirthShelly Juurlink sits in her Fall River living room, pointing left, pointing right. There’s the spot on the floor where she laboured for eight hours in a birthing pool. There’s the spot the futon was set up, where her seven-pound, five-ounce boy slid out, under the care of Shelly’s husband, Perry Sankarsingh, and the couple’s doula and two IWK midwives.

“We christened this place,” Shelly says, laughing. “We were really happy we were able to do it here.”

After their son Lennon was born, Perry cooked breakfast for the whole team — coffee, eggs, toast and fresh mango.

Shelly rested, ate and nursed the baby while everyone hung out for  a few hours, talking about the birth and debating what name this new little baby, who was not arriving home, but being home for the first
time, would be called.

“They helped make it a celebration,” says Perry of the midwives and doula.

This isn’t a birth the way many Nova Scotians picture it, and it’s one the IWK is happy that women in HRM are able to access.

Registered midwife, Erin Bleasdale, checks on baby Lennon just moments after he is born.

Midwife-attended births became a core part of IWK care when midwives were first registered by the province five years ago. IWK midwives’ scope of practice includes hospital births and home births,
both with a focus on low-intervention and relationships.

“We don’t get the outcomes we get because we have ‘registered midwife’ after our names,” says Shelly’s midwife, Kelly Chisholm. “We get the outcomes we get because we spend so much time with women.
We develop a trust.”

Chisholm and her colleagues remain in contact with some clients for years. (Almost on cue, a mom and new baby walk into the café where Chisholm and I are meeting. They hug, and coo over the baby, who’s nursing inside a Snugli. The scene is repeated with a different mom a few minutes later. Another former client walks by the window and waves enthusiastically).

“There’s barely a coffee shop I can go to without running into somebody,” says Chisholm, who has attended between 400 and 500 births. “It’s really nice.”

The 41-year-old’s story of deciding to go into midwifery has an unlikely setting indeed: she watched a mother sea turtle lay her eggs on a Guyanese beach as part of an overseas youth outreach trip during

4“They cry these big jelly tears and they moan. It’s beautiful. It’s amazing. I walked away from that and I was, like, I want to do that with human beings.”

IWK midwives conduct prenatal visits off site at a Dartmouth clinic that isn’t much like a clinic at all. “It’s set up so that women feel like they’re more in their living room,” Chisholm says.

There are chaises instead of exam tables and space for soon-to-be siblings to play. (A big bonus for Shelly, who needed to bring her two year- old daughter, Lilah, with her to her check-ups). Prenatal appointments last about 30 minutes. Some postnatal visits are conducted in the family home.

“In terms of a service experience,” says Perry, “it’s great for the family. We never had to pack up a little baby and go to the hospital for check-ups when he was two or three weeks old. They came there.”

Perry says home birth wasn’t even on his radar before he met Shelly. With their first baby, he says, it took some convincing. Now he’s a convert.

“Going to bed as a family two hours after you have given birth is a pretty great feeling.”

5Another difference with the midwifery model is exceptional continuity of care, says IWK VP Patient Care, Jocelyn Vine.

In a family practice care model, women may have good continuity throughout their prenatal care, but when the day (or night) of delivery arrives, that woman’s physician may not be on call.

“Midwives are on call for one another,” says Vine, “but they work hard to ensure that the woman knows that other midwife in the case of her primary practitioner being busy. It’s partly the relationship you are able to form throughout the journey.”

Shelly was lucky to get into the IWK midwives’ care. She and Perry had moved to Nova Scotia from Ontario mid-pregnancy and were first with a midwife in Antigonish. They moved again to Halifax and happily made it onto Chisholm’s roster only a month before Lennon’s birth.

A little fewer than 10,000 babies a year are born in Nova Scotia, half of them at the IWK. Only one per cent are midwife-attended.

“It’s a very small subset,” says Vine, “but it could be bigger. Because the number of women who have normal, low-risk births is a fairly large group.”

The small number of midwife-attended births isn’t because the practice — which is a registered medical profession and thousands of years old — is an outlier. In fact, demand for midwifery services in HRM far outstrips the IWK’s resources.

Registered midwives Erin Bleasdale (L) and Kelly Chisholm (R) weigh baby Lennon.

Chisholm is one of six midwives (four full time and two part time) in a practice that takes in 16 to 20 women a month. Protocol requires a midwife and a second birth attendant at all births, so the program just hired five birth-unit nurses to act as home-birth attendants.

But that doesn’t change the demand for the service. “We could keep at least one or two more full-time midwives busy, starting tomorrow,” Chisholm says. Chisholm, who’s in her 14th year of “baby catching”, was self employed for a decade in B.C. and New Zealand before coming home to join the IWK. But she feels strongly about hospital affiliation.

“We needed to be a part of the IWK when we became registered, because that was how buy-in was going to take place in terms of all the other professions. The public has a huge amount of respect for the IWK, so it gave us the credibility instantly.”

Sanction, it turns out, has been a two-way street. Births at the IWK run the gamut from those following the most healthy low-risk pregnancies, to the most complicated highrisk situations.

Jocelyn Vine says the IWK has a strong record when it comes to low-intervention birthing for low-risk pregnancies. But the midwives, she says, “have helped ground us in that practice. I think we were good before. But we are better now.”

Low intervention was exactly what Shelly wanted and midwifery was her chosen road to get there. Her daughter, Lilah, was born at home with the assistance of a midwife in Guelph. Even with her first pregnancy, she didn’t have any reservations about delivering at home. Trust in the home-birth process,
Shelly says, stems from trust in the midwives.

Perry admits he was concerned about the what-ifs, more with this birth than with their first. In Guelph, the couple were three minutes by car from the hospital. Here, the IWK is half an hour away on Hwy. 118.

Erin Bleasdale (L) and Kelly Chisholm (R) join mom Shelly Luurlink and doula Wanda Cox in welcoming baby Lennon in the family’s home.

The midwives reassured him that signs of trouble emerge early enough that they can do a transfer of care in time from anywhere in HRM if that’s what’s needed (up to 30 minutes from the IWK). Also, Chisholm and her colleagues don’t take women into their practice whose pregnancies are likely to need hospital care, based on a specific list of medical exclusions.

Shelly was a healthy 35-year-old on her second low-risk pregnancy. Chisholm had no reservations. “We have this general feeling,” Perry says, “that science will save us. So, it’s very natural for people, when they are having children, to want to have the best care available. So they look to hospitals. But I think that we have made pregnancy into an illness as opposed to a natural process.”

Perry doesn’t discount the need for hightech care in complicated pregnancies. But when it’s appropriate, he says, midwifery should be available.

“I realize that we were lucky to have had the experience we had,” he says. “Not everybody has that experience. Shelly’s labour was pretty routine, uneventful. So we felt pretty safe.”

Chisholm, for her part, is eternally sanguine. “I get to be with people during one of the best times of their lives,” she says more than once, almost amazed at the truth of it. “And I get paid to do it.”

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The truth about vaccinations

This article was written by Lindsey Bunin for the Fall 2014/Winter 2015 issue of Izaak Magazine – an in-depth, behind the scenes, all-access publication highlighting the incredible, everyday happenings at the IWK Health Centre. World-leading IWK immunization expert, Dr. Noni MacDonald, shares insight on a complex and timely topic.

The digital age in which we live has greatly changed the way we gather and process information. If we have a question these days, most of us just “Google it!”
While the convenience of immediate information can suit our desire for instant gratification, it’s not necessarily the most accurate approach. This is especially true when it comes to the often-controversial topic of vaccines.

vaccinationsDr. Noni MacDonald is a professor of pediatrics at Dalhousie Medical School with an appointment in Pediatric Infectious Diseases at the IWK Health Centre, and her expertise has afforded her opportunities to teach and practice in countries around the world. One of MacDonald’s major research interests is vaccines, particularly in the areas of safety, hesitancy, pain mitigation and policy issues. She is a key member of the research team at the Canadian Center for Vaccinology at the IWK, has published more than 300 papers on such topics and has long been recognized in Canada as an advocate for child and youth health and as a leader in pediatric infectious disease.

In an effort to help clarify vaccination information for families, MacDonald has provided insight into some commonly asked questions.

Aren’t my children safe if everyone else’s children are vaccinated?
“Some vaccines work better when everyone is vaccinated,” MacDonald says. “This is called ‘herd’ or ‘community’ immunity. If everyone is vaccinated for measles, for example, the virus will stop circulating. However, herd immunity doesn’t work for other diseases, such as tetanus, because the tetanus bacteria are in the environment, in soil and dust.

“Besides, you don’t know if everyone around you is vaccinated, and people travel far and wide in our mobile society. You’re taking a huge risk if you’re depending on everyone else to be vaccinated to protect you or your child from measles, for example.”

Aren’t vaccines only for infants and children?
“Most vaccines are for infants and children because there is no natural protection from many serious vaccine-preventable diseases such as pertussis, tetanus, diphtheria, measles, some strains of influenza, meningitis, etc. While a mother transfers some of her antibodies to the infant during pregnancy, these do not last very long after the baby is born. Similarly, the antibodies in breast milk are not enough to protect the infant from many of these diseases.

“An increasing number of vaccines are being developed for adults so they will be protected into old age, the shingles vaccine is one example. It’s also been proven that immunizing adults can help protect infants and children. For example, re-immunizing adults (a booster) for whooping cough prevents infected adults from passing this terrible disease to infants: parents and grandparents take note!

Wouldn’t natural immunity be better?
“Immunity induced by vaccines is effective and much safer than natural infection.
Vaccination is a better choice because it avoids the risk of getting some terrible  disease complications, like brain damage with measles, deafness with mumps, death with tetanus and pertussis, and more,” MacDonald explains. “We’re also learning more about boosting childhood vaccinations with repeat vaccinations later in life, to ensure immunity doesn’t wane as we get older.”

Now that major illnesses have largely disappeared, we really don’t need vaccines anymore, do we? 

“The success of vaccines makes it appear that many infectious diseases have disappeared, but sadly that’s not true,” she clarifies. “There are outbreaks of measles and whooping cough throughout North America, and a resurgence of polio in Asia, Africa and the Middle East. Vaccination rates must be very high (over 90 per cent) to stop the spread of these viruses and bacteria, so when not enough people are vaccinated outbreaks can occur. Today, people travel far and wide and may not be aware that they’re not just bringing luggage with them.”

Do vaccines cause autism and other disorders?
“Vaccines do not cause autism. The increased rates of autism are in part the result of changes in the way the condition is assessed or recognized. Autism is known to be a genetic disorder with other contributing factors, but vaccines are not a factor. There is no proof that vaccines cause autism or any other diseases, like multiple sclerosis, but
there’s plenty of proof that vaccines prevent very serious infectious diseases.”

Is it true that vaccines have damaging and long-term side effects that are yet unknown?
“Vaccines have been used over many decades in millions of people around the world.
Extensive global networks track reactions to vaccines known as ‘adverse events following immunization,’ to find out which events are due to vaccine, and which are just coincidence (not caused by vaccine).

“There are now many years of data that prove the safety of vaccines. The global networks alert health professionals to any new concerns about a vaccine. The most commonly reported reaction is a sore arm. The risks of serious complications from contracting diseases like measles, whooping cough and hepatitis are much more common and can be far more serious than any adverse event from a vaccine.”

Why don’t we consider vaccine preventable childhood illnesses as just an unfortunate fact of life?
“They used to be, and millions of children died from diseases that are now prevented
with vaccination,” MacDonald says. “Thousands of children still suffer from these diseases because they don’t have access to the range of vaccines we have in North America. We’re privileged to live in a country where so much serious illness, disability and death can be prevented with a few doses of vaccine”

Can’t the flu vaccine give you the flu or make you sick?
“The flu vaccine cannot give you the flu. The flu virus used in the vaccine is killed or broken when the vaccine is manufactured. The flu vaccine is given when many flu-like illnesses are already circulating in the population so, if you get sick following your flu shot, it isn’t from one of the infl uenza strains contained in the vaccine. The ‘real’ influenza is a very serious illness and not to be confused with a cold or stomach illness.”

Do you think the flu vaccine is really effective?
“Influenza is a very sneaky virus that changes its outer coat every year. This is why a new version of influenza vaccine has to be made and given each year. Sometimes the experts are able to make the vaccine match well to the new influenza strain, other times the match is not so good. When the match is spot on, the vaccine is very effective; when it is less well matched, it is less effective BUT still far better protection than if no influenza vaccine is taken.

“Antivirals and other off -the-shelf medications are not very effective against influenza, so the treatment for influenza is simply bed rest and lots of fluids. Influenza is quite contagious. If you’re not protected by vaccine when exposed to someone incubating or having influenza, you easily become infected and then spread it to others who are not immunized in your family, at work, at school, etc. For many people, the extreme fatigue from influenza is very debilitating and disruptive to their lives, even if they do not get one of the more serious complications. It’s so much easier to just get a flu shot.”

This story and many exciting others are available for FREE though the online version of Izaak magazine.

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Change Makers – Jacob

This article is a series of three, written by Tom Mason for the Fall 2013/Winter 2014 issue of Izaak Magazine – an in-depth, behind the scenes, all-access publication highlighting the incredible, everyday happenings at the IWK Health Centre. A stay at the hospital can be tough, but for some exceptional young people, it’s also a time to grow , gain strength and learn about who they are. 

Jacob Hamilton

Jacob Hamilton

For Jacob Hamilton, paying it forward means finding strength in his own life. At 19, Jacob has been through more than most people his age. He’s already struggled with mental illness, and the stigma that surrounds it, for several years.

Jacob spent four months in the IWK inpatient mental health unit starting at age 17. He endured weeks of difficult medication changes, missed out on family and school events, even spending his birthday and the days leading up to Christmas in the hospital. Through it all, the IWK staff was there to help him, at times becoming almost part of his extended family. “They even took part in Christmas activities with me,” he says.

Today Jacob uses his own experiences to help other young people suffering with mental illness. He volunteers with the IWK Foundation and has worked to raise money for a new inpatient mental health unit for the hospital that will offer much improved care space for those with acute mental illness requiring hospitalization at the IWK. He speaks out to help improve adolescent mental health care in Nova Scotia, and he advocates for young people, to help them overcome the stigma that so often goes with mental illness.

“Mental illness is a disease like any other,” he says. “There’s nothing to be ashamed of, and there’s always hope. There are a lot of youth out there dealing with these issues. They need to know how they can access mental health care.”

He’s also attending Dalhousie University, working on a science degree and planning to major in neuroscience, microbiology and immunology. Jacob recently received a $40,000 scholarship to help him pay for university and he’s doing well with his studies, but he still deals with his illness every day. “I have good days and bad days,” he says. The hours he gives back as a mental health volunteer are one of the ways he copes. “I do it as a way to give back to the IWK. I lost a lot of time in my life because of my illness. I lost a year of school. The IWK helped me get better. They helped me get back to real life.”

Jacob says that people with mental illness need someone in their corner to help them get proper treatment in their most difficult days. That’s what motivates him to work so hard. “They need to fight for the right care, and the irony is they really aren’t equipped to fight,” he says. “There are a lot of patients who can’t speak about their problems, but I don’t mind speaking out.”

This story and many exciting others are available for FREE though Izaak Magazine’s fully interactive mobile app, available for download on the iTunes Newstand and Google play. You can also read Izaak magazine online through your desktop computer.

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Change Makers – Sonja

This article is a series of three, written by Tom Mason for the Fall 2013/Winter 2014 issue of Izaak Magazine – an in-depth, behind the scenes, all-access publication highlighting the incredible, everyday happenings at the IWK Health Centre. A stay at the hospital can be tough, but for some exceptional young people, it’s also a time to grow , gain strength and learn about who they are. 

Sonja Weilgart-Whitehead

Sonja Weilgart-Whitehead

At the age of 18, Sonja Weilgart-Whitehead is already an old hand at talking to the media. The Herring Cove teenager was just 15 when she spearheaded a media campaign that focused attention on evacuation policies at Halifax Schools – a campaign that changed those policies for students with mobility issues.

Sonja has quadriplegic cerebral palsy, a condition that comes with significant mobility challenges. “My high school had an evacuation policy that said they couldn’t carry disabled persons out of the building because it would risk injuring the person responsible for carrying the,” she says. “Instead, we were supposed to go to a designated safe area and wait for the fire department.” But the designated safe room in Sonja’s high school was located right above a propane tank, with furniture blocking the only window that rescue personnel could use to access it. “I know that if my school ever wet up in flames, I was going to be toast.”

I was a situation that Sonja had no intention of ignoring. She and her mother contacted the media and began a series of interviews to shed light on the topic. The campaign immediately caught the attention of Nova Scotia cabinet ministers Ramona Jennex and Marilyn Moore who offered her an apology and set out to change the school policy. “They changed it for everyone in the province,” she says. “It means a lot, even though I was almost ready to graduate. With the old policy, it was like they were saying my life wasn’t as valued as the other students.”

Sonja is used to overcoming challenges. Her first extended stay at the IWK began the day she was born, when she was 18 months old. She’s made many trips to the hospital since then. “Over the last six years I’ve been getting a lot better because of a phenomenal surgery that the IWK gave me. Now I can walk without tangling by feet, without being crumpled over. I can swim a lot better too. It’s forever changed by life.”

Today, Sonja is studying for her Bachelor of Arts (honours) degree at Carleton University in Ottawa, and received the Robbie and Jean Shaw Scholarship. She plans to go on to become a lawyer advocating for people with disabilities. She chose the university because of its unique program for physically challenged students – a program that includes 24/7 attendant services and full wheelchair accessibility. She is also nationally-classified para-swimmer on the Carleton varsity swim team and involved in horseback riding, sailing, skiing and rock climbing.

This story and many exciting others are available for FREE though Izaak Magazine’s fully interactive mobile app, available for download on the iTunes Newstand and Google play. You can also read Izaak magazine online through your desktop computer.

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Change Makers – Jacqueline

This article is a series of three, written by Tom Mason for theFall 2013/Winter 2014 issue of Izaak Magazine – an in-depth, behind the scenes, all-access publication highlighting the incredible, everyday happenings at the IWK Health Centre. A stay at the hospital can be tough, but for some exceptional young people, it’s also a time to grow , gain strength and learn about who they are. 

Jacqueline Wigle is busier than the average 20-year-old. In addition to a full slate of classes at Dalhousie University, where she majors in theatre studies, she devotes much of her spare time to helping young people cope with illness.

Jacqueline Wigle

Jacqueline Wigle

Jacqueline volunteers with “You’re in Charge” an IWK program that helps teenagers with chronic diseases and their parents learn to manage their own health. She also volunteers with Camp Brigadoon, a camp for kids with chronic illnesses in the Annapolis Valley. She advocates for social inclusion for children with developmental delays, speaks out about Crohn’s disease, and works with young people to help them through their own health issues.

Her drive to help others is matched with her empathy. Jacqueline was first diagnosed with Crohn’s disease – a painful, and often severe, inflammation of the gastrointestinal tract – when she was 12. Her treatments meant at least eight lengthy stays at the IWK where she would undergo a procedure known as total parenteral nutrition (TPN) that provides all her food through intravenous fluids, a procedure designed to give her inflamed intestinal tract a rest. The TPN treatments often lasted two weeks at a time – a strain on any busy teenager.

“The hardest part is craving food,” she says. “I’d be okay until I saw food commercials on TV and then I would really start to miss the taste of it.”

Jacqueline calls Crohn’s “an unsexy illness” and says that sufferers often get ignored because of the stigma attached to a digestive disorder. “Let’s face it. It isn’t an easy thing to talk about,” she says.

Two years ago, as a member of the IWK Youth Advisory Council, Jacqueline headed up a project called “Passionate for T.P.” to lobby for better quality toilet paper for inpatients with gastrointestinal disease. “Patients with those kinds of problems spend a lot of time going to the bathroom,” she says. “Having a good quality toilet paper can be very comforting and helpful for them” Thanks to those efforts, today IWK inpatients can access higher quality toilet paper whenever they need it.

She manages to do it the way she meets every challenge in her life: through humour. “The best thing you can do when you’re dealing with something like this is to stay positive and try not to take things too seriously. If you allow yourself to see the funny side, it’s a whole lot easier to get through it.” That’s where her love of theatre, music and dance comes in.

“What matters is to be happy. That’s why I got involved with theatre and that’s why I got involved with the IWK. I wanted to be able to see my own hospital experience in a positive way. I wanted to get something positive from my illness.”

In the spring of 2013, Jacqueline received the Robbie and Jean Shaw Scholarship, an award given to former IWK patients who have made a difference in their community. She hopes to go to law school when she graduates and would like to channel her passion for advocating on behalf of young patients into a law career.

This story and many exciting others are available though Izaak Magazine’s fully interactive mobile app, available for download on the iTunes Newstand. You can also read Izaak magazine online through your desktop computer.