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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
university.

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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Pregnancy was a very difficult time for me.

Reproductive Mental Health is just one way the IWK Health Centre supports women’s health. This service helps women with mental health concerns while they are under reproductive care—before, during, or following a pregnancy. This past weekend, women showed their support by participating in the Shoppers Drug Mart Run for Women, and were able to raise a remarkable $12,000 to support the Reproductive Mental Health Services at the IWK. Here is one patient’s story about how the IWK helped her though her difficult time.  

IWK FoundationI was about four months pregnant with our second child when I ended up at the IWK Mental Health Reproductive Center. I was sent to a social worker at the IWK Health Centre, and I credit her for helping me get to where I am today.

My boyfriend and I have had a rocky relationship and one day I showed up for my appointment at the perinatal centre in a crying mess because we had yet another bad fight. I was immediately referred to the Mental Health Reproductive Center because I literally felt out of control – a complete emotional wreck. Pregnancy was a very difficult time for me. I have always struggled with low self-esteem, emotional irregularity, and childhood issues. I have spent over 20 years talking with therapists and realized that my issues ran quite deep. I often felt overwhelmed by my list of issues and what was required to “correct” them. I felt like I was the only mother going through this and while it was supposed to be the happiest time of my life, I felt alone and overwhelmed.

My obstetrician explained that some women experience postpartum depression while other’s can experience it during the pregnancy itself. I was one of the later. I literally would feel hormones surge through my body and I didn’t know what to do. I needed help badly and I wanted to be a positive role model for my children, so I had to address my problems head on and get the help, advice, and support in order to do so.

The Mental Health Reproductive Centre at the IWK provides therapy and support to expectant mothers and will continue to do so up to a year following their child’s birth. I stayed on for two years, because I had a substantial history of a personality disorder with emotional highs and lows. My social worker was determined to see this through for me. She didn’t give up on me when she could have easily sent me on my way. I have the utmost respect for the IWK and their services as they followed through with every single physical and emotional issue that I ever raised to them.

– Tara

Make a gift to the IWK Health Centre Foundation. 


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The Golden Hour.

Jennifer Jollymore is a registered nurse in the Birthing Unit at the IWK Health Centre – a leading centre of excellence that provides quality care to women, children, youth and families in the Maritime provinces and beyond. 

A mother holds her new born child.

A mother holds her newborn child.

I’m sometimes amazed at how much change I’ve witnessed with regards to skin-to-skin contact (SSC) in the four short years since I graduated nursing school and began my career at the IWK Health Centre as a Birth Unit nurse. Not that long ago, it was still common practice for babies to be delivered and immediately transferred to the resuscitation area, whether they were at risk of needing resuscitation or not. The baby would be dried and then swaddled with blankets before being brought back to the parents for cuddles.

Sometimes, any number of interventions could take place between delivery and cuddles with mom and dad. Weighing, measuring, eye ointment, vitamin K injection, newborn head-to-toe assessments are all tasks that could have occurred prior to a new mother holding her just born baby for the first time.

Fast forward four years. Today on the Birth Unit, when there is a normal, uncomplicated delivery, babies are dried on mom’s chest, immediately placed skin-to-skin and left there uninterrupted for their first hour after birth. We like to call it the “Golden Hour.” During this hour, most assessments and procedures can be done while the baby is skin-to-skin with mom or with dad (if mom is unavailable or unwell).

The research behind skin-to-skin contact is abundant. We know that skin-to- skin facilitates newborn transition to life on the outside, stabilizing their temperature, blood sugar level and breathing. Skin-to-skin contact also prepares babies to initiate feeding.

It’s easy to observe and record all of the measurable advantages SSC offers such as those mentioned above. What is sometimes less obvious though are the bonding and attachment behaviors SSC promotes. In January 2013, we had the opportunity to follow-up with several families who had had a Golden Hour after their delivery. Mothers were contacted a couple of weeks after they went home from the IWK. When asked about their parenting experience to date, amazingly, all of the mothers talked about their skin-to-skin with their infant.

“What was best was that she got my smell right after birth – nestled right in after birth and stopped crying. It would not have been the same without that opportunity. It was much better for her (baby) and I fell in love right away,” said one mom about her experience.

There are so many benefits of skin-to -skin contact beyond the initial transition in the first hour of life and too many to go into detail about here. However, as the research has emerged highlighting the importance of SSC for newborns and parents at delivery, this is a practice that I’m proud to report is now routine at the IWK.

Learn more about skin-to-skin contact.


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I saw firsthand where donations are used

Angela Faulkner from Sackville, Nova Scotia, shares why she is forever thankful for the IWK Health Centre for changing her life.

Hopefully no one reading this will ever understand what it’s like to spend time at the IWK, but at least you will have an inside perspective to how all our fundraising and hard work will touch someone else’s life.

Ty and Carter

Ty and Carter

I’m the mother of two very handsome little boys, Carter, age five and Tyler who is two-and-a-half. I’m also a type 1 diabetic which adds a lot of extra concerns during pregnancy. I was followed very closely throughout both pregnancies and during my 20th week of pregnancy with Tyler, an ultrasound revealed a problem with his tiny heart. His aortic valve was too narrow for blood to travel through so the heart couldn’t operate properly. If it didn’t correct itself by the time Tyler was born, he would require open heart surgery. Little did I know at the time that Tyler’s heart problems were just the beginning of a very long relationship we would form with all the Doctors and Nurses at the IWK.

On May 26, 2009 I delivered a beautiful baby boy. I was full of anxiety worrying about Tyler’s heart but was so excited to meet. Tyler’s umbilical cord was only three inches long, resulting in a tear in my placenta and an emergency c-section. The doctor bundled Tyler up and handed him to my very proud husband, Kirk. Our excitement was short lived – almost immediately Tyler’s his nose started to bleed and bruises began to form all over his tiny body. He was immediately rushed to the NICU while we waited anxiously in recovery for news on my new baby.

Tyler had a very rare condition that results in virtually no platelets in his blood. He would require several blood transfusions before he could come out of his incubator and there was a chance of death from internal bleeding.

Tyler had seven blood transfusions over the next six days. Even once they had the platelet condition sorted there was still the matter of his heart condition, which had deteriorated. Four holes now needed to be repaired, but we had to wait until he was bigger and stronger.

I spent the next five months in the IWK and it became like my home. Tyler’s heart surgery was scheduled for September 1, and we started our daily countdown. That day was the hardest and longest day of my life. Tyler went into surgery that morning for six hours and all we could do was wait.

Ty baby picture_EDITAfter surgery, Tyler was moved into the Pediatric Intensive Care Unit for the next seven days. I would spend hours sitting beside Tyler in Intensive Care talking to the nurses who explained the purpose of every tube, needle, and sensor on him. I was terrified to hold him for fear of hurting him. The nurses taught me to change, bath, play and hold him until I was confident I could do it by myself.

I now know from the absolute bottom of my heart that there is nowhere else I would want my children to be if they are sick. I was so happy to go home with Tyler but at the same time was sad to leave the safety and security of the hospital. The doctors, nurses and other hospital staff are the best around. They meet families on the worst day of their lives yet and find a way to reassure that things will get better. Today, Tyler has several monthly appointments and has been seen in hematology, plastic surgery, genetics, cardiology, gastroenterology, ophthalmology, audiology, and respirology.

I owe my son’s life to the IWK and am very proud to work for a company like Wilson’s Fuel that supports their cause. They’ve changed so many lives and my sweet smiling two-year-old son is one of them.

The Faulkner Family

The Faulkner Family

Learn more about the IWK Health Centre Foundation.
Make a gift to the IWK Health Centre Foundation.. 


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Assisting women a world away

This article was written by Heather Laura Clarke for the inaugural issue of Izaak Magazine – an in-depth, behind the scenes, all-access publication highlighting the incredible, everyday happenings at the IWK Health Centre.  Dr. Ron George travels to Africa throughout the year to provide much needed prenatal and labour care to the women of Ghana.

Dr. Ron George

Dr. Ron George

Dr. Ronald George often witnesses women risking their lives to give birth in Ghana, where childbirth is truly a life-threatening experience. Conditions there are far different than those at the IWK Health Centre. “In Ghana, the maternal mortality rates are anywhere between 400 to 600 deaths per 100,000 live births. Unfortunately, during my brief visits to Ghana I have witnessed too many mothers die,” says Dr. George. “At the IWK, there is a chance I might see one or two deaths during my entire career.”

Dr. George is an anesthesiologist in Women’s and Obstetric Anesthesia at the IWK and Associate Professor of Obstetric Anesthesia at Dalhousie University. He also works with a group called Kybele — a non-profit, humanitarian organization dedicated to improving childbirth safety through educational partnerships and hands-on teaching.

Dr. George travels to maternity centres in Ghana two to three times a year as part of a team working to improve the care of women and children. He says Ghanaians know how unsafe childbirth is in their country and every one of them has been touched by a maternal death — whether it’s a sibling, or a close friend.

Neonatal Unit _Ghana

Over-crowded and under-supplied neonatal care unit.

Kybele partners with Ghana Health Services and local health care practitioners to work on education and the introduction of new, safer practices. The partnership between Kybele and Ridge Hospital in Accra emphasizes assessment, implementation, advocacy and the measurement of outcomes and has reduced the maternal mortality from 496 per 100,000 live births in 2007, to less than 250 per 100,000 live births in 2011.

The partnership has also created a highdependency unit for high-risk mothers — women with severe preeclampsia or recovering from obstetric haemorrhage — other key causes of death in childbirth. Dr. George says their partners are “highly optimistic” with the positive results.

Building capacity for health providers in Ghana to develop their own set of skills in their own environment is another key piece of the puzzle. An example is the creation of a nurse anaesthetist school within Ridge Hospital in Accra, something Dr. George is proud to have contributed to. “It has allowed us to ensure that obstetrics and anesthesia care is taught appropriately at the start of their careers,” he says.

Kybele member (Laurel Bookman) doing impromptu teaching of neonatal resuscitation.

Kybele member (Laurel Bookman) doing impromptu teaching of neonatal resuscitation.

He also helps bring childbirth pain relief to women in Ghana — something he says is in high demand. On a recent trip, Dr. George met with a woman for whom Kybele had provided pain relief during the birth of her first child. Unfortunately, the team was back in North America when it was time for her second child to be born. “She told us how she had begged for pain relief during her second birth, but we were not there to provide it,” says Dr. George. “She kept asking when pain relief will be available for all women in Ghana. It was very moving to see that our efforts are appreciated.” Kybele is actively teaching and advocating for pain relief during childbirth.

Dr. George says he’s “very thankful” for the services he is able to provide women delivering at the IWK Health Centre in Halifax. “In Ghana, especially in remote areas, women die from very preventable things, and the rate of stillborn births is distressingly high,” says Dr. George. Always a moving part of his visits to Ghana, Dr. George was recently at the hospital during the weekly “first baby visit” for the new moms. “The mothers all show up in beautiful white dresses, which are traditionally their church outfits, and there is a lot of prayer and singing,” says Dr. George. “Some of the babies aren’t named right away, because they don’t know if they will survive. This is when they name their child, and celebrate that both the mother and baby have survived this initial week.”

To read the full issue of Izaak Magazine visit www.iwkfoundation.org/izaak.

Make a gift to the IWK Foundation.


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You make me better.

When you donate to the IWK Health Centre Foundation, your gift changes the lives of Maritime women, children, youth and families who require specialized care services at the IWK. In our 2012 Gratitude Report you will see how, together, we are making the IWK better

I was so happy to be referred to the IWK. Coleen helps me talk about how I’m feeling, which is very important. I’m also grateful my baby was born in this special place.” – Chrissy Lowe

A strong goup of women and a very well loved little girl. Dorothy, Chrissy, baby Faith, Coleen Flynn and Dr. Joanne MacDonald.

Christina Lowe was expecting her first baby when she experienced feelings of sadness and despair, which are not typically associated with the joy of pregnancy. She soon realized these were symptoms of depression. She was referred to the IWK’s Reproductive Mental Health Service – a program providing treatments to women facing mental health issues during pregnancy or in the first year after birth.

Chrissy met regularly with mental health social worker Coleen Flynn, who also helped her cope with anxiety as her due date approached. Anxiety is a common experience with many pregnant women. Chrissy gave birth to her daughter, Faith Lowe-MacLean on April 5, 2012. To manage her continued depression, she now meets with Coleen every few weeks. Today, with the support of her grandmother Dorothy, Chrissy is focused on feeling better and caring for her beautiful baby girl.

Read more about Christina and other IWK stories in our 2012 Gratitude Report.
Make a gift to the IWK.