Obstetrical care closer to home: team-based high risk care in Canada's Arctic

The Qikiqtani Region of Nunavut is served by a regional hospital with over 400 births annually. In Nunavut, age-specific fertility rates are over 8 times the national average, with increased pre-eclampsia, postpartum hemorrhage, and preterm birth. For Inuit women, giving birth closer to home, instead of in a city over 2000 km away, is of paramount importance. In a region with no obstetrician, this has posed challenges for family physicians. To provide safe, culturally-relevant care, a multi-faceted approach was developed. Care is delivered by a core team of full-time family physicians. A comprehensive orientation guide was created, with protocols to standardize and clarify the scope of the team's capabilities. Developed from existing guidelines, use of the MoreOB program, and in consultation with Maternal Fetal Medicine, these were modified to the local context. A consensus process is used to update protocols at an annual physician retreat. Diagnostic tools (ex. fetal fibronectin) are available in all communities. Telehealth is used for weekly multidisciplinary rounds, where community nurses join in reviewing all high-risk pregnancies and women at term. Mandatory consultation with another family physician exists for decisions regarding induction or caesarian section. Physicians are increasingly able to manage complex cases and caesarian section rates are below the National average (<10%). Need for out-of-region referrals has decreased, due to early initiation of preventative therapies for preterm birth or preeclampsia. Challenges include increasing physician numbers, integration of midwifery in a setting with no obstetrician, and inability to expand telehealth due to internet bandwidth limitations.

This abstract was presented at the Innovative Solutions in Remote Healthcare - 'Rethinking Remote' conference, 23-24 May 2016, Inverness, Scotland.