At the core of individual, organizational and governmental initiatives and activities is Council’s commitment to improve access to care for all Ontarians, regardless of geography. PCMCH’s health quality and improvement strategies and activities span the maternal/child/youth continuum of care and have a significant impact on the way in which health care is accessed by the public, and delivered, monitored, and evaluated by providers and the system-at-large. Some of PCMCH’s strategies and initiatives are in the active phases of implementation and evaluation, while others are in the planning stages. Led by subject matter experts from across Ontario, PCMCH’s initiatives and projects are grounded in evidence, experience and a shared goal to improve the delivery and quality of care for mothers, babies, children and youth in Ontario.
In 2009, the Ministry of Health and Long-Term Care requested that the Provincial Council for Maternal and Child Health establish an expert panel (the Breastfeeding Services and Supports Work Group) tasked with providing cost-effective recommendations and options to support the delivery of breastfeeding supports and services in Ontario with a focus on improving breastfeeding initiation, duration and exclusivity rates. The Work Group, consisting of breastfeeding experts from across the province and a variety of disciplines, commenced their deliberations in November 2009. As part of Ontario’s Healthy Kids Strategy, the Ministry of Health and Long-Term Care is investing more than $2.5 million to help families give their infants a sound nutritional start. The Baby Friendly Initiative (BFI) Implementation Strategy is one such investment and is aimed at enhancing breastfeeding in Ontario. The Strategy will provide both community health organizations (Community Health Centres, Family Health Teams, Aboriginal Health Centres) and hospitals with training, tools, guidance and educational resources to help achieve the World Health Organization’s BFI designation and adopt best practices that meet BFI requirements. To learn more visit the Baby-Friendly Initiative Ontario website. Work Group Terms of Reference (PDF) Work Group Membership (PDF)
It is estimated that 1 in 5 individuals experience an early pregnancy loss, defined as a loss that occurs at less than 20 weeks into the pregnancy. Experiencing a pregnancy loss can be a very emotional and traumatic time for expectant parents. When patients first experience the symptoms of an early pregnancy loss, they frequently seek medical care in an Emergency Department (ED), however, because these cases still represent a small proportion of total ED visits (less than 1%), healthcare providers and other staff in the ED may not have as much experience treating them, in particular, addressing their emotional and bereavement needs. The physical and emotional care that healthcare providers can offer to individuals experiencing an early pregnancy loss has an important impact on their long-term emotional well-being. As such, it is critical that healthcare providers working in EDs attend to the patients’ psychological and emotional needs in an empathetic, caring environment. Compassionate care acknowledges pregnancy loss as a loss of life and considers the spiritual, emotional and cultural expressions of the pain that accompanies the loss of a baby. In January 2017, the Provincial Council for Maternal and Child Health, in partnership with Health Quality Ontario and the Champlain Maternal Newborn Regional Program, convened an Expert Advisory Panel, which was tasked with the development of recommendations for healthcare providers and staff, to guide the […]
Following the PCMCH’s release of its recommendation and Guideline for the Use of Fetal Fibronectin (fFN) testing in Ontario, with the support of the Ministry of Health and Long-Term Care, fFn testing was adopted province-wide. fFN testing assists clinicians in determining whether a woman, who may be at risk of preterm birth, requires admission to hospital and/or transfer to a high risk perinatal unit. Evaluation of the testing protocol revealed significant cost savings to health provider organizations and the system as a whole, as well as increased quality and safety of care to mothers and their newborns. The following resources serve to augment the education provided by Hologic, and to provide 24/7 access to information for healthcare providers in Ontario hospitals.
Infectious diseases are caused by pathogenic microorganisms, such as bacteria, viruses, parasites or fungi. The diseases can be spread from one person to another, directly or indirectly, through fluid exchange or exposure to vectors, or from the environment. Public Health Ontario provides public health and health care partners with information, tools, and resources for the prevention and control of infectious diseases. The original consensus-based policy was developed November 2008 by the Provincial Maternal-Newborn Advisory Committee Infection Prevention and Control Work Group. It has been subsequently reviewed and revised by The Provincial Infectious Disease Advisory Committee (PIDAC) in 2013. The updated document “Best Practices for Infection Prevention and Control in Perinatology” is available online at: Provincial Infectious Diseases Advisory Committee (PIDAC) (Knowledge Products).
The preterm birth (infants between 34 weeks and 0 days and 36 weeks and 6 days gestation) rate is increasing in Canada. These infants may experience higher rates of temperature instability; respiratory distress; feeding problems; hypoglycaemia; jaundice and sepsis. The clinical resources published in this section are intended to assist in the management of this patient population. Work Group Terms of Reference (PDF) Work Group Membership (PDF)
The PCMCH convened an Access Work Group to develop recommended strategies to achieve a coordinated system of maternal and newborn services that will provide equitable access to timely, high quality, evidence-based, family-centred care for all pregnant women and newborns in Ontario. One of the Access Work Group’s first orders of business was to develop standardized levels of care definitions for maternal and neonatal units. Currently, Ontario has 96 hospitals that provide maternal and newborn care and services with 49 being NICUs or Special Care Nurseries. Working in partnership with the LHINs, PCMCH rolled-out standardized levels of care definitions and their implementation represents a significant accomplishment and ground-breaking innovation in improving the system of maternal-newborn care in the province. Access to Care Work Group Membership (PDF) Access to Care Work Group Terms of Reference (PDF) The Ontario Levels of Maternal and Newborn Care by Hospital The Ontario levels of maternal-newborn care, by hospital, are now available by clicking on the link below (June 2018 update).
A review of low volume, rural, and remote intrapartum services in Ontario. The Provincial Council for Maternal and Child Health recently completed a gap analysis to look at local access to safe, high-quality intrapartum care services in lower volume centres (less than 500 births a year) across the province. The gap analysis utilized a mixed-methods approach that included: An environmental scan of the existing literature, professional statements, and expert reviews of specific rural sites; Findings from interviews with 16 geographically representative lower volume intrapartum care sites to understand gaps, challenges, and best practices in delivering safe, high-quality intrapartum care close to home; and Qualitative analysis of data from the Better Outcomes Registry & Network (BORN) and Institute for Clinical Evaluative Sciences (ICES). Key themes highlighted by the findings of the analysis include: Impact of geography on quality and access to care; Variations in models of care, staffing models, and human resources strategies; and Knowledge and involvement of regional maternal-child networks. To learn more, please download a copy of our Gap Analysis HERE. COMING SOON: In the fall of 2018, a distance map will be published that will provide an overview of the duration of time pregnant people travel within the province, to reach intrapartum care services. For more information please contact firstname.lastname@example.org
The practice of separating a newborn from its mother soon after birth is common. Modern day hospital routines continue to significantly disrupt the early maternal-infant relationship, contributing to unnecessary admissions to the special care nursery. Mother-baby dyad care, including skin-to-skin contact of healthy infants and mothers, is an important component of maternal-newborn care. Beginning at birth, mothers and newborns should be viewed as a unit with no disruption of the parent-infant relationship. The following recommendations and resources support the implementation of mother-baby dyad care. Work Group Terms of Reference (PDF) Work Group Membership (PDF)
The impact of drug addiction on a pregnant woman has profound effects, not only on her health and wellbeing but also that of her newborn baby. Maternal substance use during pregnancy is an important risk factor for negative pregnancy and neonatal outcomes. The infant at risk for Neonatal Abstinence Syndrome (NAS) is also at increased risk for pre-term birth, low birth weight and intrauterine growth restriction. PCMCH was instrumental in identifying the rapidly growing incidence of opioid dependent pregnant women and their infants, who experience withdrawal after birth. PCMCH’s work resulted in education and support for providers by providing interventions in the form of NAS clinical guidelines and recommendations to support the provider community in addressing the psychosocial needs of opioid dependent women during the preconception, antenatal and postpartum/post discharge stages. Clinical guidelines also address the need to monitor the infant post birth and provide evidence informed approaches to pharmaceutical and non-pharmaceutical interventions to manage the symptoms of withdrawal. The following resources and clinical guidelines support the clinician in the identification, care and management of infants with NAS. Please note that this guideline is for information purposes only. These recommendations reflect the information available as of the date it was issued and therefore should be used in that context. Please use your own clinical judgment when applying any management strategies documented […]
In April, 2017, the Provincial Council for Maternal and Child Health (PCMCH) approved a recommendation by the Maternal Child Transport Advisory Committee that CritiCall Ontario facilitate all urgent/emergent, referrals for neonates where consultation/advice, transfer and/or transport from a Level I to a Level II, between Level IIs or to a Level III, for cases where medical, surgical and/or diagnostic care is not available locally. This effectively expands The Neonatal Consult, Transfer, and Transport Process launched in September 2015 to include all urgent/emergent inter-facility requests for advice/consultation to a higher level of care. PCMCH, CritiCall Ontario, and Ontario’s Paediatric Academic Health Sciences Centres’ Neonatal/Paediatric Transport Teams, are partnering in this provincial process, which is designed to: Expand service through CritiCall Ontario to all neonates where consultation/advice, transfer and/or transport from a Level I to a Level II, between Level IIs or to a Level III, for cases where medical, surgical and/or diagnostic care is not available locally; Streamline the process for the benefit of neonatal patients in Ontario; and Maximize the efficiency of scarce and specialized resources required to care for this patient population. This expanded process will benefit patients by ensuring that a comprehensive assessment is conducted to: Support the provision of timely advice regarding patient management; Confirm the appropriateness of the level of care required; Determine if a specialized […]
In 2013, the Provincial Council for Maternal and Child Health (PCMCH) convened the Neonatal Follow-Up Clinic Work Group (NFUC-WG) to examine the current state of Neonatal Follow-Up Clinics (NFUCs) in the province and to make recommendations for best practice. The NFUC-WG included clinicians and administrators, as well as representation from Ontario’s children’s treatment centres, and the Ministry of Child and Youth Services. The work group’s report details the current state of NFUCs in Ontario and includes a series of clinic and broader system recommendations to address the needs of the NFUC population as well as leveraging existing resources within the healthcare system. The report and its recommendations were unanimously approved by the PCMCH Board on June 22nd, 2015. Work Group Terms of Reference (PDF) Work Group Membership (PDF) Implementation Committee In September 2015, the Neonatal Follow-Up Clinics Implementation Committee was convened to advance the recommendations of the NFUC-WG Report. The Committee consists of representatives from various clinics across the province. The aims of this Committee are as follows: 1. To reduce variability of practice among NFUCs and align standards; 2. Create a strategy and implement the clinic recommendations in collaboration with NFUCs; 3. Create a strategy and implement the broader system recommendations in collaboration with relevant provincial Ministries; and 4. Develop an evaluation framework with indicators to assess the process and […]
The Ontario Antenatal Record has been updated! The Provincial Council for Maternal and Child Health (PCMCH), in partnership with BORN Ontario, the Ontario Medical Association, and the Association of Ontario Midwives, announces the 2017 release of the Ontario Perinatal Record (OPR). The OPR update and User Guide development was undertaken by a provincial committee representing practitioners using the current antenatal record including obstetricians, midwives, family physicians, nurses and nurse practitioners, as well as other stakeholders that support high quality maternity care such as Best Start, Public Health, BORN Ontario and PCMCH. The updated Ontario Perinatal Record is the 5th revision to the antenatal record and replaces the 2005 version. What’s new in the OPR? Updates to the 2017 OPR include: Spreading out and enhancing the original two-page record to three pages to allow for more thorough documentation of medical, genetic, and psychosocial issues A total of five pages including a page of mental health screening resources and a standardized postnatal visit record Consolidation of all lab and ultrasound tests on page 2 A comprehensive section on immunizations Prompts for special circumstances requiring time sensitive interventions Inclusion of mental health screening questions and tools Updated genetic history and investigations Updated language respectful of gender identity and the multiple ways in which individuals may identify themselves as a parent Grouped and […]
Retinopathy of prematurity (ROP) is an abnormal development of retinal blood vessels in premature infants as a result of immature and incomplete vascularization of the retina. Visual impairments such as retinal detachment and blindness can occur in infants at risk if symptoms progress to the advanced stages. It is imperative for infants born at risk have access to screening services and follow up. The ROP expert panel worked on several objectives relating to remote screening and improving access to care. Clinical guidelines for ROP eye examinations to promote consistency and standardization of practice across all hospitals are included on this page. Work Group Terms of Reference (PDF) Work Group Membership (PDF)
The Retro-transfer Implementation Work Group (RTIWG) made recommendations that support timely and efficient retro-transfers which in turn allow for timely admissions and transfers of high risk women and neonates. This report introduces standardized communication, education and documentation tools that will streamline the system. Recommended tools include the new Provincial Maternal Transport Record and Provincial Neonatal Retro-transfer Record. These forms and resources are designed to support teams as they implement a process to facilitate neonatal retro-transfers in a consistent and timely manner, to educate and communicate with providers, patients and families, and to ensure that aspects of care are not delayed or missed because of a transfer to another centre. Work Group Terms of Reference (PDF) Work Group Membership (PDF)
As part of the Safer Birth initiative, the Provincial Council for Maternal and Child Health (PCMCH) has developed best practice recommendations for the safe administration of oxytocin used in augmentation and/or induction. As oxytocin is a high alert medication, there is heightened risk of causing significant patient harm when used in error. The overall goal of this work will be to reduce adverse outcomes associated with the misuse of oxytocin by reducing variation in care and reinforce safe drug administration principles. To support implementation of these best practices, various tools have been created such as a standardized order set and safety checklist. About this Project This work focuses on identifying best practice recommendations that can be applied to low risk pregnant patients who are eligible for oxytocin for augmentation or induction of labour. This report will not address the use of oxytocin for the use of contraction stress test or oxytocin challenge test; risks and benefits associated with other medications or methods of cervical ripening and induction of labour (prostaglandin, dinoprostone, mechanical cervical ripening); administration of oxytocin for postpartum hemorrhage prophylaxis; and oxytocin regimen for intrauterine fetal demise. The following groups will benefit from this work: Pregnant people and their families: Gain access to reliable information on oxytocin through shared decision making, and receive quality care when being administered this […]