RCP e-News October 2018

Canadian Association of Perinatal & Women’s Health Nurses (CAPWHN) Newsletter - The September 2018 issue of the CAPWHN Newsletter is now available! Additional editions of CAPWHN newsletters are also available on the CAPWHN website. CAPWHN welcomes your comments, compliments, and suggestions. Contact them at admin@capwhn.ca.

For more information visit www.capwhn.ca.

SOGC Releases Statement on Maternal Sepsis - Sepsis is the third most common direct cause of maternal mortality. Unfortunately, rates of maternal sepsis are on the rise, globally and in high income countries, although the reason for this is unclear. Maternal Sepsis is highly preventable and deaths due to sepsis can be prevented if they’re recognized and treated early. The SOGC Infectious Diseases Committee has released a statement recommending that every health care facility should be aware of the signs and symptoms of sepsis and have systems in place to provide prompt identification along with aggressive treatment. The SOGC encourages each health care facility to discuss their approach to the detection and management of sepsis. To assist with this, SOGC is forming a task force to review the current literature available on bedside tools to assist in the identification of maternal sepsis, identification of at risk patients and appropriate treatment algorithms and pathways.

Influenza Vaccine: 2018 - 2019 Guidelines for Nova Scotia Health Care Providers - The 2018-2019 Influenza Campaign is commencing soon. As in previous years, all Nova Scotians aged 6 months and older will be eligible to receive the influenza vaccine. It continues to be of utmost importance that individuals at high risk for influenza be immunized; including pregnant women; and individuals capable of transmitting influenza to others. This influenza season, Nova Scotia will offer the following influenza vaccines:

  • inactivated quadrivalent influenza vaccine for individuals 6 months of age and older; including pregnant women at any stage of pregnancy
  • inactivated high-dose trivalent influenza vaccine for residents of Long Term Care facilities (nursing homes and residential care facilities) 65 years of age and older.

Please discuss the benefits of the flu vaccine in pregnancy and offer it to all pregnant women. The vaccine is also safe for breastfeeding mothers. It is expected that public health will begin distribution of the influenza vaccine beginning the third week in October.

As in past years the Nova Scotia Department of Health and Wellness has released a document containing key messages using FAQs to support this year’s Influenza Program. To view this document click here. Please circulate this information widely to your colleagues who care for pregnant women and new mothers. Additional resources can also be found on the Nova Scotia Department of Health and Wellness and the Public Health Agency of Canada website.

SOGC Responds to the ARRIVE Trial –The ARRIVE trial, on elective induction in nulliparous women with a singleton low risk pregnancy at 39 weeks, has produced a great deal of attention and commentary. In response, the Society of Obstetricians & Gynecologists of Canada has released a statement. It is important to be reminded that this study, as with any study, needs to be interpreted with care. Careful interpretation of the results of this study enables healthcare providers to use their best clinical judgment in the timing of indicated induction in low risk nulliparous women where gestational age is securely known by early ultrasound. However, at this time, it is not appropriate to recommend elective induction solely to reduce the risk of caesarean section in an otherwise low risk nulliparous patient. The SOGC induction of labour guideline, which covers both current indications as well as methods, is currently under revision and this study will be factored into the statements and recommendations arising from that guideline.

French Translation of NSHA Resource – The recently developed pamphlet, ‘Options for Birth after Cesarean’ has been translated into French! This resource will serve as an information source for French speaking women and their families regarding trial of labour after cesarean (TOLAC). The title of the resource is ‘Choix d’accouchement après une césarienne’ and is available on the NSHA website. It can also be ordered from the Print Shop using this associated print code - FF85-1891.

IWK Health Centre Receives BFI Designation – The IWK Health Centre has received Baby-Friendly Initiative (BFI) designation, making it the first health centre in the Maritimes to achieve that status. Baby friendly hospitals have demonstrated that they have policies and care practices that meet the gold standard for mother/baby care practices related to breastfeeding. BFI is a global quality improvement program of UNICEF and the World Health Organization. It’s based on 10 Steps which set out standards for health services to improve the care environment and practices so that parents are enabled and supported to meet their infant feeding goals. BFI is for all families so they are supported to make informed decisions and benefit from evidence based care such as skin-to-skin contact immediately at birth and during painful procedures, keeping moms and babies together, and supplementing feedings when it is medically appropriate to do so.

The IWK is one of less than 20 hospitals in Canada (approximately 10 percent) to have achieved BFI designation. Congratulations to the staff, leaders and physicians who have worked so hard to reach this goal. While this is a huge achievement for the IWK, BFI designation is a journey and is part of continuous quality improvement. IWK’s BFI Committee has already begun to develop ongoing work plans to support future improvements and sustain successes!

Tdap in Pregnancy - To support the option of administering Tdap in every pregnancy the Medical Services Insurance Program (MSI) in Nova Scotia issued billing guidance for physicians in July 2018.  Physicians were advised to “bill as EC with explanatory text” noting that the woman is pregnant. See page 1 of the MSI/Medavie bulletin at this link: http://msi.medavie.bluecross.ca/wp-content/uploads/sites/3/2018/07/MSI-Physicians-Bulletin-July-2018.pdf

RCP Learning Module Posted on the Provincial Learning Management System – The RCP Hypertension Maternal Newborn Learning Module has recently been posted to the Provincial LMS. It can be accessed on the LMS following the usual log-in process and by selecting the “Reproductive Care Program” catalogue. A convenient and helpful feature of the LMS is the ability to print reports and track the completion of the learning modules. This feature is a beneficial tool for managing ongoing professional development.

The learning modules are freely accessible through the RCP website and while they were originally developed to help novice nurses attain the basic competencies required during orientation, they have been found to be useful to all members of the perinatal team. As the modules undergo their regular review and update, they will also be posted to the Provincial Learning Management System (LMS).

Changes to Public Health Online Prenatal Resources - The ‘Welcome to Parenting’ online platform was launched on September 15, 2014 to support universal access to prenatal information and support. A recent review of the Welcome to Parenting data indicated that the rate of new users has decreased and online class participation is low. Since the launch of ‘Welcome to Parenting’, a number of new and updated pregnancy and parenting websites have become available. Based on these findings and the availability of credible online resources, Public Health has decided that the ‘Welcome to Parenting’ contract will not be renewed. As of September 30, 2018 new users will not be able to register on the ‘Welcome to Parenting’ online platform. Existing participants will have access to the site until December 31, 2018.

Public Health’s ‘Pregnancy & Parenting Support’ webpage has been updated and includes a variety of credible resources and information for families. This page will also be available in French. For more information regarding this change click here.

Cannabis Resource – The Canadian Public Health Agency has developed an evidence brief to provide key messages for health care providers (HCP) to share with individuals planning a pregnancy, who are pregnant or who are breastfeeding; and also to provide information to inform HCPs about the risks and health effects of cannabis use during pregnancy and breastfeeding. It can be accessed here.

Recent Publications of Interest – Several publications have been recently released and are now available for your review. Several titles with links have been provided below for your information and reading enjoyment:

Canadian Pediatrics Society Practice Point - Addressing Vaccine Hesitancy in Immunization Programs, Clinics and Practices

Changes to Fetal Health Surveillance Education – The Canadian program, Fundamentals of Fetal Health Surveillance, has been used across the country for the last 20 years. The current online module and manual are available via the University of British Columbia (UBC) Learning Portal. To support UBC with ongoing costs related to the required maintenance and updates to the online resources, changes are required. Effective September 1, 2018, there is a fee of $30.00 to write the Fundamentals of Fetal Health Surveillance examination. Bulk exam purchasing is available to reduce the cost. Access to the FHS module and manual will continue to be accessible and free of charge.

This change is one of several this year in the FHS practice area. Others include CAPWHN’s Position Statement related to Fetal Health Surveillance Education for Nurses released in February 2018 as well as revisions to the SOGC’s Fetal Health Surveillance clinical practice guideline which is anticipated in 2019. Exploration of the best approach to FHS in NS is underway in an effort to build consistency throughout the province to align with recommendations from the National FHS Steering Committee. Please stay tuned for more details.

SOGC Releases Statement on Respectful Birth – Each year there are more than 380,000 births in Canada. For most deliveries, obstetricians, nurses, family physicians, midwives and doulas provide extraordinary care and are mindful of the particular vulnerability of women during and after labour, and are deeply sensitive and caring to the needs of the women in their care. There are, however, instances when women either were not properly listened to, or felt this to have been the case. In response to recent media reports, the Society of Obstetricians & Gynecologists of Canada has released a statement to remind health care providers of the importance of appropriate and caring behaviour during labour and delivery as well as to remind women of their rights during the birthing experience.

Recently Revised RCP Resource – The Unanticipated Birth Outside the Birthing Unit: Guidelines for Labour Assessment, Imminent Delivery, and Transfer has been updated and is now available on the RCP website.

Occasionally, women arrive in active labour in the Emergency or Outpatient area of a facility where a maternity service is unavailable. This document has been developed to support health care professionals who do not deliver babies as part of their usual practice. It is intended to provide guidance and support, to safely and effectively assess and care for laboring/birthing women and their newborn. Hard copies of this document are being printed and are expected to be delivered by the end of October to Emergency and Outpatient departments across the province. For more information please contact the RCP office: 902-470-6798.

More Cannabis Resources from SOGC – SOGC has been focused on promoting awareness about the risks of using cannabis in any form during pregnancy and while breastfeeding. In the days and weeks to come, they will be engaging Canadians using their social media channels. Their messaging encourages women to speak with their health care provider about the potential short and longer-term impacts that cannabis can have on their fetus and child. A number of resources have been developed to support care providers. Recognizing that women have been receiving mixed messages about the safety of cannabis in the media for many months, SOGC has prepared two documents to assist and support having these conversations in practice. The concerns highlighted are grounded in evidence and include references:

Patient Handout - What You Need to Know about Cannabis, Pregnancy and Breastfeeding

Provincial Cannabis Working Group Recording - In May the provincial Cannabis: Pregnancy, Breastfeeding and Parenting Working Group hosted a conference call for health care leadership and providers who work with pregnant women and young families. The call was planned in response to health professionals’ concerns expressed in anticipation of the changes to cannabis legislation. The purposes of the discussion were to:

  • provide an update on ongoing provincial work;
  • share provincial key messages such as:    
    • There is no known safe use of cannabis in pregnancy, breastfeeding and parenting; if you choose to use, use smaller amounts and less often (lower risk)
    • There is enough emerging evidence to be concerned and therefore we will be continually monitoring the research and surveillance, and updating staff based on any new or relevant recommendations;
  • review the 2 reference documents endorsed by the working group, and
  • provide an opportunity to navigate common questions and concerns that staff/providers are managing on a regular basis related to pregnancy, breastfeeding and parenting.

Most of the discussion is facilitated by 3 advanced practice nurses from the IWK: Dr. Glenda Carson, Cynthia Mann, and Brenda Hewitt, although the working group is a partnership between RCP, IWK, Public Health, and NS Mental Health & Addictions. 

The recording of this call is now accessible. Due to the nature of this technology you can hear people joining at various times, especially at the beginning, and so you may wish to skip past the introductory first few minutes to access the main discussion:

To listen to the recorded audio conference (toll-free Canada/US):      

1-800-408-3053 (when prompted, enter Passcode: 662913824#)

  • Instant Replay Controls:
  • Press 1 – Skip backward 5 seconds
  • Press 3 – Skip forward 5 seconds
  • Press 4 – Skip backward 5 minutes
  • Press 5 – Pause the playback
  • Press 6 – Skip forward 5 minutes
  • Press # or 0 – Return to the beginning of the conference
  • Press * – End the conference playback

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