Place of Residence,

Prenatal Care & Neonatal Outcome

in Northern Canada
Presenter: Bryany Denning, M.Sc. 1,2,3 Supervisors: Duncan Hunter , Susan Chatwood 1 2

(1) Queen’s University, Kingston, Ontario (2) Institute for Circumpolar Health Research, Yellowknife,
Courtesy of Mary Carothers, Fort Smith Health & Social Services
Northwest Territories (3) Public Health Officer, Public Health Agency of Canada
Midwifery Program

Characteristics of the Prenatal Care Provision in Transfer

Birthing Services in the Yukon, Northwest Territories and Nunavut Study Population and Non-Transfer Groups
Transfer Status Transfer Status
Hospital Transer Non-Transfer
Transer Non-Transfer
Midwifery services n % n % n % n %
Communities (<1000 population) Territory Type of Health Care Provider
without birthing services Northwest Territories 32 36.4 55 39.0 OB/GYN - - 12 8.5
Towns (>1000 population) Nunavut 46 52.3 35 24.8 Doctor 21 23.8 101 71.7
without birthing services Yukon 10 11.4 51 36.2 Midwife 9 10.2 - -
Nurse or Nurse Practitioner 54 61.4 22 15.6
Maternal age at birth
15 to 19 years 11 12.5 13 9.2 Same care provider
Inuvik 20 to 24 years 27 30.7 21 14.9 for pregnancy and birth
25 to 29 years 28 31.8 45 31.9 Yes 21 25.0 84 59.6
30 to 34 years 12 13.6 40 28.4 No 65 73.9 55 39.0
Cambridge Bay 35 to 39 years 6 6.8 20 14.2
YUKON NORTHWEST Prenatal Care received as
40 years and over - - - -
TERRITORIES NUNAVUT Iqaluit early as wanted
Whitehorse Education level Yes 70 79.5 120 85.1
˛ Less than high school 33 37.5 32 22.7 No 14 15.9 20 14.2
˛
Yellowknife High school 20 22.7 31 22.0
Rankin Inlet Post-secondary degree of diploma 32 36.4 76 53.9 Attended Prenatal Classes
Fort Smith Yes 31 35.2 53 37.6
Courtesy Rajiv Rawat Partner status No 55 62.5 86 61.0
Partner 70 79.5 118 83.7
Setting No Partner 16 18.2 20 14.2 Number of Prenatal Visits
10 or more 51 57.5 104 73.8
In the three northern Canadian territories, prenatal care and birthing Household Income <10 37 42.0 37 26.2
<$30,000 24 27.3 31 22.0
options vary widely. Large centers tend to have comprehensive services $30,000 to <$60,000 19 21.6 24 17.0 Gestational age at start of prenatal visits
with a combination of Nurse Practitioners, Midwives, GPs and OB/GYNs $60,000 to <$100,000 20 22.7 39 27.7 10 weeks 11 12.5 8 5.7
>$100,000 - - 32 22.7 Before 10 weeks 77 87.5 133 94.3
providing care. Smaller communities tend to be staffed exclusively by Nurse Missing 21 23.9 - -
Practitioners, Nurses, or Community Health Representatives, and birthing
services are provided by transferring women to larger communities at 37 Aborignial Status
At least one Aboriginal Identity 67 76.1 53 37.6
weeks gestation. At present, only seven communities have birthing services; No Aboriginal Identity 16 18.3 82 58.2 Neonatal Morbidity
all pregnant women residing outside these communities are required to leave
Maternal Smoking For the purposes of this study, neonatal morbidity was
their home communities at 37 weeks gestation to give birth in a larger centre. Ever 45 51.1 34 24.1
Never 43 48.9 107 75.9 considered present if the infant was considered to be low birth
Background weight (<2500g); high birth weight (>4500g); preterm birth
Frequency of alcohol consumption (less than 37 weeks); admission to an intensive care or special
Neonatal outcomes have been linked in the literature to the availability, during pregnancy
Ever 5 5.7 13 9.2 care unit at birth; and readmission to hospital during the first
quality, and continuity of prenatal care (1-7), though the mechanism Never 80 91.0 126 89.4 five months of life.
through which this relationship operates, and how prenatal care interacts
Use of street drugs while pregnant
with other risk factors, are still unclear. In the north, coordination of Ever - - - - Table 3. Risk of Neonatal Morbidity
maternal health services and transfer for childbirth is yet another factor that Never 80 90.9 138 97.9
Neonatal Morbidity
impacts both availability and continuity of care, and in turn, may exaggerate OR 95%CI CV
Abusive incidents during pregnancy
poor outcomes. Yes 8 9.1 8 5.7 Transfer for Childbirth 1.92† 1.29-2.84 30.9
No 80 90.9 132 93.6
Women who are transferred for childbirth have to travel hundreds of Territory
kilometers, spend a month or more away from their homes and families, Maternal Parity Northwest Territories 49.3
Multiparous 61 69.3 87 61.7 Nunavut 3.32† 2.12-5.19 19.0
and give birth without their spouse, friends or family present: the social, Primiparous 18 20.5 39 27.7 Yukon 1.00
economical and psychological effects of this practice have been examined in
Maternal Obesity
qualitative studies (8-12). Obese 11 12.5 25 17.7 † Coefficient of variation between 16.6% and 33.3%
Not obese 77 87.5 116 82.3 F Coefficient of variation above 33.3%, data suppressed
Objectives
This study was designed to explore and describe the experiences of women
living in remote regions. Information on residency was not available thus Applications for clinical services, research programs and policy
transfer status was used as a proxy for women who live in small communities
and are dependant on being transferred for comprehensive perinatal care. • Programs designed to coordinate birthing services, such as the Stanton Northern Women’s Program, and community based
birthing services, also require ongoing evaluation and promotion as viable models to support birthing experiences in remote
Methods regions.
• Prenatal guidelines and education programs needs to be informed by evidence and the unique demographic characteristics of
The Maternity Experiences Survey 2006/2007 the northern regions of Canada.
The data source for this study was the Maternity Experiences Survey • Perinatal databases need to be developed and established in northern jurisdictions to support evidence-based decision making.
• Comprehensive research programs that include partnerships with clinicians, policy makers and researchers will improve
2006/2007. The survey was conducted by the Maternity Experiences Group,
the relevancy of programs and services in northern populations.
under the Public Health Agency of Canada’s Canadian Perinatal Surveillance
System and in partnership with Statistics Canada, in order to capture the
perceptions and behaviours of women surrounding pregnancy and birth.

The variables to be examined in this study were analyzed at the provincial

and territorial level by the Maternity Experiences Group, and a report was Conclusions References
published outlining the study findings. From this report, we are able to • Women living in communities where transfer for childbirth is 11. Healthy
H lthh People
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territories, and the average responses in Canada as a whole. and health risk factors for poor neonatal outcomes.
• Women living in communities where transfer for childbirth is
Study Population
mandatory also reported fewer prenatal visits, a later initiation
of prenatal visits, and less continuity of care provider.
Respondents to the Maternity Experiences Survey who responded “Yukon”
“Northwest Territories” or “Nunavut” to the question “Where did you
• Women living in communities where transfer for childbirth is
receive the majority of your prenatal care?” This question was used to select mandatory had more outcomes indicative of neonatal morbidity.
study participants in order to avoid inappropriately including women who This could be related to the higher prevalence of risk factors
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of their pregnancy, or women who had moved to a new province or territory
after the birth of their child, as the responses of these women may not be
representative of someone receiving prenatal care in northern Canada.
Discussion
within this group rather than the reduced access to prenatal
care; however, more access to prenatal care services may also be
helpful in mitigating the effects of the risk factors present.
Acknowledgments: Thank you to the Research Council
of Norway for their assistance in attending IPY Oslo.
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