The AMA provided services through the Reproductive Health Program in making continuous improvement in quality care, and in prevention and the promotion of wellness.
The Committee on Reproductive Care had two main purposes:
- To assess the quality care provided to pregnant women and their newborns
- To inform physicians, midwives, hospitals and others on trends and issues in reproductive care
This committee was mandated by a ministerial order to study the deaths of:
- Women during pregnancy, delivery or post-delivery
- Stillbirths, after 20 weeks gestation or a weight of 500 grams or more
- Newborns less than one month old
The AMA had provided these services regarding maternal deaths since1936 and reviewed stillbirths and newborn deaths since 1954.
The program worked in partnership with Alberta Health and Wellness, notably the Population Health and Surveillance branch. The program was jointly funded by the AMA and Alberta Health and Wellness.
As a testament to the success and importance of this program, look at the dramatic improvement in perinatal and maternal health over the past decades.
- In 1955, 25 babies died out of every 1,000 births.
- By 1998, baby deaths had decreased to 5.2 out of every 1,000 births - a five-fold improvement.
In terms of maternal mortality rates:
- In 1960, 4.9 women out of 10,000 died during pregnancy or giving birth.
- By 1998 maternal deaths had decreased to 0.8 per 10,000 births - again, a five-fold improvement.
The Committee on Reproductive Care had a broad and varied membership:
- Family and rural physicians, obstetricians, neonatologists (specially trained physicians that look after babies in neonatal intensive care), pathologists (who perform autopsies) and pediatricians
- Students
- Government representatives
- Other community representation
- The Alberta Association of Midwives
A subcommittee called the Peer Review Committee was responsible for the review of cases of maternal, stillbirth and newborn deaths, and operated under the Alberta Medical Evidence Act.
The Alberta Association of Midwives had also been invited to participate in the peer review process, as we believed they would bring a valuable perspective to the process.
One of the main focuses of the AMA Committee on Reproductive Care was quality assurance. In this capacity we:
- Reviewed cases and analyzed trends
- Conducted case reviews and analyzed trends
- Provided feedback to physicians, midwives and hospitals
- Identified quality care issues
- Collaborated with Alberta Health and Wellness to produce the Reproductive Outcomes Report. This report contained important information on birth rates, mortality rates and obstetrical interventions such as Caesarean section rates.
- Developed forms used by physicians, midwives, nurses and vital statistics. As a result we identified a trend of an increase in multiple births.
- Developed and implemented guidelines
Another way that the AMA Committee on Reproductive Care functioned was in an advisory role to a number of different groups. Two instances we worked with government in the:
- Newborn Screening Program
-
HIV Screening in Pregnancy Program
The results showed that 97% of pregnant women in Alberta were being screened for HIV. In the first two years of the program, 31 women were identified as HIV positive.This means we could get the necessary treatment to these women so that they could avoid transmission of the virus to their babies.
We have also developed a number of resources such as the:
- Stillborn Investigation Protocol, which deals with grief management for parents, and other topics
- Breastfeeding Resource Directory for Alberta
- Prenatal Care Plan
We were always working on several health promotion projects in addition to our other work. There are a few recent success stories including the Condom and Pill Project and the Fetal Alcohol Syndrome (FAS) Partnership.
In partnership with Health Canada, we created and implemented a very successful condom and pill education project. Health Canada and the Canadian Medical Association explored how this might be implemented Canada-wide. The program has already been implemented by community health programs in Ontario and Quebec.
We have also been a major player in the Fetal Alcohol Partnership. With additional funding through the partnership we:
- Conducted a physician needs assessment on fetal alcohol syndrome, a survey that has been adopted for use across the country by Health Canada
- Developed the FAS clinical practice guidelines which have been adopted by the FAS Prairie Partnership and in parts of eastern Canada
- Trained physicians on prevention and harm reduction
- Trained physicians how to develop a fetal alcohol syndrome diagnosis teams in four regional health authorities: Calgary, Capital, Lakeland and David Thompson
- Facilitated training of staff in youth offenders centres, a joint effort with the department of justice
Other major accomplishments:
- Our program was viewed as a provincial resource on reproductive health issues.
- We were nationally recognized for the high quality of our statistics and program materials.
We are very proud of the strong, positive partnerships that we created and maintained through all our work with other health care professionals, other committees and various levels of government.
We believe that the program's quality assurance activities were essential to ensure that high quality reproductive health care were being provided to Albertans and that in monitoring these activities we had the opportunity to alert the minister and other key stakeholders of issues that needed to be addressed.
October 16, 2001 presentation to SPC Committee on Health and Community Living
Grace Guyon, Manager
Reproductive Health & Special Projects, AMA