Mother with high-risk pregnancy transferred to Saskatoon
By Jodie Sinnema, Edmonton Journal December 4, 2010 A mother from the Peace River area with a high-risk pregnancy was transferred to Saskatoon on Thursday because all the appropriate hospital beds in Alberta were full.

Four newborns from the Royal Alexandra Hospital were also transferred to Grande Prairie with their mothers to ensure some neonatal intensive-care beds for higher-risk babies remained available for emergency cases in Edmonton.

"It is unusual," said Dr. Ernest Phillipos, regional director for newborn care in Alberta Health Services' Edmonton zone. "We have to keep some beds available so that we don't transfer out of province."

"In obstetrics, there are peaks of times when it's very busy and then there's other times when it's less busy," said Dr. Nan Schuurmans, Edmonton zone's regional director for women's health. Edmonton is the catchment area for high-risk mothers from places such as Yellowknife, N.W.T., and Fort St. John, B.C. No one is turned away, even during the annual baby boom that tends to take place in May and June.

"It's unusual to send someone out of province, but we have made allowances to do that if we have to," Schuurmans said.

"Mothers would rather stay as close to their home communities as possible, and mothers and babies should always, ideally, stay together. That is our goal to do that, but if for the safety of either the mother or baby we have to move them, then that's what we do because we put safety first."

The four babies from the Edmonton area no longer needed the highest level of care, or Level 3 beds, so they could be placed in Level 2 beds located in places such as Grande Prairie, Red Deer or Medicine Hat. Nine of 10 Level 2 beds in Grande Prairie are full. Edmonton's Grey Nuns and Misericordia hospitals also have Level 2 beds, but the Grey Nuns had 28 babies in a ward funded for 25 beds, and the Misericordia was caring for 11 babies and one open bed.

The woman from Peace River needed a high-risk obstetrics bed in a hospital that also had a neonatal intensive care bed for her newborn, just in case she had an early birth. But as of Friday morning, all 20 such high-risk obstetrics beds at the Royal Alexandra Hospital were full, as were the 11 at the Foothills Hospital in Calgary. Those are the only Alberta sites that have high-risk obstetrics.

All but two of the neonatal intensive care beds at the Alex were also full, and all but one at the Foothills. The 14 neonatal beds at the Stollery Children's Hospital were also full of premature babies.

Peace River has three regular obstetrics beds, and very ill or premature babies are always flown with a medical team to a big city hospital.

Schuurmans said there has been a steady increase in Alberta's birth rate over the past five years, with 41,560 babies born in 2005 and approximately 51,045 babies born in 2009.

There are also many more multiple births than in the past, Phillipos said, since older women are using fertility treatments to become pregnant. Twins and triplets are often born prematurely and need more intense hospital care.

In the past six weeks, seven sets of triplets have been born in the province, putting a squeeze on the health system by requiring 21 hospital bassinets with specialized staff for weeks at a time.

"Trying to predict the future is like trying to predict the stock market," Phillipos said. "It's stressful on us as a staff because we try to keep the moms closer to home."

He and Schuurmans said Alberta Health Services is reviewing how many more delivery, obstetrics and baby beds need to be added in the province to respond to the growing population in the coming years.

"You don't want to have so many beds that they're sitting empty and it's wasting precious dollars, but again you can't predict necessarily when the population is going to have a lot more babies," Schuurmans said.

"We do need to respond to that." Alberta Health Services has recently come close to sending other mothers over Alberta's borders. On Wednesday, the Royal Alexandra Hospital, which is funded to run 60 neonatal intensive-care beds, was overflowing with 65 babies.

That almost necessitated the transfer of a Fort McMurray mother with a high-risk pregnancy to Saskatoon, but she ended up in Calgary.

A provincial protocol, in which obstetricians, neonatologists and nursing managers work together, helps determine where and how to shuffle babies and mothers so each receives appropriate care.

During slower times in the past few months, local hospitals have also accepted high-risk mothers from B.C. and Saskatchewan.

"We help each other as provinces," Phillipos said.

Tom Noseworthy, a health-policy analyst on sabbatical from the University of Calgary, said transferring a pregnant mother out of province isn't necessarily a bad thing, as long as it doesn't happen often, which would indicate a trend in inadequate resources here.

"This is good medicine when they do that," Noseworthy said. "It really is not usual."

While such stories pull at the heartstrings since they involve babies, David Eggen, executive director of Friends of Medicare, said it's important patients of all types have access to quick, appropriate emergency care.

On Wednesday morning, for instance, Edmonton hospitals had 11 patients waiting in emergency stretchers for beds where they could be cared for by mental-health staff. One of the patients had been waiting three days.

Eggen said more obstetric beds are needed. A clinic in Brooks in southern Alberta reopened this past summer after two physicians were recruited to deliver babies. The clinic had been closed for more than a year, forcing mothers to head to Medicine Hat, which subsequently experienced a baby boom.

There, the birth rate soared 50 per cent in four years.

In early 2007, four women with high-risk pregnancies in the Calgary and Lethbridge areas were transferred to Great Falls, Mont., because Foothills Hospital's neonatal intensive-care unit was at capacity.

At approximately the same time, another five high-risk pregnancies from southern Alberta went to Edmonton, and a Lethbridge woman pregnant with triplets was sent to Toronto.

Officials blamed the full wards at Foothills on too few nurses and beds. Families said they were being financially and emotionally burdened by the transfers, since they didn't have nearby family support and needed to pay for accommodations and airfare.

Alberta Health Services is financially supporting the families of the mother and babies transferred this week.

jsinnema@edmontonjournal.com

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