Healthy mothers, healthy babies

Prenatal care is an important part of keeping mothers and babies healthy. The Partners in Inner-city Integrated Prenatal Care (PIIPC) project was designed to help connect pregnant women with prenatal care in their communities.

Dr. Maureen Heaman [BN/78, MN/87, PhD/01], professor in the College of Nursing and the principal investigator for PIIPC, has worked to improve maternal health her entire career. In her work she’s researched the risk factors for preterm birth in Manitoba women and found that lack of prenatal care is one of them.

Despite the importance of this service, Manitoba has regional variations in rates of inadequate prenatal care, with high rates in the inner-city communities.

 “We needed to target these areas for improvement and needed to find out why these women weren’t using prenatal care in these areas,” Heaman said.

Consulting with inner-city women, health-care providers and other stakeholders, data were collected on prenatal care and a steering committee was formed to come up with interventions to submit for a Canadian Institutes of Health Research (CIHR) grant.

Out of this funding the Partners in Inner-city Integrated Prenatal Care (PIIPC) project was born in 2012 with Heaman as the principal investigator and Lynda Tjaden from the Winnipeg Regional Health Authority (WRHA) as the principal knowledge user. The aim of PIIPC was to reduce barriers to prenatal care for pregnant women in inner-city Winnipeg.

The PIIPC project itself was a major interdisciplinary effort involving researchers, clinicians and representatives from the University of Manitoba; the WRHA; Healthy Child Manitoba; Manitoba Health; and Nanaandawewigamig – First Nations Health and Social Secretariat of Manitoba.

To help reduce barriers to prenatal care, the PIIPC project consisted of four health system improvement initiatives:

• Midwifery care was provided at Healthy Baby/Healthy Start community groups in the inner city.
• Enhanced outreach to pregnant women through Street Connections van
• Facilitated access to prenatal care was provided through Women’s Hospital and the midwifery program at Mount Carmel Clinic.
• A social marketing campaign was implemented to promote the importance of prenatal care and where to access services.

These four initiatives were designed to reduce some of the barriers to accessing prenatal care identified by inner-city women, including not knowing where to get care; long waiting times for appointments; lack of child care and having personal problems. Transportation was also a major barrier for some women.

“We really tried to be flexible to get women care,” Heaman said. “Providing bus tickets and taxi slips really helped because it’s a big barrier for lots of these women. The care providers were really aware of the issues these women were facing and were nonjudgmental, caring and took time to listen and that’s why the women kept coming back.” 

One of the ways to get the women coming back was through marketing the PIIPC project in the neighbourhoods where they lived.

“We had posters in bus shelters that mapped directions to the nearest spot to get prenatal care from that bus stop,” Heaman said. “We had pamphlets, a website and created a YouTube video, ‘This Way to a Healthy Baby,’ that got a number of hits.”

Recent evaluation of the PIIPC project has shown that the initiative reached most of the outcomes it set out to achieve. Across the board, outcomes for moms and babies improved, with participants in PIIPC starting prenatal care  earlier in their pregnancies and having more prenatal visits, as well as  having a reduction in babies apprehended at birth. 

“In a previous study we found over 95 per cent of the women were motivated to have a healthy baby but for some of the women there were a lot of barriers to seeking that kind of care so we tried to build on that motivation,” Heaman says.

The evaluation of the PIIPC project can be found here and the PIIPC Infographic here.

Marshall Wiebe