Postpartum Implementation Guidelines for the Healthy Babies, Healthy Children Program
Table of Contents
The purpose of the Implementation Guidelines is to support Boards of Health, MCSS Regional/Area offices, and networks of service providers to plan and implement the Healthy Babies, Healthy Children Postpartum Enhancement, announced by the government of Ontario in March, 1999.
The Healthy Babies, Healthy Children Postpartum Enhancement seeks to achieve a continuum of care from the hospital to the community for all mothers and newborns. All mothers will receive a telephone call within 48 hours of their day of discharge from hospital with the offer of a follow-up home visit. This announcement also included the provision of funds to hospitals to allow all mothers the option of staying in hospital for up to 60 hours after a normal birth for assessment, support, and follow-up purposes.
The Healthy Babies, Healthy Children Postpartum community follow-up described above is the acceptable level of community follow-up for mothers with a hospital length of stay of 60 hours. While all mothers will have access to this community follow-up, a more intensive community follow-up may be necessary for mothers who choose a hospital length of stay of less than 60 hours. It is essential that all postpartum follow-up activities be integrated to ensure a continuum of services for families.
The addition of the postpartum component to Healthy Babies, Healthy Children is based
on recognition of the following :
- All parents, and their children, will benefit from additional information about parenting and linkages to community programs that support parenting. The birth of a child provides an opportunity to offer information about parenting, as it is a time when parents are receptive to information to help them deal with the change that is taking place in their lives.
- The transition for mother and newborn during the first few weeks following birth is a time of significant physical, emotional, and psychological change.
- Families will benefit if the existing range of community programs and services that support parents and infants are provided in a more universal and integrated manner.
Healthy Babies, Healthy Children is a prevention/early intervention initiative intended to
improve the well-being and long term prospects of children.
The overall vision for the Healthy Babies, Healthy Children program is that :
- Every child (prenatal to age six) in Ontario will be provided with opportunities toachieve his/her optimal potential.
- Every child in Ontario will have access to effective integrated programs and services that support healthy child development.
The goal of the postpartum component is twofold : that every mother and newborn in Ontario will be provided with the support they need in order to make a healthy adjustment in the first few weeks of life; and that all families will have access to parenting information and parenting support that is responsive to their needs.
The knowledge that a safe and nurturing environment, adequate nutrition, and secure
mother-infant attachment is linked to early neurological development and the recognition that all families benefit from parenting information and support, connect the goal of the postpartum component to the overall vision of Healthy Babies, Healthy Children.
- The postpartum component of Healthy Babies, Healthy Children provides universal support and access to services for all families immediately following the birth of a child.
- The postpartum enhancement builds on and supports the existing principles of Healthy Babies, Healthy Children.
- The goal of the postpartum component is achieved by building on existing services while avoiding duplication of service.
- The postpartum enhancement is integrated with other components of Healthy Babies, Healthy Children so that continuity of care is achieved for all families.
The postpartum component supports the attainment of the expected outcomes of Healthy Babies, Healthy Children :
- Improved child health and development.
- Increased parenting confidence and knowledge.
- Decreased parental stress and increased parental support.
- Increased family integration into the community.
- Increased integration of programs and services that support healthy child development.
Although Boards of Health have the lead responsibility for the postpartum component they will work with hospitals, midwives, community care access centres, physicians and other community partners across the health and social services sectors to implement the postpartum component of Healthy Babies, Healthy Children.
Boards of Health will be accountable for ensuring collaborative planning to implement the postpartum community follow-up. Public health units will need to consult with hospitals, other public health units, and other health and social service providers for this collaborative planning. The Implementation Working Groups referred to in the Healthy Babies, Healthy Children, Phase 2 Implementation Guidelines should be utilized in planning the postpartum component.
Within this collaborative planning process, different organizations will have lead responsibility for specific aspects of the postpartum component of Healthy Babies, Healthy Children :
- Public health units and hospitals are jointly responsible for identifying a process that ensures public health units receive notification of all births from hospitals and receive this notification in sufficient time to allow for contact with the mother within 48 hours of the day of discharge.
- Public health units are responsible for ensuring that all mothers are contacted within 48 hours of their day of discharge from hospital, and that all mothers are offered a home visit.
- The Healthy Babies, Healthy Children Postpartum component and guidelines have been established based on what is an acceptable level of community follow-up for mothers with a hospital length of stay of 60 hours. In cases where the mother chooses a hospital length of stay of less than 60 hours, a more intensive community follow-up may be necessary. Public health units and hospitals are jointly responsible for ensuring appropriate community follow-up protocols are in place for mothers who chose to be discharged from hospital with their newborns when their length of stay is less than 60 hours. The integration of all postpartum follow-up activities is essential to ensure a continuum of services for families.
- In cases where public health units receive notification of birth for families that reside outside their jurisdiction, the two public health units involved are jointly responsible for establishing a procedure that ensures the appropriate public health unit is notified of the birth in sufficient time to allow for contact with the mother within 48 hours of discharge. The public health unit receiving the information from the hospital is responsible for ensuring that the information gets to the appropriate public health unit
- Boards of Health, MCSS Regional/Area offices, and the Implementation Working Groups are jointly responsible for providing a range of health and social services that support families in the postpartum period.
- To receive funding for the Postpartum Enhancement of Healthy Babies, Healthy Children, Boards of Health are responsible for developing and submitting an implementation plan. The Office of Integrated Services for Children will provide a template for the implementation plan. Each year, Boards of Health will also be asked to submit plans that include all components of Healthy Babies, Healthy Children to The Office of Integrated Services for Children.
Refer also to the Roles and Responsibilities in the original Healthy Babies, Healthy
Children Implementation Guidelines (page 19).
Public Health units are notified of all births in their jurisdiction by the hospital or midwife through the use of the Postpartum Screening Tool. All screens are forwarded to the health unit regardless of the score, providing informed consent to do so has been obtained from the mother. Additional information will be collected at the time of completion of the Postpartum Screening Tool so that health units can be advised of relevant postpartum information.
In situations where the mother does not consent to the Postpartum Screening Tool being forwarded to the Public Health unit, separate consent may be sought by the hospital or midwife to forward identifying information only, which will permit the Public Health unit to make contact with the family.
- All mothers are contacted within 48 hours of the day of their discharge from hospital. When the birth has been attended by a midwife, the midwife is responsible for informing the family of the opportunity to have contact with a public health nurse, including a home visit.
- When the attempt to reach the family by telephone is unsuccessful, the public health nurse uses local protocols to determine what steps are taken in attempting to make contact with the family.
- A postpartum telephone assessment is carried out by a public health nurse who is skilled and experienced in maternal/newborn care. The current brief assessment will be modified to reflect that it is both an assessment of postpartum adjustment as well as an aid in determining the family’s level of risk.
- As a result of this telephone assessment, the public health nurse may identify families with scores less than 9 from the Postpartum Screening who are at high risk and should have the In-depth Home Assessment completed. Conversely, the telephone assessment may reveal that families with scores equal to or greater than 9 are not at high risk.
- All mothers are offered a home visit in a manner that invites participation in the program.
- The timing of the home visit is determined by the public health nurse and the mother, and is based on the results of the telephone assessment or on protocols established between the hospital and the public health unit.
- The home visit is carried out by a public health nurse who is skilled and experienced in maternal/newborn care.
- The in-depth assessment, for those families whose score on the Postpartum Screening was equal to or greater than 9 or who were identified as high risk during the telephone contact, is initiated during this home visit with families where the public health nurse is or will be the primary professional service involved.
- For those families where the primary professional is from another service agency, the public health nurse does not initiate the in-depth assessment.
- The telephone contact includes assessment questions related to :
- the mother’s physical health, nutritional status, breast care, parenting, support systems, emotional health, medical supervision and other determinants of health;
- the infant’s feeding and nutrition, general health status, infant care, and medical supervision, and
- the health and well-being of other family members, and their adjustment to the new baby.
- Some families may not want a home visit from the public health nurse. In this case, the mother is provided with information on community resources that support parenting, (e.g. breastfeeding clinics, infant parenting groups, parenting centres), and with the Healthy Babies, Healthy Children telephone number.
- Care is family centered, individualized, and culturally sensitive. It is based on the family’s strengths, the age of the infant, and the supports available to the family.
- The visit includes, but is not limited to, an assessment of the following areas. The intensity of the assessment will vary depending on the age of the infant or on protocols that exist between the hospital and the public health unit :
- infant feeding and hydration
- the infant for jaundice and other abnormalities
- the mother with regard to her physiological recovery following delivery
- the mother’s confidence in basic baby care
- the mother-infant interaction
- the mother’s emotional health and adjustment
- the safety of the home environment
- parenting knowledge and parenting capacity
- the level of parenting support available
- family relationships and family adjustment to the new baby
- the health and development of other young children in the family.
- The visit includes, based on the above assessments, the appropriate teaching, nursing interventions, and/or referrals.
- When further service is required with respect to maternal and newborn postnatal adjustment, this is provided either through continued public health nursing involvement or through linkage with other services.
- The linking of families who are appropriate for the other service components of Healthy Babies, Healthy Children is achieved through a seamless service approach.
- All parents are provided with information on parenting and linked to community services that support parenting: e.g. infant parenting classes, breastfeeding clinics, parent drop-in centres.
- The family’s plans for future health care are reviewed. These plans should include the evaluation of the infant by their physician or other primary care provider, which under normal circumstances takes place within 5 to 7 days following the birth. These plans should also include the postpartum evaluation of the mother by their physician or other primary care provider, which under normal circumstances takes place within 6 weeks of the birth.
The postpartum component of Healthy Babies, Healthy Children is meant to be offered to all mothers and newborns in Ontario. Therefore, Boards of Health, in partnership with First Nations communities and Aboriginal organizations, must include the postpartum component in the joint planning process that is already taking place with respect to delivering the other components of Healthy Babies, Healthy Children. An appropriate model that ensures all mothers are contacted and offered a home visit needs to be developed in a way that meets the needs of families in First Nations communities. For example, public health units might consider contracting to health centres in those First Nations communities that have health centres; links with Medical Services Branch might be considered for fly in communities.
OISC will develop and implement a training program to respond to the initial training needs of program staff. OISC will provide ongoing support and consultation to the field on all components of Healthy Babies, Healthy Children.
The provincial evaluation of Healthy Babies, Healthy Children will include the evaluation of the postpartum component. Outcomes specific to the postpartum component will be identified in the evaluation.
Boards of Health will be required to report financial and statistical data related to the provision of the postpartum component.
July 30, 1999 : Public health units to submit local implementation plans.
August 25, 1999 : OISC review and approve local implementation plan.
August 30, 1999 : OISC advise public health units of the results of review and
approvals; adjustment to funding as necessary.
October 1, 1999 : Implementation of the Postpartum Enhancement of Healthy
Babies, Healthy Children