Mothers and their babies share a deep bond. It’s a connection new research shows actually begins during pregnancy and is so powerful that it can influence a child’s future well-being. This discovery is incredibly important, especially for mothers grappling with drug addiction, homelessness or trauma. For them, these stressors can disrupt normal maternal bonding, leading to a cycle of vulnerability that can last for generations.
Now, a new study led by Dr. Ron Abrahams (pictured right), director of BC Women’s Fir Square Combined Unit, is seeking to show how regular ultrasounds can be used to break that cycle by helping women struggling with substance use connect with their unborn babies.
Breaking the cycle
As a young general practitioner, Abrahams routinely saw women recovering from drug addiction have their babies removed from their care immediately after birth – a practice he found totally unacceptable. In 2003, to address the needs of these women, Abrahams established BC Women’s Fir Square Combined Unit, the first program of its kind in Canada dedicated to keeping moms with their babies as they stabilize and withdraw from substance use.
In a groundbreaking study currently underway at Fir Square, Abrahams and his team are using bi-weekly ultrasounds to help patients connect with their unborn babies and feel more positive about their pregnancies. Abrahams believes that the comfort and connectedness the mother feels when she sees her baby is then communicated to the baby itself. He also believes that seeing the baby helps influence the mother to make healthier choices.
“When the women first see images of their fetus, they walk around the ward, saying ‘Look at my baby, you can see his hand, see his face.’ Clearly, the last thing on their minds at that moment is using drugs,” says Abrahams.
Abrahams is currently evaluating the results of this study in hopes of developing the use of ultrasound among vulnerable expectant women as a standard of care across Canada.
The early results are certainly encouraging. “The focus switches from self-medicating and trauma to their babies and themselves, as well as to going back into the community,” says Abrahams. “If something as simple and accessible as regular ultrasounds can help facilitate this process, we should use it."
When Dr. Buhler enthuses about going mobile, she's not taking about her cell phone. Her goal is to make "mobile" fetal monitoring during labour available to any woman who needs it.
Instead of being tethered to a large, static fetal monitor, the labouring mom wears a waterproof wireless device that continuously transmits information about the baby’s heart rate and the strength of her contractions to a central monitoring station. The maternity care team can keep a close eye on her progress, but she is free to get out of bed, move around or take a soothing bath.
“Changing positions is the first comfort measure that a woman instinctively chooses,” Dr. Buhler says. “Care providers know that being mobile and active reduces complications, shortens labour and helps with pain control.”
She notes that mobile monitoring helps women at higher risk to have a better chance of having a normal birth. The concept is backed up by research showing that staying upright and mobile helps labour progress, decreasing the need for interventions like forceps deliveries or Cesarean sections.
As well as induction, one of the most common reasons for monitoring during labour is the administration of epidural anesthesia. Mobile monitoring is a good fit with the innovative “walking” epidurals that are provided by the Department of Anesthesia at BC Women’s.
With BC Women’s fully equipped with telemetry, 5,000 women a year will have access to mobile monitoring – a plus for women and their caregivers - at the same time promoting normal labour and birth. Dr. Buhler concludes. “a woman doesn’t have to sacrifice the comfort of moving around or being in the bath for the sake of monitoring the baby. Now we get to have the best of both worlds: technology and nature are in harmony here.”
Written by Anne MacLaughlin
After years in Obstetrics, Gynecology, Psychiatry, and Psychology, Dr. Brotto has become a leading expert in women’s sexual health and well-being. As Executive Director of the Women’s Health Research Institute, she leads collaborative women’s health research at BC Women’s, PHSA, UBC and other partner universities. Together, these teams of researchers are investigating and
advancing women-centred healthcare in British Columbia and beyond.
“When women are healthy, all of society benefits. When we study societies where women are not healthy, it is immediately evident that many different aspects of those societies suffer.” says Dr. Brotto.
“Without research, excellent healthcare is simply not possible.”
We are so grateful for the devotion, commitment, and innovation of all the researchers working behind the scenes
to transform healthcare for women and their families.
Dr. Michael Farmer obtained his MD degree at the University of British Columbia in 1988 and after six months as a resident in Obstetrics and Gynecology, found his niche in Family Practice, with a high-volume maternity care practice. He has been on Active Staff in the Department of Family Practice since 1990 and has done well over 2500 deliveries in that time. In fact, he has now delivered six second-generation babies!
As a Clinical Assistant Professor in the UBC Faculty of Medicine, Dr. Farmer is very involved in resident training for the Family Practice and Obstetrics programs. He also teaches Obstetrics to 3rd and 4th year undergraduate medical students, as well as midwifery and nursing students.
In addition to his administrative roles at BCWH, Dr. Farmer manages a busy clinical practice and shares in on-call services with the Family Practice Maternity Service as well as providing on call services to BC Women’s Youth Pregnancy and Parenting Program (YPPP), BC Women’s Perinatal Addiction Service (PAS) and BC Women’s Doctor of the Day (DOD) service.
Now that his two children are grown and away at university he has more time to spend with his volunteer medical work. Dr. Farmer was working in Haiti within days of the massive earthquake happening and in October will once again be travelling with 40 other volunteer doctors and nurses to work in Guatemala with Health for Humanity.
Dr. Farmer is a food and wine connoisseur and his passion is travelling. This year he and his partner visited their 78th country, and next on the list are India and Sri Lanka.
With one in nine women at risk for developing breast cancer, Dr. Paula Gordon knows her work as Medical Director of the Breast Program at BC Women’s Hospital is on the frontlines of saving women’s lives. An award-winning teacher, researcher and visionary, it is a task for which Gordon and her team are well equipped through the Sadie Diamond Breast Health Imaging Centre at BC Women’s and its state-of-the-art tomosynthesis mammography. “The key to saving lives is finding breast cancer early,” affirms Gordon, “because that’s when most types of breast cancer are highly treatable.” Tomosynthesis, which takes high-resolution images from multiple angles and then combines them into 3-D images, represents a dramatic step forward in breast imaging. “In many cases, the initial mammograms are conclusive, reducing the need for additional images,” says Gordon, She’s excited that BC Women’s will be soon begin a trial of screening with this exciting technology. Dr. Gordon’s work recently earned her the prestigious Order of BC, and lead to her being selected as one of Canada’s 100 Most Powerful Women. She remains a tireless proponent of regular mammograms and providing women with access to high-quality examinations. For Gordon, it’s more healthy, breast-cancer-free women that will be the living proof of her program’s success.
Written by Ann Collette
Photography by Karolina Turek
Dr. Deborah Money, Vice President of Research at BC Women’s, routinely researches the unexplored frontiers of medicine in search of better treatments for her patients. A world-leading expert in infectious diseases in obstetrics and gynecology, her research into using anti-viral drugs to prevent the transmission of HIV from mothers to babies has reduced transmission rates to less than 1%. Money, in collaboration with Dr. Gina Ogilvie and Dr. Sheona Mitchell, is currently developing a model for widespread HPV vaccination and screening in BC using simple test kits as part of a global effort to eradicate cervical cancer. “The kits allow women living in rural areas to screen for HPV and cervical cancer quickly – without the expense of travelling to major centres.” Money also sees tremendous potential for her study of microbiomes – communities of microorganisms living in the human body that hold the key to both health and disease. “We’re close to being able to profile the ideal microbiome, understand when it’s disrupted and ultimately start trialing new therapies.” Money is also working on the leading edge personalized medicine – a microbiome gene mapping effort that could help doctors customize the most effective treatment for each patient. “That’s the future,” says Money, “and I’m proud to play a role in ensuring BC Women’s Hospital continues to contribute to this life-saving global effort.”
Written by Ann Collette
Photography by Ian Durning
BC Women’s Oak Tree Clinic is putting a fresh spin on making “house calls.” Where a house call used to involve visiting patients in their homes, Dr. Melanie Murray and her colleagues now “call on” their most vulnerable patients using regular texts and phone calls. It’s all part of WelTel, a BC Women’s pilot project and UBC grant study funded by Gilead Sciences and Bristol- Myers Squibb aimed at enhancing medication adherence and overall healthcare for women and families living with HIV/AIDS.
Staying the course
“Problems with treating HIV and AIDS often centre around people’s engagement in their own care and our ability to contact them,” says Murray, an infectious diseases specialist in HIV care at Oak Tree Clinic. “There are patients out there who feel completely alone, so just having someone text them once a week and ask, ‘How are you?’ can be enough to make them feel connected.”
“There are patients out there who feel completely alone, so just having someone text them once a week and ask, ‘How are you?’ can be enough to make them feel connected.”
Overcoming the stigma
Today’s treatments for HIV are very successful when patients practise good adherence to their medications. Unfortunately, for many patients, the stigma and stress of living with HIV can derail taking daily meds. To help address this problem, part of the WelTel program involves sending out regular texts to support patients between appointments.
“People will often avoid coming to their appointments if they’re ashamed or embarrassed because they’re not taking their medications,” says Murray. “The WelTel program is a kind of string we can use to pull them back in and to make them feel that somebody cares.”
Patients taking part in the first phase of the WelTel program receive regular Monday morning text messages to check in and see how they are doing. A researcher monitors the responses, and then relays any potential problems to medical professionals who then contact patients directly.
“Checking in with patients on a regular basis provides an opportunity for them to let us know if they’re having problems,” observes Dr. Deborah Money, VP Research at BC Women’s. “The sooner we know patients are struggling, the sooner we can apply solutions to help prevent any serious complications from progressing.”
Money adds that the WelTel approach to patient engagement may also be a promising tool in stemming the spread of AIDS.
“The Seek and Treat for Optimal Prevention of HIV/AIDS initiative (STOP AIDS) is focused around knowing a person is HIV-infected and having them be willing to take medications and successfully stay on medications,” says Money. “If WelTel is as successful as it promises to be, then it will be a vital tool in the population-wide roll out of STOP AIDS.
While the current focus of WelTel is HIV/AIDS care, Money feels this model of patient engagement and support could readily be adapted and applicable to caring for people with other chronic conditions, such as diabetes, heart disease, arthritis and even dementia.
TELUS has recently become an important supporter of the WelTel program in the Oak Tree Clinic at BC Women’s Hospital. Once again, TELUS has stepped up to meet the unique healthcare needs of BC’s women and families. With the help from this generous, leading philanthropic company, doctors and patients will be better connected.
For now, the WelTel program will stay sharply focused on providing women and families currently living with HIV with continuous encouragement, caring support and a direct line to help when it’s needed.
Dr. Gina Ogilvie, Canada Research Chair in Global Control of HPV-related Disease at UBC and Senior Advisor + Assistant Director of the Women’s Health Research Institute at BC Women's Hospital, says she and her colleagues may be nearing a monumental breakthrough in women’s health – the global eradication of cervical cancer. "We have the possibility to head down that road, which is really exciting," says Ogilvie. New understanding of human papillomavirus (HPV) in the development of cervical cancer has led Ogilvie, an international expert in cervical cancer prevention and early detection research to conduct the groundbreaking new HPV Focal study which may lead to changes to cervical cancer screening approaches in the future. Ogilvie also leads the ASPIRE Project (Advances in Screening and Prevention in Reproductive Cancers) in Uganda, which provides women and health-care providers with an affordable, integrated cervical cancer screening kit – an initiative that saves thousands of women’s lives in the developing world. The system also provides an alternate screening option for Canadian women living in remote communities or otherwise unable to undergo a pelvic examination making this a truly global initiative. The work of Ogilvie and her team has gained a stellar reputation in this field, with BC Women’s a major player.
Written b y Ann Collette
Photography by Ian Durning
As a diagnostic radiologist with BC Women’s Hospital’s Diagnostic Ambulatory Program and clinical professor of radiology at UBC, Dr. Denise Pugash has devoted her career to conducting groundbreaking research. “The focus of my work is using real-time, high-resolution ultrasound and MRI to study fetal brain development,” says Pugash, “I’m pushing imaging to its limits.” Pugash is a world leader in using ultrasound to detect serious conditions affecting babies in-utero such as fetal infection and spina bifida. Pugash’s singular skill makes early diagnosis and treatment of these conditions possible – saving babies’ lives. Recently, the Canada Foundation for Innovation, together with the BC Knowledge Development Fund, awarded $1.655 million to PRIME (Perinatal Research IMaging Evaluation) to study advances in ultrasound technology in maternal and infant health, led by Pugash at BC Women’s Hospital. “PRIME will be a centre for imaging-based research, and training using advanced obstetrical ultrasound simulation.” Pugash’s program will guide the next generation of world-class diagnostic imagers, saving even more lives.
After completing a clinical fellowship in Reproductive Imaging at the University of British Columbia in 2002, she served as the Medical Director for the Reproductive Medicine Program at BC Women's Hospital + Health Centre from 2005 to 2013, which includes the Early Pregnancy Assessment Clinic and the Recurrent Pregnancy Loss Clinic. She is currently a Clinical Assistant professor in the Department of Obstetrics and Gynaecology at the University of British Columbia, and maintains a University affiliated private practice. Her interests involve a variety of women's health issues such as recurrent pregnancy loss, early pregnancy and gynaecologic imaging.
Photography by Ian Durning
For obstetrician/gynecologist Dr. Dorothy Shaw, advancing maternal and newborn health has long lit the path of her distinguished career. As VP Medical Affairs at BC Women’s Hospital, Shaw applies her expertise to mentoring new medical leaders. Shaw is also a driving force behind a team-building and skill development initiative at BC Women’s designed to improve communication and streamline processes for care teams and involve patients. “Clear, respectful communication across all care team members is critical to reducing complications,” says Shaw, whose staff practise team-based communication using simulation technology. “We know that saving steps is critical when you have a baby or mom in trouble where seconds can count.” Shaw, former president of the International Federation of Gynecologists and Obstetricians, recently served as inaugural chair of the Canadian Network for Maternal Newborn Child Health, bringing together more than 100 Canadian organizations with global ties to find ways to reduce preventable deaths in women and newborns. “Every time we get together magic happens,” says Shaw proudly. “It’s gratifying to see how our collaborative work is making a difference to women and families not just here at BC Women’s, but worldwide.”
Written by Ann Collette
Photography by Robert Lyons
For 18 years, Dr. Wee Shian Chan has single-mindedly pursued her passion – researching and treating medical complications in women. In that time, Dr. Chan has amassed expertise in an extraordinary range of women’s health issues and has become one of the world’s preeminent authorities on thrombosis in pregnancy. Now, as Head of BC Women’s Department of Medicine, Dr. Chan is advancing health care for women – from maternity to maturity. “BC Women’s is primed to take a leadership role in women’s health across Canada,” says Dr. Chan. “I see one of my roles as being able to harness the collective strength of all our physicians’ expertise here and work together as a team to provide the very best care for women throughout their lives.” As a clinician and also the Lead of BC Women’s Obstetrical Medicine Group, Dr. Chan will continue her research and clinical practice in the diagnosis and treatment of deep venous thrombosis and pulmonary embolism in pregnancy – the leading preventable cause of maternal death as well as in other areas relating to reducing maternal morbidity and mortality.
“My passion for research, teaching and clinical care comes from my desire to help patient navigate through pregnancy as seamlessly as possible, one-at-a-time” says Dr. Chan. “My greatest joy is to be able to do this with my heart in charge.”
Written by Ann Collette
Photography by Robert Lyons