The months following childbirth may be difficult for new parents caring for a new baby (or babies) while recovering from pregnancy and birth. Team-based maternity care draws on the strengths of interprofessional teams (physicians, midwives and allied health) to improve patient care and outcomes and is a current provincial priority in British Columbia (BC). Midwifery care provides frequent post-delivery contacts, at-home care, and on-call support during this critical postpartum period. There is a growing trend in BC towards informal team-based arrangements where midwives support mother-infant dyads after physician-attended birth. In other settings, up to 18% of postpartum individuals and 8% of newborns visited the emergency department in the postpartum 6-week period. We will examine whether interprofessional team-based partnerships in which midwives provide postpartum care is associated with hospital service use (emergency department visits, hospital readmissions), maternal or infant outcomes, and health system costs in British Columbia. Findings will inform knowledge users in health policy and system leadership positions by evaluating this aspect of team-based maternity care applied in the postpartum period.
Award Partner: BC Children's Hospital Research Institute
Understanding the challenges and opportunities in communicating vaccine risks and benefits to midwifery clients
Studies have shown that vaccinating pregnant mothers protects both mothers and children. Yet, recent surveys suggest that one third of Canadian parents are unsure about vaccinating. Mothers often decide how they feel about vaccines during pregnancy, and healthcare workers play an important role in helping them make these choices. More and more new parents in Canada choose to give birth with the help of a Registered Midwife (RM). Unlike other healthcare providers, RMs, following the guideline of Informed Choice, encourage their clients to make choices for themselves using the best available information. Because of this, some RMs feel that they should not make a strong pro-vaccine recommendation. This research project will focus on creating midwife training resources that are compatible with the model of Informed Choice. Using interviews with midwives, educators, and professional associations, we will develop tools for continuing education adapted to the RM profession. By better understanding the challenges midwives face when talking about vaccines, this study will help RMs enable their clients in BC and Canada to make better informed decisions about vaccination.
End of Award Update: October 2022
Most exciting outputs
Our research aimed to better understand how midwives discuss vaccination in pregnancy (and infancy) with their clientele. Through interviews with midwives and other professionals we learned more about vaccine conversations in pregnancies and some of the related challenges. We published research showing how Informed Choice conversations aimed to inform and empower pregnant people about vaccine decisions and described what changes could be made to better support midwives who discuss vaccination and provide vaccines to their clients.
Impact so far
We have created a vaccine communication training module with the Continuing Professional Development program at UBC, which is available in French and English to midwives across the country. Our team also published results from our interviews in international peer reviewed journals to reach a wide audience.
Potential influence
Hopefully, this research has shed light on how midwives are capable vaccine counsellors, with the training and expertise to engage and inform vaccine hesitant populations.
Next steps
This research is being continued by my colleagues at the Vaccine Evaluation Center at the BC Children’s Hospital Research Institute. Our team is continuing to collect data to develop and test a clinical intervention package that will provide communication tools like pamphlets and informative videos to be used in midwifery clinics in Canada.
Useful links
Protecting insulin-producing beta cell transplants from death and dysfunction
Diabetes is one of the most common chronic diseases among adults, children and youth. In 2008/09, the Canadian Chronic Disease Surveillance System reported 2,359,252 cases of diagnosed diabetes in Canada and a prevalence of 5.4% in British Columbia. Rates of type 1 diabetes (T1D) among children and youth have been on the rise globally. Poor control of diabetes leads to various complications such as cardiovascular disease, stroke, blindness and renal failure, resulting in a shorter and a reduced quality of life.
One of the major pathologies in diabetes is a deficiency of insulin, which is secreted from pancreatic beta cells. Patients with T1D require insulin therapy throughout their life because most of their beta cells are destroyed by autoimmune attack. Even through insulin treatment, reduced glycemic control makes complications and hypoglycemia-induced coma more likely.
Islet transplantation is a promising therapy for T1D that removes the need for insulin therapy. However, some limitations remain such as the supply of donor islets, the need for lifelong systemic immune suppression, and graft failure. Today, human embryonic stem cell (hESC)-derived surrogate beta cells are in clinical trials; however, it is likely that these cells will not be protected from immune attack.
Dr. Sasaki will generate CRISPR-Cas9-edited hESCs that can be differentiated to beta cells that express CCL22 in order to protect hESC-derived islet cell graft from immune attack. If this approach is successful, the results of this study will further the optimization of functional and immune-tolerant surrogate beta cells, which will help pave the way towards a cure for T1D.