In many rural and First Nations communities, accessing prenatal expertise is difficult and sometimes impossible. The Maternity and Babies Advice Line (MaBAL) is changing that.
The Rural Coordination Centre of BC’s MaBAL pathway is an innovative program that is helping to close the health equity gap for rural patients.
The pathway, part of the Real-Time Virtual Support (RTVS) program, helps the Ministry of Health meet its mandate of improving the delivery of maternity care across the province and working with Indigenous communities and leadership to improve health outcomes for Indigenous peoples in our province. A newly released report is shedding light on the work.
“What we've noted is that the nurses are so much more comfortable with prenatal care. They're so relieved to do the chart reviews with someone who specializes in maternity, because that’s not their main focus. With someone by their side, they feel like they know what they're doing. I think they feel they're doing better quality of care because they know that all the tests have been done and feel prepared for when the patient next visits.”
Improving access
Pregnancy can be a stressful time for expectant parents, especially if they find themselves in an area where access to prenatal care is limited.
People who live in rural, remote and First Nations communities often have to drive long distances to access care from someone with obstetrical training. The distance means rural patients have to miss work, find caregiving for family members and will need to pay more for things like meals and fuel. These barriers to care result in patients sometimes only receiving a patchwork of care, or no prenatal care at all.
That’s why MaBAL is so important—it can help rural providers who may not have experience with prenatal care to support patients in community. MaBAL is one of five instant access Real-Time Virtual Support pathways, providing immediate clinical support over the phone or Zoom for rural providers across the province.
Chart reviews for team-based prenatal care
Members of the MaBAL team, including MaBAL co-lead Dr. Amy Sawchuk and Midwife Lee Yeates, have been carrying out regular chart reviews with two northern First Nations communities. It’s part of a project that could get rolled out to other communities.
The chart review is a regularly scheduled Zoom call between the MaBAL providers and the communities of Tse Keh Dene and Kwadacha with the goal of supporting practitioners in community who are caring for patients with prenatal needs.
These calls are facilitated by one of the members of RTVS’s Virtual Medical Office Assistant team (also known as the RTVS Front Door). Once a month, the team calls the nursing station on one of the RTVS iPads at an agreed-upon time. The on-the-ground team, which includes RNs, LPNs and an NP, then work with the MaBAL provider to create plans that will best support pregnant patients.
Amy reports: “What we’ve noted is that the nurses are so much more comfortable with prenatal care. They’re so relieved to do the chart reviews with someone who specializes in maternity, because that’s not their main focus.
“With someone by their side, they feel like they know what they’re doing. I think they feel they’re doing better quality of care because they know that all the tests have been done and feel prepared for when the patient next visits.”
The calls are also an opportunity to strengthen prenatal education for both provider and patient. The nurses will learn more about the reasons for genetic screening, the timing of ultrasounds, the importance of gestational diabetes screening and more.
Amy adds: “It helps them transfer that knowledge to the patient when the patient presents opportunistically. So the hope is to increase quality of care and create equity of care without the patient needing to leave community for that care.”
One of the community nurses shared that she sees the value of having that expertise brought right to the clinic. “For most nurses, prenatal care is not typically one of our strengths. So excellent and amazing that we have access to that kind of knowledge.”
An evaluation report, Supporting Rural and Remote Maternity Care Through Enhanced MaBAL Services, goes into more detail about the impact of the service.
Supporting capacity development of providers
Dr. Kim Grieve, who has been with the MaBAL service for more than two years, is often able to give advice to both physicians and nurses on prenatal tests. In one recent case, she assisted a physician with an NST (non-stress test).
“They needed assistance with the setup of an NST machine and help interpreting the test. They had a machine in their clinic but they hadn’t used it for a very long time, and they didn’t know how to,” says Kim. “I was able to talk them through it over Zoom.”
Without being able to carry out the NST, which helps to ensure that the baby is moving and the heart rate is appropriate, the physician would have had to send the 37-weeks-pregnant patient on a three-hour round trip to the nearest hospital. Having MaBAL on the line gave peace of mind to the physician, and saved the patient the stress, hassle and expense of a long trip.
Kim says: “If a pregnant patient is ever back at this clinic, the physician may not even need to call MaBAL because they’ve learned how to use the machine. But we are here to help if they do call.”
MaBAL continues to strengthen the safety net for rural maternity care, one call at a time. Learn more about MaBAL on the RCCbc website.
“If a pregnant patient is ever back at this clinic, the physician may not even need to call MaBAL because they’ve learned how to use the machine. But we are here to help if they do call.”
