BOND - Babies Open New Doors, Powell River, British Columbia

Since 1995, BOND (Babies Open New Doors) has been supporting the women of Powell River, BC in having healthy, joyful pregnancies. Powell River, with a rural and municipal population of approximately 20,000, is located on the north end of the Sunshine Coast. It is an isolated community; one must take two ferries and drive 150 km to reach Vancouver. The town has been struggling with lay offs at the local mill for several years and general downsizing of the logging and fishing industries, and is looking to tourism to help redefine itself. However, schools have been closing and merging as young families leave to look for work and the school population declines. Powell River struggles with many of the same social issues as other small towns and those issues also impact the BOND program, e.g., teenage pregnancy, poverty, and drug and alcohol issues.

Women may join BOND at any stage of their pregnancy, and even join postnatally. They can remain in the program until their babies are 6 months old. Women come to the program by referral from physicians, public health nurses or other agencies, and also by word of mouth. Women really enjoy the program and Moira, the program's coordinator and a registered nurse, says "there is an overwhelming response from our 'graduates' that they wish they could have stayed in the program longer ".

The majority of the BOND participants are under 25. They are all dealing with one or more risk factors, whether it is social isolation, young maternal age, mental health issues, poverty, family violence, poor eating habits or substance use. Smoking is a habit among many of the women and a major concern for the staff who notice an increase in the numbers of participants who struggle with this addiction. However, during pregnancy and with support, many of these women are motivated to make positive changes to their lifestyle to provide their babies with a healthier start. "Harm reduction "is a key element in the BOND experience.

BOND prenatal and postnatal women are invited to attend the 2 hour group sessions on a weekly basis. Attendance is voluntary and participants receive food vouchers and outreach visits regardless of whether they attend the group. Most women do attend groups and enjoy the social and educational aspects of the group sessions. During the first hour of the group, women have time to socialize, weigh their babies with the nurse coordinator, and enjoy healthy nourishments. Any concerns that require one to one consultation with the coordinator or outreach worker are dealt with during this time. The program participants enjoy the social and relaxed atmosphere and many women build strong friendships within the group.

The second hour of each session consists of information sessions on healthy pregnancies and families. Moira ensures that the education sessions are relevant to the issues participants are currently facing. Sessions include guest speakers such as nurses discussing baby safety, smoking, and breastfeeding, or a support services worker talking about physical abuse and violence in relationships, or a massage therapist speaking on infant massage, or a doula speaking on the birth experience. Other popular topics include dental hygiene, drug and alcohol use, labour and delivery, baby care, and anger management. Once a month at the group, Margaret Fenwick, the program's Registered Dietitian, conducts cooking sessions and nutrition discussions with the goal of helping women develop healthy eating habits and having a healthy birth weight baby. In addition, Margaret sees individual participants for 1:1 who need dietary advice on issues such as improving their food intake or infant feeding concerns. Last year, the average baby birth weight in the program was 8 pounds 7 oz.

BOND's group sessions are held at the local Public Health Unit, which Moira describes as "a very central, non-threatening place to meet ". Public Health has been an invaluable community partner in developing and delivering the BOND Program. BOND staff provide transportation to group for those participants who cannot arrange a ride and don't have their own car. Car pooling is encouraged among the group whenever possible.

The BOND team consists of a program coordinator, an outreach worker, a registered dietitian, a group assistant (past participant) and a volunteer(past participant). The program is fully funded through the Canada Prenatal Nutrition Program (CPNP). Lori Pierreroy, the outreach worker, works one-to-one with the mothers developing rapport and providing pregnancy and lifestyle information in a non-threatening manner. Lori supports clients to develop healthy coping behaviours during times of stress or personal crises. She also recommends appropriate referrals, drives clients to appointments and acts as a liaison between the participant and the other program staff.

The coordinator, outreach worker, dietitian and Public Health liaison nurse meet monthly for file review. During these meetings, the outreach worker brings forward any problems observed during her outreach visits, for instance, a client who is not eating well. The team discusses the issues and develops a plan of action.

Food security, or food insecurity, is frequently an issue for BOND women. To aid women in buying nutritious foods, grocery store vouchers are supplied weekly. They consist of 4L of milk, $5 worth of fresh fruit and vegetables, 1 dozen eggs and 2 cans of frozen 100% orange or apple juice. Women who are in extreme need of food may qualify for a $20 emergency food voucher and an emergency food shelf of non-perishable items is also maintained for participants in need. All participants receive prenatal vitamins and a list of community groups that provide free food (e.g., the soup kitchen). Once a month there is a draw for a "Good Food Box ".

Participants say that one of the highlights of the program is when Lori or Moira visit them in the hospital after giving birth. At this time, a baby bathtub filled with baby supplies is given to the mothers as a gift from BOND. A photo is taken and placed on the BOND bulletin board at the health unit. Another popular component is the BOND binder. Each participant receives a binder when they first enter the program which is used for reference during and after the pregnancy. The binder is filled with pregnancy and new baby information, information pamphlets and many other resources. The information is "user-friendly ", divided into the three trimesters of pregnancy, breastfeeding and baby care. Detailed information on babies from birth to three months and three months to six months is included, as well as recipes for first baby foods and tips on introducing solids. Lori works through the information in the binder with the participants during her outreach visits. The women may keep the binder if they wish.

As a community-based program, BOND welcomes input from stakeholders through its Advisory Committee. The Committee meets quarterly and has representatives from various sectors including service delivery professionals and the Ministries. In addition, BOND staff participate in other community committees and initiatives such as the Maternal Infant Team, Food Security Coalition, and The Family Place. BOND shares ideas and resources with its "sister "aboriginal prenatal program at Sliammon. Last spring, the 2 programs held a "cross-cultural lunch "at Sliammon where the groups enjoyed smoked salmon, bannock, and other traditional foods and customs. BOND's sponsoring agency, Powell River Employment Program (PREP) Society, provides financial administration, policies and procedures, and other supports to enable BOND staff to deliver a quality program. PREP is celebrating its 20th anniversary of service in the community this year.

The program staff's welcoming attitude and ability to build trust with the participants help participants feel comfortable to express their feelings and concerns during group sessions. Moira explains "one 16-year-old participant was so shy initially that she could not eat or speak at all when she first came to group. Eventually she relaxed and has become very outgoing with the other women. Now she is breastfeeding her baby, she has applied for the program's volunteer position, and has gone back to school. "Through the success of its participants, Babies Open New Doors has proven itself worthy of its name. It opens new doors to a healthier and more rewarding life for the mothers and children involve.