Family-Centred Maternity and Newborn Care: National Guidelines.

Table of content

• Chapter 1 - INTRODUCTION AND PHILOSOPHY
• Chapter 2 - ORGANIZATION OF SERVICES
• Chapter 3 - PRECONCEPTION CARE
• Chapter 4 - CARE DURING PREGNANCY
• Chapter 5 - CARE DURING LABOUR AND BIRTH
• Chapter 6 - EARLY POSTPARTUM CARE AND TRANSITION TO THE COMMUNITY
• Chapter 7 - BREASTFEEDING
• Chapter 8 - LOSS AND GRIEF
• Chapter 9 - TRANSPORT
• Chapter 10 - FACILITIES AND EQUIPMENT
• Companion Documents

Preface

The Family-Centred Maternity and Newborn Care: National Guidelines were developed through a collaborative process involving 70 professionals and consumers across Canada, and facilitated by Health Canada and the Canadian Institute of Child Health. Since so many stakeholders are involved in the care of mothers and babies in Canada, the process of developing these guidelines needed to be participatory and inclusive to increase the likelihood that they would be used and have an impact. Therefore, these Guidelines are the result of a three-phase process - starting with a survey of users; proceeding with consultation with national professional and consumer organizations; and concluding with the writing and review being accomplished by individuals representing the various disciplines involved in maternal and newborn care, families and all regions of the country.

To plan the process for developing the guidelines, a Core Group of national professional and consumer organizations was established. It identified recent information that was relevant to the development of the guidelines; planned the process for writing; made recommendations regarding their structure; identified participants for working groups to write them; and planned for the roles of their participant organizations in dissemination and implementation.

Thirteen Working Groups, organized around the content of the guidelines, were established to write the content. The Working Groups members were interdisciplinary volunteers; each group was headed by the project director. The disciplines were medicine (neonatology, obstetrics/perinato-logy, anaesthesia, and family medicine); nursing (community and hospital); midwifery; families; childbirth education; administration; architecture and planning. The Core Group chose volunteers based on their expertise in particular subject areas. All regions of the country were represented. These volunteers communicated via conference calls to establish the outline for their chapter, discuss the specific content and review drafts. They continued their work through e-mail, fax, and mail communication. The volunteers each wrote specific areas of the content and the project director drew the content together and edited/revised the chapters. Each of the chapters went through three or four drafts during this process.

The specific chapters and/or the entire document were reviewed by other volunteer reviewers. In addition, the entire document was reviewed, revised, and finalized by a formal Editorial Review Team. This team of 15 individuals was interdisciplinary in composition, including consumers. It represented each of the Working Groups, had representatives who had not previously been part of the process, and represented all regions of the country. Each member had expertise in the related content. The Editorial Review Team reviewed and provided feedback on three further drafts of the guidelines. Its members identified, discussed and resolved contentious issues. The team worked exclusively via teleconferences - each chapter requiring at least three calls - and the project director was responsible for revising and editing the drafts according to the team's recommendations.

The result of this tremendous volunteer effort is the newly revised

Family-Centred Maternity and Newborn Care: National Guidelines - 2000, Millennium Edition.

Acknowledgements

The Family-Centred Maternity and Newborn Care: National Guidelines could not have been completed without the tremendous effort and cooperation of many individuals who participated in the development. The Health Canada project consultants, Janice Ireland, Marie Labrèche and Rosemary Sloan of the Childhood and Youth Division, were grateful for the collaboration and expertise of multidisciplinary professionals and consumers.

Health Canada specifically would like to thank the Canadian Institute of Child Health, with a special mention to Louise Hanvey, project director, for her input, advice and guidance during the development of this valuable document. Without her expertise, dedication and professionalism, this project would not have been managed in such a cohesive fashion. As well, we wish to mention the writing skills of Wendy Dayton, editing and indexing expertise and constant involvement of Judith Whitehead, the tireless efforts of Rolande Ostiguy, Manager, Publications Projects, Health Canada, as well as the quality of the design and page makeup by Stephanie Pelot, Pentafolio Inc.

The Family-Centred Maternity and Newborn Care: National Guidelines have been produced in collaboration with the following participants:

Aboriginal Nurses Association
Association of Women's Health, Obstetric and Neonatal Nurses - Canada
Canadian Anaesthetists' Society
Canadian Coalition for the Prevention of Developmental Disabilities
Canadian Coalition for Regionalized Perinatal Care
Canadian Confederation of Midwives
Canadian Council on Health Services Accreditation
Canadian Healthcare Association
Canadian Institute of Child Health
Canadian Medical Association
Canadian Nurses Association
Canadian Paediatric Society
Canadian Public Health Association
Canadian Women's Health Network
College of Family Physicians of Canada
International Childbirth Education Association (ICEA)
Native Physicians Association in Canada
Society of Obstetricians and Gynaecologists of Canada (SOGC)

CONTENT EDITED BY:

Louise Hanvey, RN, BN, MHA
Project Director, Family-Centred Maternity and Newborn Care:
National Guidelines
Canadian Institute of Child Health
Ottawa, Ontario

IN COLLABORATION WITH THE EDITORIAL REVIEW TEAM:

Graham W. Chance, MB, FRCP, FRCPC
Emeritus Professor, Department of Paediatrics
University of Western Ontario
Formerly: Chairperson, Division of Neonatal-Perinatal Medicine
St. Joseph's Health Centre
London, Ontario
Formerly Chairperson, Canadian Institute of Child Health
Ottawa, Ontario

William Fraser, MD, MSc
Professor and Chair
Department of Obstetrics and Gynecology, Université Laval
Québec, Quebec

Guy-Paul Gagné, MD, CSPQ, FRCS(C)
Associate Professor of Obstetrics and Gynaecology, McGill University
Society of Obstetricians and Gynaecologists of Canada
Lasalle, Quebec

Michael C. Klein, MD, CCFP, FCFPC, FAAP (Neonatal-Perinatal)
Professor, Department of Family Practice and Pediatrics
University of British Columbia
Head, Department of Family Practice
British Columbia Women's and Children's Hospitals
Vancouver, British Columbia

Susan Marshall, MSc
Board Member
Manitoba Association for Childbirth and Family Education
Winnipeg, Manitoba

Doug McMillan, MD, FRCP, FAAP
Professor of Pediatrics
University of Calgary
Calgary, Alberta

Carl Nimrod, MB, FRCSC
Chief, Department of Obstetrics and Gynecology
Ottawa Hospital - General Site
Ottawa, Ontario

Martha Nutbrown, BN
Perinatal Visiting Nurse, Reproductive Care Program of Nova Scotia
Clinical Resource Coordinator, Valley Regional Hospital
Kentville, Nova Scotia

Laurie Reid, RN, BScN, IBCLC
Infant and Preschool Resource Nurse
Community Care and Public Health
Capital Health
Edmonton, Alberta

Larry Reynolds, MD, MSc, CCFP
Professor of Family Medicine, University of Western Ontario
College of Family Physicians of Canada
London, Ontario

Kris Robinson, BSCN, SCM (UK), MSc
Clinical Nurse Specialist/Midwife
Woman and Child Program
St. Boniface General Hospital
Winnipeg, Manitoba

Vera Rosolowich, RN, SCM (UK), IBCLC
Education Facilitator, Women's Health
Misericordia Health Centre
AWHONN Canada
Winnipeg, Manitoba

Janet Rush, RN, PhD
Director of Nursing Research, St. Joseph's Hospital
Assistant Clinical Professor, Faculty of Health Sciences
McMaster University
Hamilton, Ontario

Nancy McNinch Shosenberg, RN, BScN, MHSc
Chair, Family Centred Maternity and Newborn Care:
National Guidelines Core Group
Consultant
Oshawa, Ontario

Linda Uhrich, RNC, ICCE, ICPE
International Childbirth Education Association
Winnipeg, Manitoba

Chapter Authors

CHAPTER 1

Margaret J. Haworth-Brockman, Bsc.
Chair, Equity/Access Committee
Manitoba Midwifery Implementation Council
Winnipeg, Manitoba

Louise Hanvey, RN, BN, MHA
Consultant, Canadian Institute of Child Health
Ottawa, Ontario

Susan Marshall, MSc
Board Member
Manitoba Association for Childbirth and Family Education
Winnipeg, Manitoba

Larry Reynolds, MD, MSc, CCFP
Professor of Family Medicine, University of Western Ontario
College of Family Physicians of Canada
London, Ontario

CHAPTER 2

Sharon Dore, RN, PhD (c)
Clinical Nurse Specialist, Obstetrics and Gynecology
Hamilton Health Sciences Corporation
Hamilton, Ontario

Sidney Effer, MD, FRCSC
Professor Emeritus, Obstetrics and Gynecology
University of British Columbia
Vancouver, British Columbia

Lynn Julius, RN, BScN
Thunder Bay Regional Hospital
Thunder Bay, Ontario

Doug McMillan, MD, FRCP, FAAP
Professor of Pediatrics
University of Calgary
Calgary, Alberta

Diane J. Sawchuck, MSN
Perinatal Nurse Consultant
British Columbia Reproductive Care Program
Vancouver, British Columbia

CHAPTER 3

Noreen Agrey, BA, BEd
Health Educator
Saskatchewan Institute on Prevention of Handicaps
Saskatoon, Saskatchewan

Katherine M. Crowe, RN, BSc, PHN, OPN
Supervisor, Reproductive Health
Regional Municipality of Ottawa-Carleton Health Department
Ottawa, Ontario

Cheryl Levitt, MB, Bch, CCFP
Chair, Department of Family Medicine
McMaster University
Hamilton, Ontario

Jane MacDonald, BScN, MHSc
Community Health Consultant - Researcher/Writer
Ottawa, Ontario

Diane MacLean,
Chairperson, Maternal/Newborn Care Program Community
Advisory Panel
Wellesley Central Hospital
Toronto, Ontario

Viola Polomeno, RN, BSc, MSc (A), PhD (c)
Clinical Instructor
Faculty of Nursing, Université de Montréal
Montréal, Quebec

CHAPTER 4

The ALPHA Group

Anne Biringer, MD, CCFP, FCFP
Assistant Professor
Department of Family and Community Medicine
University of Toronto
Toronto, Ontario

June Carroll, MD, CCFP, FCFP
Associate Professor and Research Scholar
Department of Family and Community Medicine
University of Toronto
Toronto, Ontario

Beverley Chalmers, PhD
Associate Professor
Departments of Obstetrics and Gynecology, Nursing and Public
Health Sciences, Centre for Research in Women's Health
University of Toronto
Toronto, Ontario

Deana Midmer, BScN, EdD, FACCE
Assistant Professor and Research Scholar
Department of Family and Community Medicine
University of Toronto
Toronto, Ontario

Anthony Reid, MD, MSc, CCFP, FCFP
Associate Professor
Department of Family and Community Medicine
University of Toronto
Toronto, Ontario

Donna Stewart, MD, FRCPC
Professor, Departments of Psychiatry and Obstetrics and
Gynecology, Chair of Women's Health
The Toronto Hospital, University of Toronto
Toronto, Ontario

Lynn Wilson, MD, CCFP, FCFP
Assistant Professor and Research Scholar
Department of Family and Community Medicine
University of Toronto
Toronto, Ontario

Dorothy Dooley, BN, RN
Community Health Nurse and Canada Prenatal Nutrition Program
Facilitator Liard Basin Task Force
Watson Lake, Yukon

Philip F. Hall, MD, BScMed, FRCSC
Professor and Director, Provincial Obstetric Outreach Program and Fetal
Assessment Unit
St. Boniface General Hospital, Department of Obstetrics, Gynaecology
and Reproductive Sciences, University of Manitoba
Winnipeg, Manitoba

Susan E. Hodges, RN, BScN (Perinatal Concentration)
National Project Coordinator, Postpartum Parent Support Program
Canadian Institute of Child Health
Ottawa, Ontario

Margaret Norum, RN, BScN
Coordinator, Perinatal Education Program
Continuing Medical and Nursing Education, University of Saskatchewan
Saskatoon, Saskatchewan

Viola Polomeno, RN, BSc, MSc (A), PhD ©
Clinical Instructor
Faculty of Nursing, Université de Montréal
Montréal, Quebec

S. Nan Schuurmans, MD, FRCSC
Regional Program Clinical Director, Women's Health
Capital Health Authority
Past President (1996-7), Society of Obstetricians and
Gynaecologists of Canada
Edmonton, Alberta

Bobbi Soderstrom, BA, MLS, BScN, RN, IBCLC, RM
Assistant Professor
Midwifery Education Programme, Ryerson Polytechnic University
Ottawa, Ontario

Linda Uhrich, RNC, ICCE, ICPE
International Childbirth Education Association
Winnipeg, Manitoba

CHAPTER 5

Susan Chesney, RN, BScN, SCM
Clinical Manager Obstetrics
Royal Alexandra Hospital, Women's Centre
Edmonton, Alberta

William Fraser, MD, MSc
Professor and Chair
Department of Obstetrics and Gynecology, Université Laval
Québec, Québec

Guy-Paul Gagné, MD, CSPQ, FRCS(C)
Associate Professor of Obstetrics and Gynaecology, McGill University
Society of Obstetricians and Gynaecologists of Canada
Lasalle, Quebec

Michael C. Klein, MD, CCFP, FCFPC, FAAP (Neonatal-Perinatal)
Professor, Department of Family Practice and Pediatrics
University of British Columbia
Head, Department of Family Practice British Columbia Women's and Children's Hospitals
Vancouver, British Columbia

Christine Kurtz Landy, RN, BScN, MScN
Manager of Reproductive Health
Wellington Dufferin Guelph Health Unit
Guelph, Ontario

Heather Mains, BFA, CD
Consumer Health Consultant
Toronto, Ontario

Dr. Roanne Preston, MD, FRCPC
Chair of the Obstetric Section
Canadian Anaesthetists' Society
Ottawa, Ontario

Kris Robinson, BSCN, SCM (UK), MSc
Clinical Nurse Specialist/Midwife
Woman and Child Program
St. Boniface General Hospital
Winnipeg, Manitoba

Jo Watson MacDonell, RN, MScN, IBCLC
Director, Birthing Unit, Breastfeeding Clinic
Women's College Hospital
Toronto, Ontario

CHAPTER 6

Oscar Casiro, MD, FRCPC
Professor of Pediatrics
University of Manitoba
Winnipeg, Manitoba

Sheila Harvey, RN, MN, RM
Manager, Foothills Nurse-Midwifery Programme
Calgary Regional Health Authority
Calgary, Alberta

Charlene McLelland, Midwife
Canadian Confederation of Midwives
Kingsport, Nova Scotia

Doug McMillan, MD, FRCP, FAAP
Professor of Pediatrics
University of Calgary
Calgary, Alberta

Arne Ohlsson, MD, MSc, FRCPC, FAAP
Director, Evidence Based Neonatal Care and Outcomes Research,
Division of Neonatology, Department of Paediatrics
Professor, Departments of Paediatrics, Obstetrics and Gynaecology Public Health Sciences
University of Toronto
Toronto, Ontario

Laurie Reid, RN, BScN, IBCLC
Infant and Preschool Resource Nurse
Community Care and Public Health
Capital Health
Edmonton, Alberta

Catherine Royle, RN, BN, MN
Program Director
Newfoundland and Labrador Provincial Perinatal Program
St. John's, Newfoundland

Janet Rush, RN, PhD
Director of Nursing Research, St. Joseph's Hospital
Assistant Clinical Professor, Faculty of Health Sciences
McMaster University
Hamilton, Ontario

Barbara Selwood, RN, BSN, MSc
Perinatal Coordinator
Vancouver/Richmond Health Board
Vancouver, British Columbia

Robin Walker, MB, ChB, FRCP(C), FAAP
Professor of Paediatrics
University of Ottawa
Ottawa, Ontario

Nancy E. Watters, BScN, MScN, IBCLC
Coordinator, Maternal-Newborn Care
Perinatal Education Program of Eastern Ontario
Ottawa, Ontario

CHAPTER 7

Gail Blair Storr, RN, MN, Med
Professor
Faculty of Nursing, University of New Brunswick
Fredericton, New Brunswick

Mollie Butler, RN, BSN, MPA
Perinatal Health Consultant
Victoria, British Columbia

Jack Newman, MD, FRCPC
Chair INFACT Canada
Toronto, Ontario

Nancy E. Watters, BScN, MScN, IBCLC
Coordinator, Maternal-Newborn Care
Perinatal Education Program of Eastern Ontario
Ottawa, Ontario

CHAPTER 8

Elizabeth Becker, BA
Program Coordinator
Bereaved Families of Ontario
Toronto, Ontario

Oscar Casiro, MD, FRCPC
Professor of Pediatrics
University of Manitoba
Winnipeg, Manitoba

Christine M. Evanochko, RNC, MN, NNP
Clinical Nurse Specialist/Neonatal Nurse Practitioner
NICU, Stollery Children's Health Centre
Edmonton, Alberta

Jane MacDonald, BScN, MHSc
Community Health Consultant - Researcher/Writer
Ottawa, Ontario

Nancy E. Malcolm, RN, RNEd, MHSc
Vice President
Patient Care Services, Women's College Hospital
Toronto, Ontario

Margaret J. McGovern, RN, BScN, MScN
Executive Director
Bereaved Families of Ontario
Toronto, Ontario

Jacqueline Zalnasky, RNC, MN, BN
Director, Nursing Services
Grace General Hospital
Winnipeg, Manitoba

CHAPTER 9

Sharon Dore, RN, PhD (c)
Clinical Nurse Specialist, Obstetrics and Gynecology
Hamilton Health Sciences Corporation
Hamilton, Ontario

Sidney Effer, MD, FRCSC
Professor Emeritus, Obstetrics and Gynecology
University of British Columbia
Vancouver, British Columbia

Lynn Julius, RN, BScN
Thunder Bay Regional Hospital
Thunder Bay, Ontario

Doug McMillan, MD, FRCP, FAAP
Professor of Pediatrics
University of Calgary
Calgary, Alberta

Diane J. Sawchuck, MSN
Perinatal Nurse Consultant
British Columbia Reproductive Care Program
Vancouver, British Columbia

CHAPTER 10

John E. Christie, B Arch, BES, OAA, MAIBC, MRAIC
Director
The Parkin Group
Toronto, Ontario

Jeannine Gourlie, RN, CHE
Manager
Agnew Peckham Health Care Consultants
Toronto, Ontario

Lynn Wilson Orr, BID, M.Arch, OAA, RAIC
Vice President
Parkin Architects Limited
Toronto, Ontario

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Suggested citation: Health Canada. Family-Centred Maternity and Newborn
Care: National Guidelines, Minister of Public Works and
Government Services, Ottawa, 2000.

Published by authority of the Minister of Health

©Her Majesty the Queen in Right of Canada, represented by the Minister of Public Works and Government Services Canada, 2000

Cat. H39-527/2000E ISBN 0-662-28702-9