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Taking care of vulnerable soon-to-be mums

Toronto, November 6, 2013

By Marisa Cicero

Marisa Cicero
Marisa Cicero, social worker, Obstetrics

Pink or blue? Happily, for the majority of the approximately 3,000 women who give birth at St. Michael’s every year, these types of questions during pregnancy are the norm. However, for the approximately 250 women a year we see in our obstetrics clinic in the Women's Health Centre who are young, marginally housed or homeless, questions like “where am I going to sleep tonight?’ or “do I have enough money to get to my clinic appointment?” complicate these women’s experiences of being pregnant.

We know that about 50 per cent of all homeless young women will become pregnant. Unfortunately, we also know that these women:

  • live in poverty – in precarious, vulnerable housing, if they are not homeless
  • are often involved in survival sex or prostitution
  • have a history of being in abusive relationships
  • have a history of child welfare involvement in their lives, either themselves as children or because of previous children they’ve had
  • have mental health and/or developmental needs
  • struggle with substances

Even with the best intentions, it can be difficult to attend the prenatal care that we know is good for mother and baby when you are struggling to survive. So, in 2005, together with some important community partners, St. Michael’s developed the My Baby and Me Infant Passport Program as a way of providing more targeted and optimal care for this population.

The Passport Program is a three-pronged program:

  1. It’s a passport, a multitasking pocket-sized book that has space for parents to journal and to keep ultrasounds pictures; acts as a mini antenatal record; contains a resource guide with information about things like where to get hot meals and help with housing; and provides education about baby’s development and common pregnancy related issues.

  2. The second part of the program is incentives: we provide TTC tokens to get to and from clinic appointments, vouchers for hot lunches to promote healthy eating and a prepaid disposable camera to record those special moments at the delivery.

  3. The third element of the program is where I think we excel. It’s our philosophy and our approach to care. Our entire team of nurses, sonographers, administrators, physicians and social workers indiscriminately apply the mission and values of our hospital towards everyone that comes into our clinic – including these women who we aim to treat with humanity and respect and endeavor to fully involve in the medical and psycho-social care they receive.

I’m happy to report that it seems to be working! Women come from all over Toronto to have their babies with us and we know from a study that we completed that mothers enrolled in the Passport Program attend more prenatal appointments, have healthier babies and report feeling more connected to their pregnancy and to their care. We’ve developed a Passport Toolkit that that allows other centres to set up their own version of the passport – something that Winnipeg is doing at the moment – and have been included on the Richard Ivey School of Business International Centre of Health Innovation.

If you’d like more information about the program, please feel free to get in touch with us:

  • Cathy Beatty, registered nurse, Obstetrics, at 416-867-7460 ext. 8044.
  • Marisa Cicero, social worker, Obstetrics, at 416-867-7460 ext. 8452.

Read about the 2009 innovation award this program received.

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.