Since the creation of the family medicine group (GMF) within the Maizerets family medicine unit (UMF), the perinatal team has taken its MISSION to offer multidisciplinary services to heart. These high-quality, timely services, available from the start of pregnancy, include the baby’s birth and subsequent care from 0 to 2 years of age.
We also have a mission of clinical teaching in perinatality, with clinical clerks, residents in family medicine, and internal specialized nurse practitioners (SNPs). Lately, in our care network, we have been seeing an increased demand for pregnancy follow-up. It has especially impacted us in the UMF, where, in addition to our regular clientele, we’ve seen an ever-increasing demand for pregnancy and newborn follow-up from patients in the community who are not registered in the GMF. These “orphan” patients need immediate care. We can’t put these pregnant women on months-long waiting lists.
Our team of nurses and doctors therefore made a policy shift in October 2009: joint doctor-nurse care of the perinatal clientele. What this means is that the clinical nurse is responsible from the time of the first call-back to patients seeking pregnancy follow-up at our UMF-GMF. Simple and efficient data collection, developed by the team, has enabled us to target the parturient’s needs from the first contact. It gives prescriptions for dating ultrasounds, prenatal vitamins and Diclectin, if necessary. It provides basic information on prenatal screening and assesses risk factors. The questionnaire is then used to loop in the doctor who will be taking over the follow-up.
Clinical nurses dedicate four half-days per office week to perinatality. A doctor from the obstetrical team is on hand in each of these time slots to support the nurse. The nurse makes a complete assessment of the pregnancy, regardless of the number of weeks of gestation, for all pregnant women without risk factors. Patients are seen by the nurse four to five times throughout their pregnancy. They are informed that they will be followed jointly from the beginning of their pregnancies. During the physical examination, the clinical nurse can perform a range of procedures on their own, depending on their skills (Pap test, STBBI test, Streptococcus B test, Leopold’s manoeuvres, uterine height measurement, fetal heart assessment, pelvic examination and evaluation of the cervix).
As for the SNP, they follow the pregnancy on their own up to 32 weeks and then jointly and alternately with a doctor until the pregnancy term. They also follow pregnant women jointly and alternately with resident doctors and partner doctors.
This process makes follow-up more widely available, increases accessibility for new clients, creates a welcome continuity of care and provides safe follow-up for the mother and unborn child. What’s nice about it is that the clinical nurses’ contribution boosts patients’ confidence. They feel more comfortable by having the possibility of speaking to a professional about any problems they might have had with their pregnancies when the attending doctor is unavailable. For these patients, our nurses act as a safety net.
With this approach, our clinical nurses have been able to get more deeply involved with their obstetrical clientele. Care is more comprehensive, and the nurses enjoy greater autonomy and, above all, greater motivation in their work. It goes without saying that one of the main impacts of our operating method is to free up schedule time so that more pregnancy follow-ups in general can be taken on by the entire perinatal team. Worth mentioning, too, is the shared and contagious interest of the doctors, clinical nurses and SNPs in working together as a multidisciplinary team with shared objectives for this special clientele.
Multidisciplinary perinatal care means that ALL pregnant women asking for follow-up are accepted.