Family Planning and Healthcare Provider Practice Patterns in Alberta: Are They Aligned With the Ready

Prenatal care is characterized by the delivery of education and services related to the health of mothers and babies. It is comprised of preconception care and family planning education that includes consultations on methods of birth control, lifestyle choices, nutrition, medical checkups as well as substance abuse (Public Health Agency of Canada, 2011). The seeking of prenatal care is not mandatory in Canada. However, regulatory bodies governed under the Health Professions Act (Government of Alberta, 2017a; 2017b) such as the Alberta College of Family Physicians (ACFP), College of Physicians and Surgeons of Alberta (CPSA), Society of Obstetricians and Gynaecologists of Canada (SOGC) and College of Midwives of Alberta (CMA) mandate the delivery of prenatal care through designated healthcare professionals, including medical doctors and registered midwives (Alberta College of Family Physicians, 2017; The College of Physicians and Surgeons of Alberta, 2017; Society of Obstetricians and Gynaecologists of Canada, 2017; College of Midwives of Alberta, 2017). The number of unplanned pregnancies in Canada remains high and the expectation of receiving prenatal care, regardless of the type of healthcare provider chosen, is unmet (Alberta Health Services, 2017a). The different focus in the scope of practice between healthcare professionals can result in differences in the prenatal education and care received. There are considerable policy implications for the differences in the delivery of health information pertaining to prenatal care in Alberta. The development of harmful behaviours as a result of a poor understanding of social determinants of health, pregnancy outcomes and child development can lead to pregnancy-related complications and an overall unhealthy population. To offer more comprehensive and consistent prenatal education to Albertans, the province launched a novel family planning and pregnancy preparedness campaign, Ready or Not, designed to provide pertinent information through an Internet-based platform (Alberta Health Services, 2017a). Funded by the Government of Alberta and delivered by Alberta Health Services (AHS), this initiative represents a diversity of partnerships involved in the service provision pertaining to prenatal health and family planning (Alberta Health Services, 2017a). Though medical doctors contributed towards the development of this campaign, their respective governing bodies may not have been directly involved (Alberta Health Services, 2017a), which can trigger discrepancies in the care provided. As such, the following capstone research study seeks to understand family planning and healthcare provider practice patterns in Alberta. Specifically, it investigates whether or not the delivery of prenatal education is consistent with the Ready or Not provincial campaign (Alberta Health Services, 2017a). This study renders important insights on the implicit and explicit decision-making process of selecting a healthcare provider for prenatal care, namely medical doctors or registered midwives, as well as the receipt of prenatal education by women in this province. Statistical analysis was conducted using the Secondary Analysis to Generate Evidence (SAGE) virtual environment analytics platform (PolicyWise for Children & Families, 2017). This studyused the All Our Babies (AOB) data (Tough et al., 2017)), which is a prospective pregnancy and birth cohort (n=3387) of Calgarian women aged 19 to 47 years (Tough et al., 2017). To better understand the connection between healthcare practitioners and the prenatal advice provided, key questions were addressed. First, the study investigated the association between the time to get pregnant and receipt of information about pregnancy planning from a healthcare provider, and the type of birth control and family planning practices used prior to becoming pregnant. Next the study examined the association between the type of healthcare provider consulted during pregnancy (medical doctor or midwife) and the prenatal education received by women in relation to the guidelines established by the Ready or Not provincial policy campaign. Third, this study explored the likelihood of receiving prenatal advice and education aligned with the Ready or Not campaign from specific types of healthcare providers (Alberta Health Services, 2017a). Demographic characteristics such as the total time spent in Canada, educational attainment, ethnicity, total income and parity impacted whether or not women received information about pregnancy planning, birth control and family planning practices prior to becoming pregnant. Nearly all the women sought care from a medical doctor as opposed to a registered midwife, and the care delivered differed between these two types of professionals. A statistically significant association was also observed between receiving information about pregnancy planning as well as the use of certain birth control and family planning practices. Women who consulted with a midwife rather than a medical doctor, on average, were more likely to receive information on nutrition, taking vitamins or mineral supplements, exercise or active living and working during pregnancy. However, those who saw a medical doctor were generally less likely to experience difficulty obtaining prenatal care (Alberta Health, 2017a). Furthermore, the differences in the scope of practice between these professionals can contribute towards variations in the delivery of prenatal care education in the province. As such, it is important to ensure that the policies in place mirror the guidelines in Ready or Not and improve the reality of prenatal care education in the province. The differences in the delivery of prenatal education requires efforts to guarantee proper preconception care in the province. Since the AOB cohort was recruited between 2008 and 2011 (Tough et al., 2013) and Ready or Not was instated in 2016 (Alberta Health Services, 2017a), the findings of this capstone project may not necessarily be representative of the current patterns in the delivery of prenatal education in Alberta. However, the recommendation for stakeholders to collaborate and develop a checklist that is to be used province-wide by relevant healthcare professionals will encourage that the guidelines in Ready or Not (Alberta Health Services, 2017a) are addressed. Furthermore, these partnerships will allow for respective licensing bodies to become more aware of the knowledge provided in this new campaign, thereby fostering the delivery of a comprehensive and consistent prenatal care education in the province.

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