Dr Jennifer Kask, a family doctor attached to the Campbell River Maternity Clinic, was inspired to seek improvements after caring for a pregnant woman in preterm labor who had to give birth at a facility not equipped for early births. 

She partnered with Dr Kirsten Duckitt, a maternity specialist, and with Facility Engagement funding from the Campbell River Medical Staff Association, the two set out to improve preterm birth rates through education, interventions, and collaboration. Together, they:

• Determined how to identify patients at risk, assess and treat those in preterm labor, and manage cases leading to preterm births in non-specialized facilities.
   
• Found that vaginal progesterone therapy as a simple intervention was a key aspect of prevention, and made efforts to ensure its coverage.
   
• Created a pathway, organized education events and developed resources for health care providers - including family physicians and nurse practitioners, and patients.
   
• Started to engage through in-person and (after Covid) virtual engagement sessions - which was crucial for spreading the project's impact.
   
• The project started in one community and successfully spread to others, including Cowichan and Port Alberni, which experience high rates of preterm births.
   
• Engaged with the First Nations Health Authority to address the higher risk of preterm birth in indigenous populations.
   
• The doctors then accessed SSC Spreading Quality Improvement Initiative funding expand the work further.
   
• Initial measurement has shown a significant decrease in preterm births at the maternity clinic and among Dr Kask's patients.
   
• Dr Kask shared a success story of a patient who benefited from the project's interventions, highlighting the impact on individual patients.|
   
• Dr Kask emphasized the importance of having a clear aim - a North Star - to lead the way to success in quality improvement projects.

Prevention of Preterm Birth Pathway initiative is supporting maternity care providers to identify patients at risk and use medical interventions to prevent preterm births.

Preterm birth is a leading cause of perinatal mortality and morbidity in Canada and worldwide.

Babies born before 37 weeks of gestation are at increased risk of severe medical problems. Having a preterm baby is also stressful for parents; particularly those who live in smaller communities, and need to leave their supports, jobs, and other children to seek specialized neo-natal intensive care in bigger centres.

Dr Jennifer Kask, a family physician attached to the Campbell River Maternity Clinic, was aware of very high preterm birth rates in communities across Vancouver Island - as much as 25% in 2016/17, compared to 7.4% and 7.8% in BC and Canada respectively (2013). 

With the support of Facility Engagement funding, Dr Kask collaborated with Dr Kirsten Duckitt, an obstetrical specialist, to engage family physicians, midwives, and allied health providers in discussions about identifying patients at risk and using evidence-based, effective interventions to prevent preterm births.

They noted that a simple vaginal progesterone intervention that helps at-risk patients extend their pregnancy to bring them closer to term, was used by obstetricians but not always by other providers or patients.

"We concluded there was a gap was in the knowledge of our colleagues and patients," she says.

"We knew a main risk factor for a mother having a preterm birth is having had a preterm birth previously," Dr Kask says. "So it was a matter of how we help to educate our colleagues and provide some resources to identify who is at risk, and how to help prevent recurrent preterm birth."

With Facility Engagement providing support for initial work, a provider adoption underway in communities around Campbell River, Dr Kask then accessed SSC Spreading Quality Improvement Initiative funding expand the work further, including to Port Alberni and Tofino, as well as the Cowichan Valley through direct work with the Cowichan Valley Tribe.

Dr. Kask notes that preterm births disproportionally affect First Nations individuals.

Dr Kask and Duckitt have spread the work across Vancouver Island rural communities. They are hoping to further spread it across all BC regions, where patients in smaller communities share the same experiences and risks, and can benefit from the pathway created.  

Dr Kask says that one of the highlights of the project has been making specialized care more accessible to other providers. 

“The neat part of it has really been the relationship and mentorship I’ve received from my colleague Dr Duckitt. She is an excellent educator, a wonderful OBGYN and was so willing to share her specialist knowledge.”

Through data collected in the maternity clinic, Dr Kask notes there has been real progress in preventing preterm births, both through measurement in her clinic showing a downward trend in pre-term births, and patient stories.

The project led to the development of a Preterm Birth Pathway with a package of resources. You can download those in the right column on this page. They include:

• a case-based CME event
• a care algorithm  
• a clinician resource (a pre-printed Special Authority form developed through discussion with Pharmacare)
• patient education materials that included patient cards and posters