1. H.E.R. Pregnancy Program: 10 Lessons Learned
Morgan Chalifoux, Team Lead, Aboriginal Community Support Worker
Ashley Robertson, Nurse Educator, RN, BScN
HER Pregnancy Program
9/17/2018

2. Outline H.E.R, Pregnancy Program 10 Lessons Learned
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H.E.R, Pregnancy Program
10 Lessons Learned
Pregnancy & Substance Use
Outcomes
HER Pregnancy Program

3. H.E.R. Pregnancy Program
HER Pregnancy Program
9/17/2018

4. Introduction Started as “Women in the Shadows” (2008-2010)
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Started as “Women in the Shadows” ( )
H.E.R. Pregnancy Program (2011-Present)
Healthy, Empowered, Resilient
Funded through Alberta Health
Harm Reduction focused
Support up to 6 months postpartum
Focused on the woman
Healthy woman = Healthy baby
HER Pregnancy Program

5. H.E.R. Staff 4 Pregnancy Support Workers 2 Registered Nurses
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4 Pregnancy Support Workers
2 Registered Nurses
1 Registered Social Worker
HER Pregnancy Program

6. H.E.R. Clientele Women involved in the street Working in the sex trade
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Women involved in the street
Working in the sex trade
Women who use substances
Women with multiple Child & Family Services involvement
Women with criminal justice system involvement or gang affiliation
Multicultural backgrounds
Highly stressed, undernourished, and homeless
Often unhealthy or abusive relationships
Women with pre-existing health problems (HIV, Hep C, STI’s, Mental Health)
HER Pregnancy Program

7. Harm Reduction & Pregnancy
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Reduction of substance use and/or abstinence is not required in order to receive respect, compassion or services – abstinence not realistic
Meets people “where they are at”, not where you wish they were. Reality based.
It builds on people’s strengths, is relationship based and non-judgmental.
Does not encourage drug use, enable harmful drug use, or “give up” on people.
Does the opposite: Enhances the ability to have increased control over their lives and their health.
It acknowledges that certain kinds of risky behaviours are safer than others (ie. eating vs injecting).
It is the proper role of health providers to help people live healthier lives, not to act as moral police  giving up control
HER Pregnancy Program

8. H.E.R. Services Pregnancy tests STI testing & treatment
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Pregnancy tests
STI testing & treatment
Prenatal bloodwork
Birth control access
Harm Reduction supplies
Fetal heart rates: promotes bonding
Labor & Delivery Support
Transportation to appointments
Crisis Interventions
Mental health support
Addictions support
Referrals
Income & housing support
Assistance with legal issues (warrant apprehension program)
Health for 2 - prenatal vitamins, milk coupons, bus tickets
Hygiene, basic needs supplies, and some baby supplies
Education – clients, students, professionals
Parenting classes
Access to cultural support
Wednesday informal drop-ins
Pregnancy resources/books
HER Pregnancy Program

9. 10 Lessons Learned
HER Pregnancy Program
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10. What was learned….
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Pregnancy support workers are the most effective way to connect with the women
They “get it” and understand the fear and mistrust, and the million challenges the women face
They may know the women already
They have experienced discrimination themselves
The women trust the professionals if the worker trusts them
HER Pregnancy Program
They “get it” and understand the fear, mistrust, and the million challenges the women face, and have experienced discrimination themselves
They may know the women already
The women trust the professionals if the worker trusts them

11. What was learned…. 2. That a Harm Reduction approach is critical
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2. That a Harm Reduction approach is critical
The women are used to being vilified by service providers
Much of the “research” on substance use and pregnancy is inaccurate
Harm Reduction philosophy and practice builds people up and strives for success, rather than the usual model of shaming, dismissing, and punishing pregnant women who use drugs
Relationship building is extremely important
HER Pregnancy Program

12. What was learned…. 3. Staying woman-focused
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3. Staying woman-focused
If you don’t have a healthy mom, you won’t have a healthy baby
Street-involved women are often seen only as vessels “who carry poor innocent victims of their mother’s bad choices”, not as capable, strong women who can be successful parents with support
The moms have been victimized and abused themselves over time, and need to be supported to heal
Women who have been sexually abused often have extreme reactions at the time of delivery
HER Pregnancy Program

13. What was learned….
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4. Being flexible, open, non-judgmental, responsive is crucial
No appointments – consistent drop-in
Looking beyond the usual scope of practice
Taking moms to appointments and attending deliveries
Able to work in non-traditional settings
HER Pregnancy Program

14. What was learned….
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5. Involving Child and Family Services as early as possible (although its not officially allowed)
Connecting with a CFS worker, who practices within a Harm Reduction framework, means that mom can learn about what she needs to do to be successful in CFS’s eyes
CFS brings some resources
The worker knows all the things mom has been doing to get ready for this child, as opposed to a CFS worker who just met mom after delivery and does not know or understand the client
Many women fear CFS and were themselves raised through the foster care systems
HER Pregnancy Program

15. What was learned….
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6. It is a great time to connect with non-pregnant women and address their issues
The team does pregnancy tests, starting the relationship from the moment of knowledge of the pregnancy. Negative tests are a great teaching and learning opportunity
It is very difficult for women to access birth control when they are street-involved. Nurses on the team provide education and support
Women who decide to terminate are supported through the process & up to 6 months post TA
HER Pregnancy Program

16. What was learned…. 7. There are many system issues that need to change
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7. There are many system issues that need to change
A homeless woman is not officially eligible to access Social Assistance until the 7th month of pregnancy. When on SA, she receives $ per month (core essential - $323.00)
Decisions on who gets tested for substances or referred to CFS depends very much on ethnicity and socioeconomic status of the mom. Yet mainstream middle class women who also use substances during pregnancy and are not suspected of doing so
Many service providers, nurses included, do not understand Harm Reduction, and practice in a manner that is harmful to mother and ultimately babe
HER Pregnancy Program

17. What was learned…. 8. Post delivery time is difficult
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8. Post delivery time is difficult
Mainstream providers do not understand how much this woman’s life has changed
Post-partum depression is increased or missed
The moms struggle to cope at 6-12 weeks post partum
The moms don’t want to stop coming to see the team, yet the program needs to end its services at some point (currently at 6 months pp)
HER Pregnancy Program

18. What was learned…. 9. The work is extremely emotionally challenging
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9. The work is extremely emotionally challenging
The team develops relationships with the moms. They see their successes and growth. They may be there for the birth. If baby is apprehended, they mourn as well. And its repetitive.
The team is constantly in advocacy mode and feel frustrated with other service providers
Pregnancy Support Workers have been treated with the same disrespect as the clients
HER Pregnancy Program

19. What was learned…. 10. The power of hope is underestimated
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10. The power of hope is underestimated
The women are afraid to bond with the fetus, believing it will be taken away
The Support Workers show that “it’s possible”
Hearing the heartbeat is a powerful moment and unlimited access to fetal heart rates is important
Once the moms feel hope, they are motivated to try
HER Pregnancy Program

20. Pregnancy & Substance Use
HER Pregnancy Program
9/17/2018

21. Stigma & Discrimination
9/17/2018
Often experience high rates of stigma, discrimination and racism
Factor in pregnancy, and things become exponentially more complex for women
People tend to focus on the fetus, and what the “horrible woman is doing to it”
People forget that addictions and mental health don’t just go away with pregnancy
Pregnancy will make it even harder to discuss substance use
Pregnant women will need a lot more sensitivity and understanding from workers
These negative experiences will make it harder for the woman to access appropriate services
Supports need to be increased instead of being taken away
HER Pregnancy Program

22. Barriers to Prenatal Care
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Previous negative experience with a health care provider (from physicians to receptionists)
Lack of understanding by health care personnel about the realities of street-involved lives
Fear of judgement by mainstream service providers (race, age, income, addictions, legal issues etc.)
Services & care focus on the fetus, with limited woman specific opportunities
Labeled as a mother vs. a woman who is pregnant
Lack of knowledge about pregnancy issues, fetal development and the importance of prenatal care
HER Pregnancy Program

23. Debunking Myths “Crack Babies” & “Oxytots” Being born “addicted”
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“Crack Babies” & “Oxytots”
Being born “addicted”
HER Pregnancy Program

24. Outcomes
HER Pregnancy Program
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25. Outcomes From January 1, 2015- March 31, 2017
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From January 1, March 31, 2017
The team provided services for 115 women:
858 children services supports
742 transportation services
177 home visits
68 babies born:
84% born without NICU admissions (11 admitted)
84% did not leave the hospital against medical advice
57% were breastfeeding
51% saw housing improvement
70% of women parenting who had planned to parent (where CFS said that % would have been apprehended)
HER Pregnancy Program

26. 9/17/2018
HER Pregnancy Program
Questions?

27. H.E.R. Pregnancy Program Streetworks Morgan Chalifoux
Ashley Robertson
Ext. 279
Boyle Street Community Services
Ave
Edmonton, AB
T5H 0K2
Facebook: Streetworks Edmonton
9/17/2018
HER Pregnancy Program