Baby steps toward family-centred perinatal care

By Dr. Ann L. Jefferies MD, MEd, FRCPC

Congratulations to the CPS on its 100th anniversary. It was an honour to be invited to participate in “The Retro-Doc Project” and to share some reflections on a CPS statement from the past. Although I still have hard copies of a few older CPS statements (yes, I am a bit of a hoarder), I do not have a copy of the statement which I chose to have a look at—“Family-Centered Perinatal Care”—published in 1979. It was a thought-provoking exercise to look back and comment on this statement.

Family-centred perinatal care is the philosophy of involving mothers and their families in all aspects of perinatal and newborn care. It is now a familiar concept for health care professionals who care for infants, children and adolescents. For many it is a guiding principle of practice. However, in the 1970s, family-centred care was not mainstream even in neonatal-perinatal medicine. Indeed, a PubMed search over a 5-year period during the 1970s, which I did in preparation for writing this piece, yielded only 8 articles. The Public Health Agency of Canada’s “Recommended Standards for Maternity and Newborn Care” did not use the title "Family Centred Maternal and Newborn Care: National Guidelines" until 1987.

At the time that “Family Centered Perinatal Care” was published, I had finished a rotating internship and had a couple of years of paediatric residency under my belt. In 1979, the presence of fathers / partners during birth was uncommon. I still recall the large nursery at the hospital where I did my internship in which babies spent much of their time during their hospital stay. A large window allowed family members and visitors an opportunity to see the new arrival. Babies were examined in the nursery, not in mother’s room. At feeding time, crying babies were brought out to their mothers in a large cart designed to carry several infants, sometimes on a predetermined schedule which was the same for each infant. Babies may also have left the nursery for some family visits.  

Thinking back, I can imagine that the concepts and recommendations of the 1979 CPS statement may have seemed forward-thinking for the time. Today, we might use the term “disruptive”. In some instances, the recommendations represented major changes in practice and hospital policy. However, the recommendations have been enacted over the years and are still in place today – presence of father during labour and in the delivery room, providing parents with time with their infant immediately after birth, early breastfeeding, direct involvement of other family members, especially siblings, with the infant and, for infants in special care nurseries, ongoing parental contact and sibling involvement as well as consideration of rooming-in for parents and their infant prior to discharge home. These remain some of the basic concepts of family-centred perinatal care today.

When I read this statement in 2022, I get the impression that the recommendations were still in an early, formative stage. Although several paragraphs are devoted to the benefits of increased contact with parents and the positives of rooming-in, the recommendation simply states that the infant should spend some time with mother in the immediate postpartum period. Ongoing rooming-in, with mother and sometimes family becoming the primary caregivers for the healthy newborn, is not included as a recommendation. Early and exclusive, ‘on demand’ breastfeeding is not emphasized. “Early access to the infant” for siblings and other family members is not well described but rather left up to the discretion of the practitioner and hospital. I wonder whether the authors wished to introduce practice changes gently.

I am also struck by the significant social/cultural changes which have taken place since the statement was written and hence are not discussed. The statement reflects the dominant notion of the family unit at the time—infant, mother, father and siblings—and uses the pronouns she and he for mother and father respectively. We now see the family with a much broader lens; it includes but is not limited to same-sex partners, single parent(s) and adoptive/foster families. The 2017 version of “Family Centred Maternal and Newborn Care: National Guidelines” defines family as all those whom the mother considers to be significant others. Supporting mothers during labour and birth is no longer limited to the fathers but is extended to any significant other of the mother’s choosing. Mothers and families have also become more culturally diverse, with diversity in language and birth practices. In my early years of training, cultural competence was not emphasized. Although not a focus, the statement similarly does not discuss culturally appropriate perinatal care.  

Nevertheless, I feel that this CPS statement has withstood the test of time. The recommendations form the foundations of current family-centred perinatal care. The longevity of the recommendations reflects the evidence base for the statement with respect to attachment, early infant behaviours, and successful breastfeeding. Over the years, further evidence has added to the strength of these recommendations.

Dr. Ann L. Jefferies is the principal author of pivotal CPS documents on infant care, writing with the Fetus and Newborn Committee - which she also chaired - for many years. Dr. Jefferies practiced at Mount Sinai Hospital, taught at the University of Toronto, and received a CPS Life Membership Award and the Distiguished Neonatologist Award in 2016/17 for her oustanding contributions to paediatrics in Canada.

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