Some Canadian women needing specialized care for anticipated high-risk preterm births are coming to Spokane to deliver their babies due to a spike in such births north of the border and a shortage of neonatal facilities and specialists there.


So far, though, all such births hereinvolving solely British Columbia residentsare being handled primarily at Deaconess Medical Center, which has 44 neonatal intensive care beds, under an arrangement through which the hospital is being reimbursed by the British Columbia Ministry of Health.


Sacred Heart Medical Center says it was approached by the province last year about accepting some Canadian patients, but had to decline all but one, because its neonatal intensive care unit, which has 40 beds, was too full for it to take on additional patients. The Spokane areas other two major hospitals, Holy Family Hospital and Valley Hospital & Medical Center, dont offer neonatal intensive care services.


Eighteen preterm babies whose mothers live in British Columbia were born at Deaconess in 2007 and spent weeks or sometimes months here in the hospitals neonatal intensive care unit at a total cost for the year of $1.6 million.


Another four or five mothers were brought to Deaconess last year because they were at risk of having their babies prematurely, but were able to return to Canada to deliver, says Ann Seaburg, manager of Deaconess neonatal intensive care unit. The hospital is reimbursed for the care provided to Canadian patients by the British Columbia Ministry of Health, which says there was a spike in high-risk pregnancies in the province last year.


Its not clear whether that spike will become a long-term trend, but, Seaburg says that with eight more Canadian infants born here so far in 2008, it appears the spike hasnt fallen off yet.


One woman, named Desiree Sayson, who was airlifted to Spokane from Vancouver, British Columbia, was here from Dec. 22 until March 12. She had gone to a hospital in Vancouver when she began having contractions 24 weeks into her pregnancy. Full-term babies are born around 40 weeks after conception, though twins are frequently born earlier. Sayson says the doctors told her she would have to travel to the U.S. in case she had her twin babies early.


I was really surprised they couldnt handle us, Sayson says. Since there was no space for her in a Seattle hospital, Sayson was flown by air ambulance to Deaconess. She was admitted to the hospital, where she stayed on bed rest for the remainder of her pregnancy.


Until last week, she stayed at the nearby Ronald McDonald House, spending her days at Deaconess, caring for her premature twin girls, Eimee and Demi, who were born Jan. 28, when she was 30 weeks pregnant.


Altogether, 69 women and babies from British Columbia were transferred to Washington state for care last year, because of a combination of limited space and a shortage of specialists in that provinces hospitals, says Sarah Plank, a spokeswoman for the British Columbia Ministry of Health.


The cost of the care is high, averaging $94,000 per patient for a high-risk birth and an extended stay in the neonatal intensive care unit at Deaconess. The hospital, however, gives the British Columbia Ministry of Health a 10 percent discount on the services it provides for those mothers and babies, says Alicia Colette, a finance representative at Deaconess. She says the Canadian government indicated it has a similar arrangement with Swedish Medical Center in Seattle.


In addition to providing medical care, Deaconess helps the parents find lodging, either at the Ronald McDonald House or at a nearby hotel, and tries to make them feel at home, Seaburg says. She says the staff even sings the Canadian national anthem for the newborn babies.


Space is at a premium in the three British Columbia hospitals that have beds for high-risk deliveries in cases where the infant likely would need level-three, intensive care, Plank says.


That level of care usually means the baby needs help breathing with a respirator, while babies receiving level-two care might need a feeding tube but would be able to breathe well on their own, Deaconess Seaburg says.


Along with British Columbia, neighboring province Alberta, which normally would share hospital resources, also was over capacity last year and often couldnt take the extra patients, Plank says.


Deaconess Seaburg says a similar spike in premature births in Washington is one of the reasons women from Vancouver sometimes are sent to Spokane rather than Seattle, which is closer.


Plank says that the normal flow for patients would be to go to Alberta first if there isnt space in British Columbias 50 or so level-three neonatal intensive care beds that are spread between three facilities. For all neonatal intensive care, the province has about 200 beds, Plank says.


The number of beds isnt the only problem, though, Plank says.


The challenge is that they require quite specialized health professionals to staff them. The neonatologists and nurses are in short supply, she says. Some of the beds we do have here are not always open because of staffing issues. You have to recruit the health-care workers to staff them.


Plank says British Columbia is working on recruitment efforts for such workers, and is studying the issue to determine whether the spike is temporary or represents a trend that will continue.


In addition to the cost of the babies care, the Canadian government covers the cost of airlifting patients like Sayson from British Columbia to Deaconess, as well as her lodging and transportation while she was here. Sayson had to pay for her own food while she stayed at the Ronald McDonald House near the hospital. Saysons husband, a structural engineer, stayed at the Ronald McDonald House with her until he had to return to Vancouver several weeks ago to work.


The reasons for the spike arent completely known, Plank says, but include the aging of the child-bearing population, with more women giving birth later in life, and an increase in obesity, diabetes, and the use of fertility drugs, with the latter resulting in more multiple births.


In Washington, there has been an increase in late preterm babies, who are born at 35 to 38 weeks, and may seem a normal weight but have difficulty breathing, or have fluctuating blood sugar or body temperature, and end up in intensive care, says Maureen Shogan, a clinical nurse specialist at Deaconess. The incidence of twins is rising here too, and she says its common to see three or four sets of twins in the hospitals intensive-care unit at any given time.


In Spokane County, preterm births leaped to 694 in 2006, the most recent year for which data are available, up from 586 in 2005, the March of Dimes says.


Seaburg says collaboration with the caregivers in British Columbia is an important part of caring for their patients. She says as the neonatal intensive-care unit has had more transfers of babies back to British Columbia hospitals, it transitions the babies to medications and apparatus, such as feeding tubes, that are compatible with those used in Canada.


Jan Moreau, a discharge planning and family education coordinator at British Columbia Womens Hospital & Health Center in Vancouver, says the goals are to care for the health of the babies and mothers, and to return the children to Canada as soon as possible. Babies who need to remain hospitalized longer can sometimes be transferred to a Canadian hospital when a bed becomes available or they need a less intense level of care.


If we can repatriate these babies, we try to, Moreau says. If we have a bed available and the baby is stable, we bring them back if we can.


Seaburg says Deaconess gets calls from Canadian health-care workers daily seeking status reports on Canadian patients here, and says the collaboration has gotten smoother as the relationships between care teams have developed.


Weve worked well together, coordinating with cross-border patient management teams by teleconference, Moreau says.


For Sayson, a native of the Philippines, getting visas for her babies could have been difficult had her husband not recently received his Canadian citizenship. Sayson returned to Canada with the girls March 12, in time for her own citizenship ceremony. As for her babies, theyand all the other Canadian babies born herereturn home from Deaconess with an extra giftdual Canadian-U.S. citizenship until their 18th birthdays, Seaburg says.


Contact Jeanne Gustafson at (509) 344-1264 or via e-mail at jeanneg@spokanejournal.com.