Dr. Victoria Allen - Obstetrics & Gynaecology

Safer birth:
Dr. Victoria Allen searches provincial database for clues to elevated risk
As a specialist in maternal-fetal medicine, obstetrician Dr. Victoria Allen (Vicky) wants to know what factors put mothers and babies at higher risk of birth-related complications. These can range from fever, infection or hemorrhage in the mother, to respiratory distress, trauma or even death in the newborn. “Tragic outcomes are rare across Canada and here at the IWK,” Vicky says. “Still, we are on a mission to discover how we can best ensure the safety and wellbeing of mother and child.”

While physicians, nurses and midwives must approach every birth as a unique and singular event, there is much wisdom to be gleaned from masses of data describing a multitude of births. In Nova Scotia, the Atlee Perinatal Database provides such a wealth of information. “The Atlee database has been collecting anonymous information about mothers, pregnancies, births and newborn outcomes for the entire province since 1988,” notes Vicky. “It is an incredibly rich resource.”

While doing her specialist training in maternal-fetal medicine at the University of Toronto, Vicky also completed an MSc. in clinical epidemiology. This gives her precisely the skills she needs to mine the Atlee database (with ethics approval) for valuable insights into the impact of maternal characteristics (such as age, weight, health), pregnancy complications, length of the stages of labour, and obstetric interventions, on outcomes for mothers and newborns.

“We have found that risks are higher when the pushing stage is drawn out over a long period of time,” notes Vicky. “For example, if a women needs a cesarean section after she has pushed a long time, her risk of infection and bleeding are higher than those of a woman who did not push as long, or at all, before cesarean. For the baby, the risk of respiratory distress goes up the longer the mother pushes, regardless of delivery method.”

Vicky and her colleagues are examining how length of pushing and delivery method (such as spontaneous, vacuum or forceps assisted, cesarean) interact with such factors as the number of times the woman has given birth, her age and health, and any pregnancy or labour-related complications, to increase risk. Their findings allow IWK birth teams to more intelligently and proactively manage each birth situation.

“We are all working together—obstetricians, family doctors, anesthetists, midwives, nurses—to determine what points in labour put what types of women at highest risk,” Vicky says. “From this understanding we hope to identify the optimum timing for such interventions as an epidural anesthesia, pitocin drip, or cesarean section. Ultimately, our aim is to safeguard our mothers and babies to the very best of our abilities.”

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