Staff initiatives and practices at Women’s Hospital at Health Sciences Centre (HSC) have set the standard for health care for women and their families in Manitoba and internationally. For over 130 years, HSC has provided exceptional patient care in the field of women’s and newborn health. More than 255,000 babies have been born at Women’s Hospital since it opened in 1950. With the opening of a new facility, HSC will continue to be a pioneer in research, leadership, and education in maternal, neonatal, and gynecological health care. Let’s look back at the history of women’s and maternal health at what is now Health Sciences Centre Winnipeg.
1888 – 1913: Maternity Hospital
The Winnipeg General Hospital (WGH) was founded in 1872 and had its first permanent building in 1875. A dedicated Maternity Hospital opened in December 1888, with a construction cost of $7,349.40. It was a two-storey brick building located 200 feet from the main hospital, facing Olivia Street. It was separate from Winnipeg General Hospital in order to keep mothers and babies safe from infectious diseases – although a tunnel was added a few years later. The hospital accommodated fifteen public patients and included four single wards for private patients. A graduate nurse supervised student nurses who gained experience at the Maternity Hospital. Obstetrics were performed by Dr. John Sidney Gray and Dr. Henry Havelock Chown.
Because most women delivered their babies at home, only two babies were born at the Maternity Hospital during its first month of operation. The Maternity Hospital primarily served unwed mothers, the destitute, rural patients, and those women whose labours were expected to be difficult. It was of great benefit to the School of Nursing and the Medical College that had just graduated its first students. It was this hospital that made clinical teaching of obstetrics possible.
As the Maternity Hospital became established, there was steady growth in the number of births and greater need for obstetrical services, with patients requiring surgery for complex cases, including tumours, cancer, and hysterectomies. These increased demands put a heavy strain on the physicians and patients and there were repeated requests for the Maternity Hospital to be expanded or new arrangements made, to accommodate the patient population.
Despite this, in 1911, the building was torn down to accommodate an extension of the Nurses’ Home. The Winnipeg General Hospital Board of Directors believed that maternity hospitals at Grace and Misericordia could meet the needs of the city. WGH staff protested this decision, due to patient demand and the opportunity for obstetrical education it offered. In the end, a temporary maternity hospital was set up in the Annex Nurses’ Home. In 1913, two new six-storey wings doubled patient capacity at WGH. The fourth and fifth floors of the West Wing were designated as the Maternity Wards.
1913 – 1950: Maternity Wards
In the first year of operation, the number of births on the Maternity Wards rose from 166 to 446 – an increase of almost 170%. The obstetrics section was staffed by one nurse, with physicians taking on rotations in the obstetrics and gynecology sections. By 1917, a Gynecological Clinic was offered through the Outpatient Department twice a week. A weekly Prenatal Clinic was added to the Outpatient Department in January 1919 for the ‘care of expectant mothers’ who were otherwise unable to come to the clinic for medical attention and advice. Over 125 patients visited during its first year. Prenatal Clinic staff worked closely with the WGH Social Services Department team to offer support – including at least one home visit – for those who needed it after the birth of a baby. The success of the Prenatal Clinic grew and it was eventually offered twice a week.
In 1923, the Department of Obstetrics was enlarged and two additional appointments were made – Dr. Frederick McGuinness and Dr. W.F. Abbot were appointed Clinical Assistants in Obstetrics. Dr. McGuinness would eventually go on to be Head, Department of Obstetrics and Gynecology, and was influential in lobbying for the opening of a separate maternity hospital.
In 1926, the services offered for mothers expanded with the opening of a weekly Postnatal Clinic, which provided advice to mothers on how to care for their babies and themselves. Follow-up visits were essential for the success of this program. The Winnipeg Hospital Aid and Convalescent Board provided a set of clothing, linens, and sometimes toiletries to the Social Service Department to give to mothers in need when leaving the hospital, especially during the 1930s.
The Prenatal and Postnatal Clinics were very well attended throughout the late 1920s and into the 1930s. In 1931, there were over 4,000 visits to the Prenatal Clinic. Unmarried mothers were also increasing in numbers, which placed greater demand on the Social Service Department.
In 1931, the demands on the Maternity Ward became overwhelming and over thirty women were transferred to other hospitals in order to deliver their babies. In addition, the depressed economy and decrease in revenue forced the trustees to close the Outpatient Department in 1933 – which included the Prenatal and Postnatal Clinics. Additional space for patients, a nursery, and service room were provided as a Maternity Annex in WGH in the 1930s and 1940s.
The need for a dedicated building was becoming increasingly apparent. In 1945, a committee was appointed to plan and organize a separate maternity pavilion. Bird Construction Company Limited was hired to build the new Maternity Pavilion in 1948, to be opened in spring of 1950.
1950: Maternity Pavilion
The official opening of the Maternity Pavilion took place during the evening of 26 April 1950. John T. Boyd, Vice-Chairman of the WGH Hospital Board, officiated at the ceremony. Approximately two hundred guests, including provincial, civic, and hospital officials, attended the event that concluded with the WGH School of Nursing Glee Club singing the hymn, “Bless This House”. The Maternity Pavilion was open for public tours over the next three days and over one hundred twenty White Cross Guild volunteers assisted nurses to direct visitors and serve as guides.
It was estimated that thousands of people toured the new facility during the open house. Though the bright colour combinations in the new hospital caught the eye of guests, it would inevitably be the increased and more efficient use of the space that left a lasting impression. When describing the Maternity Pavilion, Grace Johnson, who became the first Director of Nurses at the Maternity Pavilion, stated,
“Nothing is left desired for the welfare of both mother and babe. It has been stated that it is one of the most modern in Canada. It is truly a dream come true for many. One of the features that is so noticeable to those of us who have lived through the overcrowding in the previous department is the space and the lack of confusion. As the units, labour rooms, nurseries, and wards are separate there is comparative peaceful surroundings for the mothers”.
When it opened, the Maternity Pavilion was considered to be a state-of-the-art, modern facility. It was separate from the General Hospital to reduce the risk of infection. It included a bed capacity of 132, and was designed to provide maximum safety and comfort to mother and baby. It included ten labour rooms and one operating room. Eighteen self-contained nurseries featured automatic temperature and humidity controls, and a modern formula feeding room was equipped to prepare six hundred baby feedings per day.
The Department of Obstetrics and Gynecology of Winnipeg General Hospital was by now a strong and active teaching unit of the Faculty of Medicine. The new Maternity Pavilion, with its modern facilities, created opportunities to enhance the scope of training for students, interns, and graduates, and provide training in the latest methods in obstetrical practice.
Investment in a new Maternity Pavilion underscored the importance of having babies in a hospital, providing peace of mind to the mother thanks to constant supervision by staff with access to the most modern methods and equipment.
Staff at the Maternity Pavilion were able to offer:
- Special care of newborns and 24/7 supervision – especially true with premature infants, including the availability of a Premature Nursery with temperature, humidity, and oxygen control
- Prenatal, postnatal, and newborn services
- Specialized care for complications associated with pregnancy – diabetes, cardiac conditions, toxemia
- Private rooms
The move to the Maternity Pavilion is still remembered to this day. Though the intention was to move patients from WGH slowly over time, Mother Nature had other plans. As spring flood waters rose around hospitals closer to the rivers, patients were transferred to WGH, which means the women and babies had to be moved to the Pavilion as soon as possible. With the help of everyone on staff – and while babies were being delivered – the Pavilion was cleaned and set up. All patients were moved from WGH to the Pavilion in two hours. In the middle of the move, the Pavilion’s first baby was born: at 2:57pm, Mrs. Betty Goosen, (also spelled Goossen and Gossin in other accounts) who was evacuated from Morris hospital due to the flood, had a baby girl. In total, three babies were born on 6 May 1950, and the first meal arrived – on time – at 5pm.
From 1950 to 1952, only the first two floors of the Maternity Pavilion were open due to a lack of nursing staff. This period also signified a change of leadership at the Maternity Pavilion with the resignation of Dr. Frederick McGuinness. In his stead, Dr. Elinor Black was appointed Professor and Head of Obstetrics and Gynecology at the University of Manitoba, Faculty of Medicine, the first such appointment for any female graduate in Canada. Under the leadership of Dr. Black, the Department of Obstetrics and Gynecology grew in size and in stature to assume its rightful place as a major clinical department.
The success of the Maternity Pavilion was evident in the record number of births that took place in 1953 – 4,019 babies were born – possible only because the third floor was opened in February. This expansion relieved some of the overcrowding on the Labour Floor; however, lack of space for other services was still an issue. The Prenatal and Postnatal Outpatient Clinics that closed in 1933 due to financial constraints were resurrected, and were well-received and attended. In 1956, plans were made for an Infectious Unit in the Obstetrical area, so that women with infections could be contained in one area, thus reducing risk of further contamination. 1 West was re-arranged to provide single patient accommodation for women facing difficult pregnancies.
1973 – 1989: Women’s Centre/Women’s Hospital
In 1973, Health Sciences Centre was established by the government of Manitoba. It combined the Winnipeg General Hospital (which included the Women’s Pavilion), the Children’s Hospital, The Manitoba Rehabilitation Hospital, and the D.A. Stewart Centre (Respiratory Hospital) into one campus with one administration. The Women’s Pavilion was renamed the Women’s Centre in 1973, which was changed to Women’s Hospital in 1979.
In the mid-1970s, it was acknowledged that the Women’s Hospital required substantial renovations and upgrades in order to continue to deliver excellence in obstetrical and gynecological care. In 1978, a commitment was made by HSC to upgrade areas in Labour and Delivery, gynecological operating rooms, and in the Intensive Care Nursery.
Major renovations eventually took place in 1982 as part of the Women’s Hospital renovation and equipment project. The project included completion of a newly integrated Labour and Delivery unit, with five birthing rooms, six labour rooms, three special delivery rooms, and a five bed recovery area. There was a High Risk Fetal Assessment and inpatient treatment unit, as well as operating theatres and an infant resuscitation area. The new unit incorporated the philosophies of family-centered maternity care, in addition to retaining its role as the principal tertiary care facility for high risk pregnancies in Manitoba.
Due to the growth of the Gynecological Oncology program at Women’s Hospital and the establishment of the Gynecologic Oncology fellowship program at the University of Manitoba, six modern operating theatres for gynecology/oncology surgery were opened. One floor of the hospital was devoted to the comprehensive care of gynecological oncology patients and included diagnostic procedures.
Further accomplishments included moving the Neonatal Intensive Care Unit (NICU) and major surgical areas into the Thorlakson building, allowing Women’s Hospital to continue to accommodate High Risk Fetal Assessment, related clinical investigation Obstetrical/Gynecological ambulatory care, day surgery, and maternal and health problems.
Despite functioning with limited space and planning for renovations that took ten years to complete, Women’s Hospital continued to expand services and programs including the introduction of PKU testing for early detection of genetic deformities, expansion of the perinatal program, and establishment of a perinatal high-risk transport program (Neonatal Transport Program). It also achieved major results in treating hyaline membrane disease, also known as infant respiratory distress syndrome.
1990 – 1999: New Practices
The mid-1990s was a transitional period for the Women’s Hospital and HSC as a whole. In June 1994, the HSC promoted a program management structure. However, several nurse-driven practices emerged in the early 1990s at the Women’s Hospital.
Kathy Hamelin, Clinical Nurse Specialist, researched the principles of Kangaroo Care (also known as KC or skin-to-skin) that had been practiced and studied in hospitals in Europe. This model of infant care was primarily used with medically stable premature infants or sick infants where the infant, wearing only a diaper, was placed in direct skin-to-skin contact with their mother or father for as long as beneficial. This contact not only encouraged bonding, it was discovered that the parent’s stable body temperature helped to regulate the baby’s temperature more smoothly than an incubator; infants also experienced more normalized heart rate, respiratory rate, increased weight gain, and more successful breastfeeding.
Other programs and research at Women’s Hospital were influenced by the Baby-Friendly Hospital Initiative (BFHI), launched in 1991 through UNICEF and the World Health Organization, for maternity hospitals or wards that were supportive of breastfeeding. This initiative was the basis for the creation of the Breastfeeding Service at Women’s Hospital.
Throughout the early 1990s, a number of Outpatient Services were initiated to improve parent/child development at home. Programs such as Cradle Chat (a drop-in program that provided information and support for mothers, fathers, and babies) and a breastfeeding clinic and hotline were being used regularly and were described as valuable services.
In 1985, the Antenatal Home Care Program was established. The program offered a safe, community-based alternative to hospital care for women experiencing complications of pregnancy including high blood pressure, preterm labour, premature preterm rupture of membranes (PPROM), or diabetes. A nurse would visit patients in their home to provide daily, semi-weekly, or weekly care depending on the needs of the patient. This program was the first of its kind in Canada and the model from which many other Canadian programs were developed. It expanded its services in November 1991, and became part of the WRHA in 2000. The program continues to thrive in 2019.
Building on the commitment to meet the health needs of all women, the Mature Women’s Program was created in 1994 as a joint initiative of the Women’s Hospital Ambulatory Care Department and Department of Obstetrics, Gynecology, and Reproductive Sciences. It specialized in dealing with a range of gynecological issues, including menopause transition and hysterectomy alternatives.
Operating rooms for elective surgery, recovery, and pre-operation became available for all women. Over time, surgeries became less invasive, faster, and requiring less pre and post operation recovery. Same-day admission became an option, so women can remain at home the night before, helping to lower hospital costs and increase the patient’s comfort. Health care workers at the Women’s Hospital provide state-of-the-art surgical care, including Laparoscopic, Hystroscopic, Vaginal, Uro-Gynecologial, and Laparotomy procedures. As technology changed, so too did availability and complexity of surgery. To support the surgical environment of Women’s Hospital, a nurse-managed Pre-Assessment Clinic was made available to provide pre-operative assessment care to all patients who require admission post operatively, an anesthesia consult, or collaborative care from other allied health providers.
In the late 1990s, gynecology and gyne-oncology clinical programs were reviewed and efficiencies made for improved care and service within the operating room, day surgery, post-anaesthesia, inpatient care, palliative care, and pre-admission clinic. Nurses were utilized in both clinical areas to provide service related to both inpatient and outpatient events, which contributed to a more seamless and supportive care continuum. The volume of surgeries, and the complexity of the procedures continued to increase over time, and the Women’s Hospital team rose to the challenge. Laparoscopic surgery, for example, reduced surgery length, recovery time, and pre-surgery time, allowing for more resources to be available for patient care.
2000 – 2019: Family-Centered Model of Care
On 1 April 2000, HSC became an operating division of the Winnipeg Regional Health Authority and came under the governance of the WRHA Board of Directors. Subsequently, many research and program developments surrounding women’s and newborn health began to involve collaboration with numerous WRHA stakeholders, and programs were often piloted across the region.
Starting in 2000, HSC began to emphasize a family-centred model of care, where the medical staff come to an agreement about the patient’s health care plan based on the family’s needs and beliefs.
As a result, the Women’s Family Birthplace, or LDRP, opened in September 2000. This unit was the brainchild of Drs. James Allardice and Myrna Rourke, who envisioned a more home-like setting for healthy women and their babies. The philosophy focuses on the woman, her family, and the celebration of the event. The Birthplace offered patients alternative birthing options, including the integration of midwives, and alternative pain management. It was modeled after the Labour, Delivery, Recovery, Postpartum concept where families can share in all phases of the birthing experience in one place. The model was in place until 2016 when demand outpaced space and resources. Women were getting pregnant later in life, sometimes with other health issues, and postpartum care was becoming more complex, and requiring more resources that the LDRP model could accommodate. Subsequently, while labour, delivery, and recovery remained in one place, postpartum care was moved elsewhere to facilitate the level of care that was needed.
Another example of family-centred model of care was the implementation of the Care Map system for low-risk mothers, which outlines the best sequence and timing of care based on clinical guidelines, best practices, and the family’s wants and needs. Alternative birthing options were offered and encouraged. For example, from 1998 to 2001, the hospital updated its education on Midwifery. Furthermore, support care in labour was acknowledged as an important part of the labour process. Water, exercise balls, and stools were just a few of the tools used to facilitate the labour process.
Obstetrical triage is a necessary area in the Women’s Hospital. Patients who are experiencing complications or have questions are triaged by nurses who direct them to the care or answers they need. Approximately 80% of patients are able to go home after seeing the triage nurse, and the rest are admitted to the appropriate area of the hospital.
The Women’s Hospital gained access to Patient Care computers in 2002, making administration and research easier and leaving more time for patient care. As part of a hospital-wide approach to continuous improvement and adding value for our patients, communication boards were added to patient rooms, facilitating timely, two-way communication between patients, families, and care givers.
Understanding the needs of the patient is a key part of the family-centred model of care, and extends to the home and community. As one example, HSC made an effort to involve itself and its care in Indigenous communities and customs. In the 2010s, the Women’s Hospital started to reach out to nearby and remote Indigenous communities, as a way to inform the development of programs created for women’s and baby’s health. In 2011, WRHA developed the Prenatal Connections program, which offered services for women and families from First Nations, Inuit, Metis, and other remote communities who had to leave their home to obtain specialized care.
The hospital also took steps to protect women in compromised places, physically and emotionally. The Partners in Inner-City Integrated Prenatal Care Project was developed in 2012 to reduce barriers of prenatal care for pregnant women in inner-city Winnipeg. Additionally, in 2015, a nurse-led collaborative pilot project found that family-centred care – keeping mother and baby together – was beneficial for newborn babies of opiate-addicted mothers who were on methadone maintenance.
Though the Women’s Hospital implemented extraordinary programs, increased its level of care through education and technology, and improved their procedures, they were physically limited by the space – or lack thereof – of the current building. Dreams of a large, state-of-the-art facility would not go unanswered.
2008 – Current: Women’s Hospital Redevelopment Project
In 2007, Manitoba Health Minister Theresa Oswald announced that a new women’s hospital would be built at HSC. In January 2008, the planning committee began selecting functional programmers and architects, and conducting a public consultation process to gather input from Manitobans on the design and priorities for the hospital. From the very beginning HSC was committed to continued excellence in patient care and fostering community relationships. Helga Bryant, HSC’s Vice-President and Chief Nursing Officer said, “We want to know what women value in this type of facility and what we can include that will help make their stay or visit more comfortable”.
By the end of 2008, a series of goals were outlined in the Women’s Hospital Project Charter. The new hospital should be: women and family centred, functional and effective, a centre of excellence, safe and secure, sustainable, welcoming and accessible, and positively integrated into the neighbourhood. The primary aim: to provide enhanced care in a homelike atmosphere.
Plans for the building included accommodations for low-risk and high-risk maternity, gynecological, and palliative care patients, as well as a state-of-the-art Neonatal Intensive Care Unit. It would serve as a surgical and consultation hub for women of all ages, and would enhance its position as a teaching hospital with more classrooms, meeting spaces, and private spaces to consult with patients. A direct connection to the Children’s Hospital, via skywalk, was vital.
Based on community feedback, the new hospital would have a wildflower theme, and would be welcoming, calming, restful, private, environmentally friendly, and homey, with accommodations and resources for partners or support people.
Construction on the new HSC Women’s Hospital began in June, 2011. At nearly 400,000 square feet – a 25% increase from the current capacity – the new Women’s Hospital will be the largest and most complex health care project in Manitoba’s history. It will encompass 173 beds, private rooms and bathrooms, ceremonial and green spaces, state-of-the-art family-centred mother and baby units for fetal assessment, obstetrical triage, labour, delivery, recovery, neonatal intensive care, women’s surgical centre and inpatient gynecological unit, infection control, and improved accessibility.
According to Nicolette Holling-Kostiuk, Clinical Manager of the Women’s Hospital Redevelopment Project, the building is designed with LEED (Leadership in Energy and Environmental Design) Silver certification in mind, which means more windows letting in sunlight. Private rooms and more elevators are beneficial for women, families, and hospital staff. Family-centred care will ensure that mothers and babies will be cared for as a unit, within the context of their families, and not separated unless necessary.
The new hospital will be the first area at HSC to expand the use of the Electronic Patient Record (EPR), allowing integration of information to provide accurate and timely information to care providers. The Fetal Assessment Unit ultrasound and report will be integrated with the information system so care providers can readily access the information for labouring women. The Rh Clinic will utilize the EPR to support clinic processes. The Colonoscopy Clinic will also benefit from the information sharing by providing reporting capabilities for CancerCare Manitoba’s CervixCheck program.
The new facility will feature decentralized workstations – rather than a single main desk in each wing – so health care professionals are better able to assist patients. Each wing will also have its own supply room, cleaning room, and med room so all of the necessities are in one area. Staff will implement best-practice for access to computer charting, confidential discussions, teaching opportunities, telehealth capabilities, and areas for rest and rejuvenation.
Hospital leaders have been in training and brainstorming sessions since 2008 to ensure it will all run smoothly before it opens. Many of the programs and technologies that will be seen in the new hospital will have been practiced and implemented in advance to ensure a smooth transition. A commissioning team has inspected each building system as the hospital was being constructed to confirm that equipment and systems are functioning as intended and to resolve any issues before opening.
Monika Warren, Director of Women’s Health, said “[i]n any clinical work we embark on, we’re trying to assess service delivery. We do our best to listen, acknowledge, and learn from what patients have told us about their experiences. When we plan, we start with the question ‘Will it improve patient experience?’” Incorporating the views of the community with the wildflower theme, spiritual spaces, green and relaxation spaces, and a homey environment is a significant step towards improving experience. The new programs and technology, based on years of knowledge and experience, will do the rest.
The new HSC Women’s Hospital will allow staff to build on well-established methods of care, with improved space and technology. It will allow the dedicated staff team to improve the patient experience, and facilitate continued excellence in research, leadership, and education of women’s and maternal health.