2008 2009 2010 Readers’ Choice Award Voted Favourite Dentist Sp e c i a l De l i v e r y 2 www. r v h . o n . c a *Including in-store promotions. Amount before taxes. Offer ends April 30th, 2012. Coupon must be presented at time of purchase. Limit of one (1) coupon per transaction. Not valid with any other coupon. No cash surrender value. No mechanical reproductions accepted. A full or partial refund may void this coupon. ADVERTISING- (To process discount, use $ Off Transaction Discount and select Coupon 1) THYMEMATERNITY.COM Sp e c i a l De l i v e r y 3 www. r v h . o n . c a Inside What’s RVH celebrates your special delivery...........5 Pregnant? No doctor? No problem!.............6 Who will take care of me?............................8 Exercise in pregnancy.................................10 Things to avoid during pregnancy..............11 When every bite counts..............................12 Barrie midwives..........................................15 How will I know I’m in labour?..................16 Give your baby the best start....................18 What about the pain?.................................20 News hound meets his match....................22 Special care for special babies...................25 RVH has ‘labour’ pains too.........................26 Taking care of children ..............................28 Help for new parents ................................30 News hound has met his match See page 22 Published by 21 Patterson Road Barrie, ON L4N 7W6 Special Delivery Magazine is published in cooperation with Royal Victoria Hospital’s Corporate Communications Department and The Barrie Advance. TODDLER & CASA PROGRAM • We accept children at 18 months • 5 children only per classroom • Calm, structured, consistent routine • Daily naps in a cozy atmosphere • Hot lunch/snacks inclusive • We get excited about toilet training! • Qualified nurturing instructors • Ask about our extended before Two Locations and after care hours Visit our web site and register online at: www.maplehillmontessori.com Sp e c i a l De l i v e r y 147 Toronto St., 767 Huronia Rd., Barrie 728-1008 Fax 728-8022 4 www. r v h . o n . c a RVH celebrates the arrival of your special delivery C By Dr. Vincent Wu RVH Chief of Obstetrics ongratulations on this exciting time in your life and thank you for choosing Royal Victoria Hospital for your ‘Special Delivery’. Last year almost 2,200 babies made their debut at RVH and it’s always a family affair! Here at RVH, we support a family-centred approach to maternity care. We also believe strongly in providing care to the new family both physically and emotionally, so our team includes obstetricians, family physicians, midwives, paediatricians, anesthesiologists, nurses, as well as a staff social worker. RVH’s attractive birthing rooms which feature private bathrooms with showers allow women to labour and deliver in the same bright, spacious room. All eight rooms feature peaceful views overlooking the nearby forest or lake. RVH has a whirlpool tub available for labouring moms. If complications arise, fully-equipped operating rooms are nearby to handle emergencies. continued on page 9 Infants to Senior Kindergarten �������������������� Sp e c i a l De l i v e r y 5 www. r v h . o n . c a Pregnant? No doctor? No problem! C hristina Williamson is excited about the arrival of her first child, but worried because she has no family doctor. So the high school teacher did a bit of homework herself and found the Barrie Prenatal Clinic. Armed with a list of 10 questions, the expectant mom sits in the waiting room until it is time for her first prenatal appointment. “This is my first child so I really have no idea what I’m doing. I want to make sure I have the right information and that I have someone to help me along the way,” says Williamson. The mom-to-be is just one of thousands who have found the answers to their pregnancy questions at The Prenatal Clinic. Now in its eighth year, the clinic is open Monday to Friday from 8 a.m. to 4 p.m. providing prenatal care to women without a family doctor of their own. And that means the world to expectant moms like Williamson. “It is very important to have a clinic like this,” continued on page 7 Barrie Midwives provides primary care throughout pregnancy, labour, and birth, and for six weeks post partum. • No doctor referral needed • Choice of birthplace: home or RVH • Fully funded by the Ontario Ministry of Health • On Call 24 Hours a day, 7 days a week 705-727-7 660 • www.barr iem idwives .com 1 Quarry Ridge Road, Suite 303, Barrie, ON L4M 7G1 Sp e c i a l De l i v e r y 6 www. r v h . o n . c a continued from page 6 says the 31-year-old woman. “Prenatal care is to more of a prenatal counselling role. They also vital. It is very important to know that as the discuss Integrated Prenatal Screening tests which pregnancy progresses your baby’s health is being can determine if the woman has a lower or higher monitored. I’m a little worried and so for me, it is chance of having a baby with Down Syndrome, important to know that you have someone to see genetic disorders, or an open neural tube defect when you have questions.” (when the skull or spine does not develop Although well-read and a huge user of properly). the internet, Williamson believes there is no Once at the clinic the mom-to-be will remain substitute for being able to ask questions and under the care of the clinic’s roster of three family have them answered by a medical professional doctors, who rotate shifts at the clinic. face-to-face. Her questions range in subject At the 28-week mark her care will be matter from nutrition, foods transferred to one of seven to avoid, premature birth and obstetricians at Royal Victoria calcium intake, and whether Hospital (RVH) or until just after she can still play volleyball, but the delivery of the baby. her most pressing question is “Pregnancy is a very exciting about travel. She had planned time for a woman and her on climbing Kilimanjaro with her family, and I just like helping high school class, and just isn’t these new moms through that sure if she should still go. time,” says Dr. McNaughton. Her instinct was right - the “We want the women and energetic teacher is advised to their babies to get off to a good put her travel plans on hold – start.” for now. Williamson admits just Once the baby is born, the having her first few questions mom is welcome to go back answered has already put her to the Well Baby Clinic where mind at ease. her child will receive regular That’s good news for the immunizations and checkups physicians who work at the clinic, until the age of four. Dr. Jennifer McNaughton (left) because it is the very reason the And for Williamson, she’s consults with Heather Hurban, medial clinic was opened. The purpose fine with putting her Kilimanjaro assistant, during a busy day at the of the clinic is to ensure that climb on hold because she Prenatal Clinic. women without a family doctor knows she and her husband have a much bigger have access to prenatal care. adventure ahead of them. “We welcome women to visit early in their The Prenatal Clinic and Well Baby Clinic pregnancy to have their questions answered and (Monday to Friday from 8 a.m. to 4 p.m.) and tests completed,” says Dr. Jennifer McNaughton. lactation consultant appointments (Monday and “There are a lot of physical changes during Thursday from 9 a.m. to 3 p.m.) can be made by pregnancy and we want to be here to ensure both calling 705-725-8796. All services are covered mom and baby are safe.” under OHIP and are located at 125 Bell Farm The physicians at the clinic perform regular prenatal check ups and are available to answer Road in Barrie. Appointments should be booked questions ranging from nutrition and exercise in advance. 21 Essa Road 301 Blake St. 728-2823 728-2429 www.pharmasave.com Sp e c i a l De l i v e r y 7 www. r v h . o n . c a Who Dr. Shannon Causey, spends a moment with new mom Lori Houle and her newborn delivered by C-section. will take care of me? D uring your pregnancy there will be many professionals involved in providing healthcare for you and your baby - obstetricians, family doctors, midwives and nurses – and one thing you can be sure of is that you will get consistent and exceptional care from all of them. To ensure the entire team of professionals involved in your care are up to date with the latest best practices, and working collaboratively to keep the lines of communication between all parties open, they - obstetricians, family doctors, midwives and nurses – have embarked on a three-year program entitled MoreOB. “The care at RVH has always been excellent, but this program will take us to the next level. It will keep us on top of the latest advances in obstetrical care and ensure effective communication between all care providers and the patient,” says Barb Leonard, RN Birthing Unit and one of the co-chairs of the MoreOB Progam. “Our ultimate mission is patient safety – at all times.” So who would be involved in your care? Family doctors may provide prenatal care up to 28 weeks if there are no concerns or complications with your pregnancy. Five family doctors at RVH still deliver babies and follow Sp e c i a l De l i v e r y their patients through the entire pregnancy and delivery. All other family doctors will transfer your care to one of seven obstetricians once you have hit the 28-week mark. At RVH there are eight midwives who are members of the healthcare team. Midwives provide care from the early stages of pregnancy until six weeks after the birth. If you do not have a family doctor, or your family doctor does not provide prenatal care, the Prenatal Walk-In Clinic will provide prenatal care up until 28 weeks. Please contact (705) 725-8796 for an appointment. You should see your family doctor or obstetrician once a month until you are 28 weeks and then every two weeks. At 36 weeks, your visits should increase to once a week. If you have specific concerns relating to your pregnancy, please make sure you speak with your care provider directly. The Birthing Unit nurses provide one-on-one care while you are in active labour. They will be with you through the labour and delivery of your baby. The obstetrician on-call for the day will monitor your labour and attend the delivery of your baby. Following the delivery of your bundle of joy, your obstetrician or midwife will monitor your post-partum care while in hospital. As long as continued on page 9 8 www. r v h . o n . c a continued from page 8 - Who will take care of you there are no complications you should expect to be discharged from the hospital within 24 to 48 hours. There is usually one follow-up visit with your care provider within two to six weeks of delivery at which point your care will return to your family doctor. While in hospital, your newborn will be under the care of your family doctor. If your family doctor does not have hospital privileges, or you do not have a family doctor, your newborn’s care will be assigned to a group of physicians who provide baby care at RVH. After discharge your newborn will be followed regularly by your family doctor. If you do not have a family doctor, you can attend the Well Child Health Clinic at the Barrie Community Health Centre (705-734-9690 ext. 235) or the Well Baby Clinic at 125 Bell Farm Road (705-725-8796). continued from page 5 - RVH Celebrates your special delivery In fact, the availability of specialized care at Royal Victoria Hospital means most families don’t need to leave the community to get the care they may need. Expectant moms who still have a family physician in another community may have their care transferred to a Barrie obstetrician and deliver their baby in the city where they live. Our Birthing Triage Unit is a specialized area for moms-to-be. All women who are experiencing symptoms of labour or require a prenatal assessment will come to the triage unit just outside the Birthing Unit on the 4th floor. Our Special Care Nursery, with its own neonatologist and latest technology, allows us to care for our tiniest patients close to home as well. And to give parents peace of mind our Birthing Unit, Obstetrics and Special Care Nursery are all high security areas monitored with video cameras. All patients and visitors must be buzzedin from the nursing station. Just newly implemented is an Infant Security System. All babies born at RVH will be given a special electronic ankle band. If a baby is carried within six feet of a door the system will sound an alarm and automatically double-lock all doors. The birth of a child is a magical time in your life, with our caring approach and wide range of sophisticated services, we are committed to not only providing a memorable birth experience, but giving your little one the best possible start in life. Learn and Play Daycare Centre Limited Spaces for infants available. Call to reserve your spot today! Caring for infants to Senior Kindergarten. Providing exceptional daycare in Barrie for over 21 years. Call for information 7721-4905 21 4905 Limited spacing Full and part time available Sp e c i a l De l i v e r y 9 www. r v h . o n . c a Exercise in pregnancy By Dr. Jaco Scheeres anadians are encouraged to include exercise as part of a healthy lifestyle. Many women enter pregnancy with regular aerobic and strengthconditioning activities already as a part of their daily lives. Other women see pregnancy as an opportunity to modify their lifestyles to include more health-conscious activities. In uncomplicated pregnancies, women with or without a previously sedentary lifestyle should be encouraged to participate in aerobic and strength-conditioning exercises as part of a healthy lifestyle. Many women find that the best time to initiate an exercise program is in the second trimester, when the nausea, vomiting, and profound fatigue of the first trimester have passed and before the physical limitations of the third trimester begin. Women who have been exercising prior to pregnancy may continue their exercise regimens throughout pregnancy using the guidelines outlined below. When starting an aerobic exercise program, previously sedentary women should begin with 15 minutes of continuous exercise three times a week, increasing gradually to 30-minute sessions four times a week. C Sp e c i a l De l i v e r y Measures of exercise intensity include the “talk test” and a visual rating of perceived exertion. As the term “talk test” implies, the woman is exercising at a comfortable intensity if she is able to maintain a conversation during exercise. She should reduce the exercise intensity if this is not possible. In addition to exercise, other components of a healthy lifestyle during pregnancy include good nutrition and abstinence from smoking, alcohol, and illicit drugs. Women should stop exercising and seek medical attention if they experience any of the following symptoms: excessive shortness of breath, chest pains, painful uterine contractions, leakage of amniotic fluid or vaginal bleeding. Reasonable goals of aerobic conditioning in pregnancy would be to maintain a good fitness level throughout pregnancy without trying to reach peak fitness or train for an athletic competition. Women should choose activities that will minimize the risk of loss of balance and fetal trauma. Brisk walking, stationary cycling, crosscountry skiing, swimming, or aquafit, are aerobic exercises that cause less trauma to the joints and ligaments and less bouncing up and down of the centre of gravity than running or jogging. It is suggested that a warm-up and cool-down period be included in any exercise regimen. Some women may experience symptomatic hypotension from compression of the vena cava by the pregnant uterus and should modify these exercises to avoid the supine position after approximately 16 weeks gestation. Regular exercise is an important part of maintaining a healthy lifestyle. This is no different during pregnancy. Studies have shown that mild to moderate level of exercise has no harmful effects on a healthy pregnant woman or her baby. In summary, mild to moderate levels of exercise is recommended in a normal and healthy pregnancy. If you have medical problems or pregnancy complications, be sure to talk to your doctor before starting an exercise program. 10 www. r v h . o n . c a Things to avoid during pregnancy! By Dr. Enrique Reyes Alcohol It is well known that alcohol can damage the unborn child, so the safest approach is to avoid it altogether during pregnancy. However, a mother who had an occasional drink before she realized she was pregnant, likely has not put her baby at risk. It is not clear how much alcohol consumption will cause harm to the baby. Excessive amounts ingested steadily could result in a low-weight baby with a small head, facial and limb abnormalities, mental retardation or behavioural problems. This is known as fetal alcohol syndrome (FAS). it is best to quit before you get pregnant. Plan to smoke two cigarettes less each week until you are down to only three a day. It may then be easier to quit - which your baby will also appreciate after birth. Drug Abuse Babies born to mothers who use illegal drugs may show signs of addiction at birth, may be irritable and fussy, and their ability to learn may be impaired. A woman who is using illegal drugs should stop before she gets pregnant. If she finds herself pregnant while still using drugs, she should discuss it with her physician as soon as possible, to get the help and support needed to stop. Smoking The many chemicals inhaled when smoking are known to affect the placenta and some can affect the baby. Studies have clearly shown that the function of the placenta is affected – producing smaller babies, fetal distress, premature labour and sometimes bleeding (in heavy smokers and to a lesser extent in those who smoke less than five cigarettes a day). If you are a smoker Sp e c i a l De l i v e r y If you need help If you feel that you need some support in the area of substance abuse please phone the SOS Umbrella Program - a program designed for pregnant women - ask for Kelly Wilkie 726-4224 ext. 2304. 11 www. r v h . o n . c a When every bite counts! But remember you are not eating for two! By Jane Anne Sullivan, Registered Dietitian at Royal Victoria Hospital W hile it is not true that pregnant women should eat enough for two people, it is a good idea to make every bite count nutritionally. Eating right is very important for many reasons. It helps maintain a healthy weight; helps meet an increased need for iron and prevents anemia; provides needed energy and, believe it or not, speeds up the recovery time after delivery. Good nutrition is essential as it also helps prevent common pregnancy problems like heartburn, nausea, constipation and fatigue. When you are pregnant, you need to pay special attention to your intake of nutrients such as calcium, vitamin D, iron, folic acid and essential fatty acids. Calcium and vitamin D are found in milk and milk products. Three to four cups of low fat milk per day can meet both calcium and vitamin D requirements. Milk substitutes, such as cheese and yogurt each day can meet the requirements for calcium during your pregnancy, but not always vitamin D unless these products are fortified. continued on page 13 Sp e c i a l De l i v e r y 12 www. r v h . o n . c a continued from page 12 Folic acid is needed to support your body’s expanding blood volume and the growth of the tissues you need to support your baby. Folic acid has been found to decrease the risk of neural tube defects (i.e. spina bifida) in your baby. Folic acid can be found in green leafy vegetables, whole grain breads and cereals. Health Canada recommends, “Women who could become pregnant and those who are pregnant should take a multivitamin containing 0.4 mg of folic acid every day.” Iron is an important mineral in a new mother’s diet as it is needed to support the significant increase in the mother’s red blood cell production. Canadian recommendations state that adequate iron stores and a healthy diet can provide sufficient iron to meet these increased needs for iron, but most women enter their pregnancy with low to just adequate iron stores. This is why iron supplements are usually recommended, especially in the second and third trimesters. Health Canada recommends, “Pregnant women should also ensure that their multivitamin contains 16-20 gm of iron.” Iron should be taken with juice or water and apart from meals and other mineral supplements. Essential Fatty Acids (EFA’s) are an important part of the pregnant woman’s diet. Linoleic acid and a-linolenic acid are essential fatty acids. These fats are important for the proper fetal neural and visual development of your baby. You may not have adequate amounts of these EFAs if you eat foods that are high in saturated fats or hydrogenated fats, which are commonly found in commercial bakery products, fried foods and many other convenience foods. Also, women who greatly restrict their intake of fat may also have a low intake of EFA’s. Foods that have large amounts of EFA’s include most common vegetable oils (canola and soybean), margarines and salad dressings made from non-hydrogenated oils such as canola, olive and soybean. Corn, sunflower and peanut oils, some nuts and peanuts are also good sources. Marine fatty fish such as salmon, mackerel and sardines are good sources of fatty acids. Current recommendations are that all women should eat at least 150grams of fish each week. Check the Health Canada website for recommendations on fish intake and mercury found in various types of fish. Weight Gain During Pregnancy Pregnancy isn’t the time to cut back on calories or “go on a diet”. A healthy weight gain during your pregnancy can help to give your baby a healthy start to life. It can also reduce the risks of complications in your pregnancy as well as improve your health in the future. Weight gain can vary depending on your prepregnancy Body Mass Index. In 2009, Health Canada adopted new recommendations for total weight gain during pregnancy. If your pre-pregnancy BMI is in the normal range (18.5-24.9) the recommended total weight gain is in the range of 11.5-16 kg. If your prepregnancy BMI rates you as underweight or overweight, be sure to consult with your doctor. Try for a slow and steady weight gain, but remember that all women gain at different rates. Find out your prepregnancy BMI and your recommended weight gain at www.healthcanada. gc.ca/pregnancy-calculator and talk to your health care provider. During pregnancy, women should eat a balanced, healthy diet. The average woman requires 2200 calories per day to maintain adequate nutrition. Health Canada recommends women in their first trimester do not need to increase their calorie intake but need to choose foods that are more nutritious. Then in your second and third trimester you may need an extra 350-400 calories per day to gain the weight you need to for your pregnancy. In addition, it is recommended that you increase your complex carbohydrates (such as rice, pasta and potatoes) to make up 30 to 40 per cent of your total caloric intake. Remember to eat “twice as healthy” NOT “twice as much”. Be sure to follow the Canada’s Food Guide recommendations. Often just including two to three extra Food Guide servings each day is all the extra calories you require for adequate weight gain. continued on page 14 Sp e c i a l De l i v e r y 13 www. r v h . o n . c a continued from page 13 Food Cravings As many as 85 per cent of pregnant women report craving foods or combinations of foods they never would have eaten prior to pregnancy. Sweets, fruits and fruit juices, salty or spicy foods and hard or chewy foods rank high on their lists. If the foods you crave are healthy choices, your best bet is to follow your body’s signals. If the foods you crave are not healthy choices, you need to find an alternative food choice to satisfy those cravings. Some women feel the urge to eat nonfood items such as laundry starch. If you feel this urge, do not give in and talk to your doctor. Artificial Sweeteners The sweeteners cyclamate and saccharin are not recommended for use during pregnancy. Foods or beverages containing other sweeteners are not recommended during pregnancy if they take the place of more nutritious foods. If you do choose to use foods or beverages containing sweeteners, aspartame (Equal or NutraSweet) and sucralose ‘Splenda’ may be taken in moderation as a substitute for sugar or honey. You should not have more than four packages of these sweeteners or two cans of diet beverages in a day. Vegetarian Diets If you are a lacto-ovo vegetarian (one who eats dairy and egg products) you can obtain all the nutrients you need to produce a healthy baby if you follow Canada’s Food Guide to Healthy Eating. If you are a vegan (one who avoids foods of all animal origin), you must pay special attention to getting enough of the nutrients normally found in animal products - for example, vitamin D, calcium, and vitamin B12, iron and protein. You can ask to see a dietitian for help in finding alternative sources of these nutrients. Caffeine Cut down on your intake of caffeinecontaining foods or beverages such as tea, coffee, cola or chocolate. For example, consume no more than 300 mg of caffeine per day, the equivalent of three to four cups of coffee. Herbs At this time there is not enough scientific information about the safety of various herbs and herbal products to recommend their general use during pregnancy and lactation. momstown is for neighbourhood moms wanting to connect for support, conversation and just plain fun! barrie.momstown.ca neighbourhood moms connected email address: [email protected] • 30 momstown events monthly • member privileges • interactive message board Sp e c i a l De l i v e r y 14 www. r v h . o n . c a Midwives offer yet another choice! M idwives have been regulated in the province of Ontario since 1994, and Barrie Midwives have been a part of the obstetrical team at RVH since that time as well. Our clinic is close to the hospital in the medical building at 1 Quarry Ridge Road, Suite 303. Midwifery care is free in Ontario. Like nurses and doctors, midwives are paid by the Ministry of Health. Your midwife will provide complete prenatal, birth and postpartum care for you and your newborn until your baby is six weeks old. As specialists in normal birth, midwives are trained to detect situations that may require additional care. When needed, midwives collaborate with physician and nursing colleagues as necessary. If a woman or newborn needs specialized medical care, their care is transferred to the appropriate provider, typically an obstetrician or a paediatrician. At our clinic, you will be cared for by a small team of midwives. This means that you are likely to know the midwife who delivers your baby. Partners and children are welcome to attend and participate at appointments. In order to practice in Ontario, midwives complete a four-year university degree at McMaster, Ryerson or Laurentian universities. Sp e c i a l De l i v e r y Their well-rounded curriculum includes studying normal pregnancy, labour and newborn care, as well as emergency skills. Internationally-trained midwives access a bridging program offered through Ryerson University and must complete provincial examinations prior to practicing in the province of Ontario. We are committed to providing safe, research-based care for pregnant women and new babies. Together with your midwife, you can choose to have your baby in the hospital or at home. Beyond information provided during appointments, we offer a homebirth night where a woman and her support people can speak with previous homebirth clients, ask questions, and look at the emergency equipment midwives bring. Whether the birth was at home or in the hospital, midwives visit women in their own homes in the first week after the baby is born to monitor the health of the newborn and the mother, and provide dedicated support for infant feeding and care. When your care is completed, you and your baby return to the care of your family physician. The Barrie Midwives provide safe care, free care, and excellent care to clients and their babies. Call us at (705) 727-7660 or visit our website at www.barriemidwives.com 15 www. r v h . o n . c a How will Iif I’mknow really in labour L abour is the multi-stage process that causes the cervix to dilate so that the baby can move through the birth canal. While it seems a straightforward process, it can sometimes fool women. Such is the case with Braxton Hicks contractions – which are false contractions. “While they do occur during the later weeks of pregnancy and are a tightening of the uterine wall, they are not as regular or intense as true labour contractions,” said Dr. Vincent Wu, Chief of Obstetrics, RVH. He suggests a walk around the house or a warm bath in order to relieve false labour pains. So, when should a pregnant woman come to hospital? “If you are having regular contractions every four to five minutes for at least two to three hours; if your water breaks; if you experience vaginal bleeding or haven’t felt fetal movement for a day, come to the hospital,” said Dr. Wu. “The key is to try to admit women to hospital when they are in active labour.” Wu suggests women should have a bag packed and be ready to go to the hospital at 37 to 38 weeks. A woman in the active phase of labour will usually dilate one centimetre every hour, although some women, especially women who have had other children, may progress more quickly. This is the stage where the contractions will be the most intense and close together. Women should try to stay relaxed, says Wu, and try not to eat or drink too much as this can cause vomiting during labour and delivery. Not all women go into labour at the same stage in their pregnancy. Premature labour can Sp e c i a l De l i v e r y occur before the baby reaches its 37th week of gestation. The same rules apply to premature labour as with full-term labour. Usually the guide regarding contractions is that they should be so intense they stop a woman from talking mid-sentence. If a woman is unsure about the status of her labour, she should come to the hospital to be assessed in the Birthing Triage Unit. Once it has been determined that active labour is indeed taking place, the expectant mother will be admitted to RVH’s Birthing Unit. While in the Birthing Unit there are many comfort measures to choose from. Some women may choose to have a warm shower, or soak in the whirlpool tub to relax. This may help to speed up the labour process. Other comfort measures are also made available such as hot packs for back labour and the birthing ball. This will be the time when pain management techniques, learned in prenatal classes will come in very handy. As the labour progresses, so too will the intensity of the contractions. It is at this point that a woman can choose which method of pain management she wishes to use, such as nitrous oxide (laughing gas), an epidural or pain relieving medications given by an injection or intravenously If labour is not progressing, a woman may have her labour induced. Sometimes just breaking the woman’s water will bring on labour. If that is not effective, a catheter can be inserted to dilate the cervix, a prostaglandin gel can make the cervix favorable for labour or the patient can be put on an oxytocin (PIT) drip. If labour is failing to progress and there are concerns about the health of the baby or mother, the doctor may recommend a caesarean section. 16 www. r v h . o n . c a People Care exceptional exceptional Sp e c i a l De l i v e r y 17 www. r v h . o n . c a Give your baby the best start B Christine Gannon, Resource Nurse on the obstetrics floor, assists Andrea Walker with the breastfeeding of her newborn Dwayne Roger Walker Jr. in life! reastfeeding is natural and human milk is specifically designed for human infants. RVH Obstetrical staff support moms to make informed choices related to breastfeeding and offer educational support to women regardless of the decision they make about feeding their baby. The World Health Organization (WHO) recommends exclusive breastfeeding for a minimum of six months. Health Canada is aligned with the recommendations by WHO. Breastfeeding provides optimal nutritional, immunological and emotional benefits for the growth and development of infants. Breastfeeding, while not new, is something that every newly breastfeeding woman must learn. At RVH, obstetrical staff have specialized courses in breastfeeding so that they can help to teach and support moms through the process. continued on page 19 Sp e c i a l De l i v e r y 18 www. r v h . o n . c a continued from page 18 Staff will assist moms to obtain a comfortable position for breastfeeding, a proper latch, and how to observe for feeding cues and signs of effective breastfeeding. When a mom first starts breastfeeding, she should plan on feeding eight to 12 times per day for at least seven to ten days. The first milk, the colostrums, is rich with nutrients, protein and antibodies the baby needs. In three to five days the transitional milk starts coming in, making the breasts feel more full and heavy. Babies who are breastfeeding well will have slow and shallow sucks at the start of the feed. As the milk starts to flow, the sucking should become deep and slow. There should be a pause during the suck when the baby’s mouth opens the widest. It is at this point, that the baby is drinking breast milk. There should be 10 to 20 minutes of this deep and slow type of sucking at each feed. Sometimes mothers will worry that their babies are not getting enough milk. The nurses will teach new parents about weight gain, the number of wet/soiled diapers to be expected and the cues that indicate the baby is feeding well. Sp e c i a l De l i v e r y 19 www. r v h . o n . c a What about the pain? Dr. Paul Webber administers an epidural to a labouring mom. Department of Anesthesia, RVH H aving a baby is an exciting event, but it may be painful. Labour, and the amount of pain felt, differs between women and between pregnancies. Things that affect the pain you may feel are: fear/anxiety, the size/position of the baby, the strength and frequency of the contractions, earlier birth experiences, your position and ability to move around during labour. usually used when you have a medical condition which prevents you from having an epidural. b) Inhaled gas: Nitrous oxide (laughing gas) is an anesthetic gas that you breathe through a mask during each contraction. It is released from the mask when you hold it firmly on your face and breathe deeply. The gas works almost instantaneously, and stops working three to five minutes after you stop breathing it in. Between contractions you take the mask away from your face. You will likely feel slightly dizzy while breathing nitrous oxide, but it is safe for you and your baby because its effects wear off so quickly. Nitrous oxide is only a weak pain killer, but works mainly by making you less awake and less aware of the pain. It is usually used only in the latter stages of labour or when you are pushing, if you have not previously received an effective form of pain relief. Medications a) Injections: Demerol, which is a narcotic, is most often used. Your nurse injects it, along with an anti-nausea drug, into your thigh, bottom, or arm. It works within 10-30 minutes and lasts about two to four hours. A small amount of Demerol may also be put through your IV. The IV portion works a little faster but it doesn’t last as long. No matter which way Demerol is given, it is absorbed by your blood stream and can make you and your baby sleepy. Because of this, Demerol is usually used early in labour, and not when you are close to delivering. Another form of injected medication sometimes used for pain relief during labour at RVH is PCA Remifentanil. This refers to Patient Controlled Analgesia (pain relief) using remifentanil, a narcotic drug with a very short duration of action. This drug is given by a continuous intravenous infusion, plus extra doses that you can give yourself into your intravenous tubing by pressing a button if you need additional pain relief. PCA Remifentanil is Regional Anesthetic Techniques: Epidural, Spinal, or a combination of both. Pain is greatly reduced if the nerve impulses carrying the sensation of pain from the uterus and birth canal are blocked before they travel up the spinal cord. This can be achieved using an epidural, a spinal, or a combination of both. Before inserting the epidural or spinal needle, the anesthesiologist will inject some local anesthetic just under the skin on your back. This will feel like a bee sting. After that, most people only feel some pressure as the rest of continued on page 21 Sp e c i a l De l i v e r y 20 www. r v h . o n . c a continued from page 20 Spinal: When the anesthesiologist performs a spinal, a much smaller needle is used to put the medicine directly into the fluid that is around your spinal cord. No tube is left in, so it is a “one shot” injection. A spinal starts to work faster than an epidural, but only lasts for about an hour and a half. If your labour is expected to be longer than this, the anesthesiologist may also insert an epidural catheter at the same time. This is called a CSE (combined spinal/epidural). Then, when the spinal wears off, medication is given through the epidural catheter as described above. Side effects from a spinal or an epidural are usually minor and can be easily managed. Serious complications are extremely rare. These should be discussed with the anesthesiologist, and you should have your questions answered before you have an epidural or a spinal. the procedure is done. The medications that are injected into your back should not make you sleepy or have any significant effect on your baby. Your pain will be reduced and your legs may feel slightly heavy. It is not always possible to get rid of all the pain because your baby’s position can affect the amount of pain you feel and the anatomy of your back can affect how the medication spreads around your spinal cord. Most women, though, will experience significant pain relief and will be able to rest well. Epidural: Most commonly used for labour and vaginal delivery. A specially designed needle is placed into the tissue layer surrounding your spinal fluid. A long, thin tube called an epidural catheter is then inserted through this needle and then the needle is removed. The epidural catheter is taped to your back and stays there until it is removed after delivery. An initial dose of the medication is given through the epidural catheter. It takes 10-15 minutes before you start to feel more comfortable. An electronically controlled pump is then used to give you a continuous infusion of the epidural medication for the rest of your labour. Back tattoos: In recent years, it has become more and more common to see pregnant women with tattoos on their lower back. Initially, there were concerns among anesthesiologists that tattoo dye could be carried by epidural needles into the area around the spinal cord and lead to irritation or injury. More recent research does not support this belief. Therefore, if you have a large lower back tattoo and the only way to perform an epidural is to insert the needle through the tattoo, we now consider that it is safe to do so. Our current practice is to make a small nick in the tattooed skin before inserting the epidural needle (this is painless since the skin is frozen first with some local anesthetic). This technique eliminates the possibility of any dye (or a tiny skin fragment containing dye) being carried down into the epidural space by the epidural needle. If you have a lower back tattoo, it is no longer necessary for you to see an anesthesiologist before your delivery to discuss whether you can have an epidural. Patient Controlled Epidural Analgesia (PCEA): PCEA allows you to push a button and give yourself an extra dose of medication once in a while, if you require it. The pump is programmed to set the appropriate amount of baseline infusion, the amount of each extra dose, and how often you can give yourself an extra dose. This system gives you some control over how much medication you receive. PCEA technique provides excellent pain relief, but has minimal effects on muscle strength. Therefore, your legs usually remain strong, you are able to move in bed, you maintain control over bladder function, and you keep your ability to push when it is time to deliver. Sp e c i a l De l i v e r y 21 www. r v h . o n . c a News hound has T met his match v personality Rob Cooper is wellknown as a hard news reporter who doesn’t take ‘no comment’ for an answer. He is used to working hard and playing hard, but now he’s met his match. An eight pound, two ounce little boy named Maxwell has spun this hard-nosed news hound’s world upside down. In fact, the infant managed to change some things in Rob’s world no one else had been able to - and that was even before he was conceived. It all began when the reporter entered a bank looking for financial advice and left with a soul mate. Even before Rob and Judy Cooper settled into marital bliss they discussed having children, something they both wanted. However, there was a problem, Rob was a smoker and neither of them wanted their child subjected to second-hand smoke. No children, until no cigarettes - Rob had to make some changes. “I definitely had to grow up and I definitely wanted to quit smoking. That was really important for both of us,” says Rob. So, with the help of medication and the desire for a child motivating him, Rob kicked the habit within a very short period of time. In an equally short period of time the couple continued on page 23 Sp e c i a l De l i v e r y 22 www. r v h . o n . c a Maxwell’s first bath A cuddle with Mom Welcome Maxwell Leonard Cooper Already dressing like dad replied, “How far along am I?” The pharmacist, with a look of concern on his face, asked, “You didn’t pee on the strip, did you?” Rob assured him that indeed his wife had and that the pharmacist was not sitting on a breaking news story. When Rob got home he confirmed the exciting news with Judy and the couple was so overjoyed they started to cry. And clean their house. “Almost instantly I began looking around the house and saying, “That’s got to go and that’s got to go.” Fast forward nine months to December 7, 2010. Judy and Rob Cooper are gowned-up and continued from page 22 was expecting their first child. However, Rob, ever the skeptic, didn’t think they could have conceived so quickly. As any good reporter would, he questioned the validity of the over-the-counter pregnancy test. “Judy came to me and said, ‘I think I’m pregnant,’ and I immediately said, ‘No you are not.” So Rob went to the source to find out. He took the test strip, jumped in the car and drove to the closest pharmacy to have it verified. “It was actually quite a funny moment. I showed the strip to the pharmacist and asked him what it meant. He replied, ‘It means you are pregnant sir.” Catching on to the hilarity of the situation Rob continued on page 24 Sp e c i a l De l i v e r y 23 www. r v h . o n . c a The Cooper Family continued from page 23 ready for a scheduled C-section with RVH’s Dr. Shannon Causey. At 1:38 p.m. the event they had worried about, celebrated and wished for, happened – their son Maxwell Leonard Cooper made his debut. And that’s when Rob lost it. “The doctor brought him around the corner and as soon as I saw him I just bawled. I couldn’t believe how emotional I was. There was Judy hooked up to all these wires and she’d just had a C-section and she was the one comforting me,” say Rob. “I always wanted a child I just never thought I would have one and I guess that was what was so overwhelming for me.” Judy’s recovery from the C-Section was textbook as she waited the regular six weeks before attempting any heavy lifting. She says the actual procedure wasn’t what she expected. “I was a little nervous going in, but it was actually great,” says Judy. “It felt a little weird. I was surprised that I could feel the pushing and Sp e c i a l De l i v e r y the pulling, but it wasn’t painful in the least.” After her hospital stay of three days, the Coopers were able to take Maxwell home and begin their new life. “Rob is a great hands-on Dad. He actually changed the first diaper,” says Judy. Was Rob fully prepared for fatherhood? Not on your life. But was he thrilled? You bet. “I asked as many questions as I could about parenting to as many people as possible. They all said be prepared to cope with the lack of sleep. Well, before I was married I could stay up all night, no problem – I was like a vampire. But very quickly I learned they were right. It is different when you are trying to sleep and are woken up every three hours,” says Rob. “So I suggest new parents prepare themselves for that, enjoy every moment, love your child and have fun.” And to the new fathers he adds, “try to get some of the parental leave from your wife.” 24 www. r v h . o n . c a Special care for special babies Skating champion Jennifer Robinson holds her daughter Reese McKenna in Royal Victoria Hospital’s Special Care Nursery. T he birth of a new baby is an exciting time for everyone involved. Some newborns however, require just a little extra care, particularly those who arrive earlier than planned, or those that have medical issues. That is when the experts in Royal Victoria Hospital’s Special Care Nursery (SCN) take over. Parents often feel apprehensive when their newborn is taken to the Special Care Nursery, but there is no need to be alarmed if your baby spends time in the neonatal unit. “It is normal for parents to feel apprehensive or anxious when their child is admitted to the Special Care Nursery. Parents should realize the staff involved in the care of their infants are highly qualified,” says Dr. Vincent Ho, neonatologist for the Special Care Nursery. That SCN team consists of nurses, two neonatologists, six paediatricians, an occupational therapist, social worker, physiotherapist and respiratory therapists. The Special Care Nursery currently has an Advanced Level II rating according to provincial standards, meaning it is equipped to provide intensive critical care for infants as early as 32 weeks gestational age. The neonatal nurses attend all caesarean section deliveries, and if the baby is well, this new bundle of joy will remain with mom and significant other in the recovery room. All babies go through a transition period adjusting to life outside the womb, and those born by caesarean section may not always make this change right away. Therefore, they may have to be admitted to the Special Care Nursery for some short-term observation, helping them to adjust to the outside world. Sp e c i a l De l i v e r y While RVH’s tiniest patients rest in climate controlled incubators or specially-designed cribs, family members are encouraged to participate in their care. This could mean changing diapers, breastfeeding or feeding through a tube inserted in the nose. “The vision of the Special Care Nursery is to encourage family-centered care. This means having both parents involved in the care and decision making for their newborn baby,” says Dr. Ho. “We recognize that being physically separated from your baby is stressful to the family as a whole and the staff in the Special Care Nursery will make your baby’s stay as easy as possible.” We are very pleased to be enrolled in a pilot project in conjunction with The Hospital for Sick Children and the Remote Retinopathy of Prematurity Screening Project. Retinopathy of prematurity (ROP) is a disorder that can cause blindness in premature infants. Having the exams performed at RVH means the baby does not have to be transferred to The Hospital for Sick Children in Toronto each time. Since May 2010, 27 babies have had this test. During the examinations, RVH staff are in communication with a Neonatal Ophthalmologist from The Hospital for Sick Children via video conference. The images are viewed live, and from the video, image stills are transferred securely by our ICT department to Toronto. A full report is received at RVH within 24 hours of the exam. After discharge, babies should be followed up by the family doctor for routine care, and if required, a paediatrician may be consulted for follow-up in RVH’s neonatal follow-up clinic. 25 www. r v h . o n . c a January 2011 September 2009 RVH is in the labour phase of its own “special delivery” T he staff of Royal Victoria Hospital truly consider it a privilege to play a role in the delivery of your bundle of joy. Whether it is through prenatal care, labour and delivery assistance, to infant hearing screening, we know the health of your baby is paramount to you. We congratulate you on expanding your family and we want to share our exciting news with you. RVH is “expecting” as well. We are well into the labour phase of our own special delivery, the Phase 1 Expansion Project, which includes the Simcoe Muskoka Regional Cancer Centre. It’s hard to believe that almost two years ago the expansion project was just a very big hole in the ground. From the day the first shovel of dirt was turned in March of 2009, everyone involved have kept the project on track, keeping in mind both aesthetics and patient safety. “Progress on this project has been truly remarkable and given the explosive population growth of our region, completion can’t come soon enough,” says Janice Skot, RVH President and CEO. “The Province of Ontario has demonstrated its understanding of the growing need of our community by investing in this critically important project. We also greatly appreciate the outstanding support of this project from our municipal partners – the City of Barrie, $52.5 million; County of Simcoe, $20 million and the District of Muskoka, $3 million. The community has also been very continued on page 27 Sp e c i a l De l i v e r y 26 www. r v h . o n . c a continued from page 26 supportive of this project with $35 million raised through the ‘I Believe” Capital Campaign. This is the largest capital project in Simcoe Muskoka history, and begins a new chapter in Royal Victoria Hospital’s proud history.” Much research and planning has gone into the Phase 1 Expansion Project to ensure not only is it able to provide safe, quality patient care, but does so in a bright and healing environment. But much thought has also gone into selecting the fixtures, furniture and features of the hospital to make it a soothing and healing place. For example patient rooms will be painted with soothing colours, motifs and patterns based on the four seasons. Most rooms have either a view of a lush green courtyard, green garden or a view of Little Lake and the forests that surround it. Glass walkways from unit to unit ensure patients enjoy their pleasant surroundings without being disturbed by unnecessary traffic. At RVH quality care is our top priority, so special attention has also been paid to enhancing safety throughout the building with items such as nightlights in patient washrooms, non-slip flooring, the addition of 150 more clinical ‘handsfree’ hand washing sinks, patient lifts over each bed, and more dedicated isolation rooms. All of these features add up to improved and enhanced patient and staff safety. The expansion doubles the size of the hospital, adding another 440,000 additional square feet. “The Simcoe Muskoka Regional Cancer Centre, and in fact the entire hospital, will feature state-of-the-art technology. The cancer centre will feature four radiation treatment suites, as well as 34 chemotherapy treatment spaces, all overlooking gardens and Little Lake,” says Garth Matheson, Vice President, Regional Cancer and Clinical Services. “From the new automated laboratory and the addition of new MRI and CT machines, to the interventional radiology suites and digital mammography units, the patient who enters our facility can do so knowing they have access to the most advanced technology in healthcare” It is true that when you or someone you love is sick, suddenly all that matters is your ability to get the healthcare you need. So, as you anxiously await the arrival of the newest member of your family, RVH’s gift to you is our commitment to bring you and your family quality healthcare, close to home. What does the expansion project include: • • • • • The Simcoe Muskoka Regional Cancer Centre Capacity for 165 additional inpatient beds A dedicated Coronary Care Unit An Emergency Department that will triple in size An expanded Diagnostic Imaging Department includes space for a second MRI unit and three Interventional Radiology suites • A fully-automated Laboratory • Two new Smart Operating Rooms - which are larger and more technologically advanced than existing suites for complex surgeries • classes • trendy gifts • natural products • cloth diapers 12 Commerce Park Dr. Barrie • 705-735-4302 www.serenitybirthstudio.ca Sp e c i a l De l i v e r y 27 www. r v h . o n . c a Taking care of children O wen Lapshinoff isn’t having a great day. The eight-year old Midhurst boy is at Royal Victoria Hospital for his monthly infusion of a life-saving treatment which boosts his weakened immune system. Owen has a primary immune disorder which simply means his body is unable to fight bacteria which cause infections. For four years now he’s been coming to RVH to receive this treatment, and he knows the drill. But, some days there are other places a young boy would rather be than hooked up to intravenous and lying in a hospital bed for hours at a time. Yet, it is these hours spent at RVH that enable Owen to do the more enjoyable things boys like to do - skiing, jiu jitsu and swimming. “I feel so grateful to have access to such an amazing medical facility so close to home,” says Owen’s mom, Christy Allen. “Less time travelling to Toronto for this treatment means more time living life with Owen.” Owen is just one of more than 3,000 children from Simcoe Muskoka who each year use the services of RVH’s Child and Youth Outpatient Services and that number is expected to rise. Barrie is experiencing a baby boom. In fact, according to Statistics Canada, the city has the fastest-growing youth population in Canada. Last year, almost 2,200 babies made their debut at the Tara Cooper adjusts her daughter Hannah’s hearing aid during a visit to RVH’s Child and Youth Outpatient Clinics. facility which is why RVH is dedicated to providing services to meet the needs of its youngest patients and their families. This year those young patients experienced a change in scenery when all the child and youth clinics were relocated within an easily accessible and child-friendly space on the first floor of the hospital. “We consciously moved all the child and youth clinics to the first floor, right near the front entrance, for convenience and to enhance patient safety. Some of these children are really susceptible to infection and having the clinic close to the main entrance, means they don’t have to walk through inpatient units to get where they’re going, which is critical for those children who are medically fragile or have multiple disabilities,” says Karen Fleming, Program Director, Women and Children’s Program. Dr. Brian Kuzik applauds this move as he believes this model of outpatient paediatric care is the way of the future. Kuzik is a paediatric researcher, holds academic positions as an assistant professor of paediatrics at both the University of Toronto and Queen’s University in Kingston and one of the very experienced paediatricians who work in the clinic. “This new clinic is absolutely and unequivocally critical to developing a children’s program. The continued on page 29 Sp e c i a l De l i v e r y 28 www. r v h . o n . c a continued from page 28 trend is to move away from inpatient care and paediatric diabetes, asthma, feeding and toward outpatient care, especially when dealing swallowing, neonatal follow-up, early intervention, with more complex health issues. Essentially what weight management, Down syndrome, mental we have created here is health, Infant Hearing, one-stop shopping for audiology and hearing families,” says Dr. Kuzik. aid dispensing, and the With families coming RSV (Respiratory Syncitial to RVH from as far away as Virus) Immunization Parry Sound, Bracebridge, Clinic. Huntsville, Collingwood, This spring the Complex Midland/Penetang and Care Clinic is expected to Owen Sound, it just made open and offer services sense for them to see all for children with multiple the medical professionals in disabilities and who are one spot instead of several medically fragile. RVH’s different appointments preschool Speech and in many different places, Language, Occupational says Dr. Kuzik. Even having Therapy and Blind Low to register on one floor Vision early intervention of the hospital and wait services are offered on a different floor for in various community Owen Lapshinoff receives an appointment can be locations. his life-saving treatment frustrating, especially for For young patients like in a special room located parents of children with Owen, who must make at RVH’s Child and Youth multiple disabilities. frequent visits to RVH and Outpatient Clinics. The space, which often need the expertise officially opened in October 2010, is home to of a multi-disciplinary team involved in their care, child and youth clinics for: conscious sedation, this new outpatient clinic is a godsend. • Local, live out nannies fully screened • Full-time, part-time, temporary or occasional • Returning to work, on a shift schedule or just need extra help • Special needs children catered to • Trial dates available Requiring assistance with newborns, multiples, or toddlers in the home. We have trained personnel available. Consider a trial, call us today! www.simcoenannysolutions.com Barrie, ON ph: 705.797.8473 Fax: 705.733.0265 Sp e c i a l De l i v e r y 29 www. r v h . o n . c a Contact Numbers New Parents May Need Royal Victoria Hospital Main Switchboard . ..........705-728-9802 Automated Attendant Line . .... 705-728-9090 (requires extension numbers) Diabetes Education Centre . .... 705-739-5652 Fertility Clinic .......................... 705-728-7784 Health Library ............................... ext. 42631 Imaging Services (bookings) . ........ ext. 43500 Nutrition Counseling . ................... ext. 44436 Patient Accounts ..................... 705-739-5607 Patient Representative .................. ext. 44510 Pre-admission Bookings . .............. ext. 47466 Obstetrical Information Line . ........ ext. 46444 Paediatric Asthma Clinic ............... ext. 46280 Paediatric Outpatient Services ....... ext. 47463 Preschool Speech and Infant Hearing ....................... 705-739-5696 Telephone Device for the Deaf (TDD) .................. 705-739-5618 La Leche League...................1-800-665-4324 Motherrisk Alcohol and Substance Use Helpline - ......................1-877-327-4636 Nausea and Vomiting of Pregnancy Helpline - . ..........1-800-436-8477 HIV and HIV Treatment in Pregnancy - .....................1-888-246-5840 Motherisk’s Home Line - ....... (416) 813-6780 Breastfeeding Place... ext. 813 705-721-7520 Midwives ................................ 705-727-7660 Prenatal Clinic ........................ 705-725-8796 Simcoe County Health Unit...... 705-721-7520 Telehealth . ..........................1-866-797-0000 ............................... TTY : 1-866-797-0007 Women and Children’s Shelter.705-728-6300 Barrie Pregnancy Resource Centre...................... 705-739-7280 Dr. Andrew Browning is one of seven RVH obstetricians. Obstetricians Bologna, John T., M.D. (705) 728-5311 Browning, Andrew D., M.D. (705) 728-5311 Causey, Shannon, MD (705) 737-2347 Moreau, Jan P., M.D (705) 737-2450 Reyes, Enrique G., M.D. (705) 737-5038 Scheeres, Jan J., M.D. (705) 739-7611 Wu, Vincent, M.D. (705) 728-5311 merry maids Relax. It’s Done. A friend is someone who reaches out for your hand, and touches your heart. ® • Weekly, Bi-Weekly, Tri-Weekly and Monthly Rates • One Time Cleans Making life easier. Jennifer Robinson and husband Shane Dennison hold daughter Reese. The couple are expecting their second child in May. Sp e c i a l De l i v e r y • V.A.C. Veterans Affairs Canada - Health Identification Cards Accepted • Bonded, Trained, WSIB Insured Staff 705-725-1170 30 www. r v h . o n . c a Ever ything you need for your Growing Family! Visit the PANTRY for: Frozen Products � ��� ����� � ������� � ������ ��� ����� 2 Locations To Serve You Better 35 Mapleview Dr. W. Molson Park and Highway 400 705-728-9122 Sp e c i a l De l i v e r y 31 400 Bayfield Street Bayfield Street and Livingstone 705-728-2833 www. r v h . o n . c a GRC Georgian Radiology Consultants nsity Bone poDinetm ent By Ap www.georgianradiology.com g Proudly servin the people of Simcoe County Since 1972 Georgian Radiology has grown with Barrie. X Ray No Appointment Ne eded BARRIE LOCATIONS Appointment Bookings 726-7442 5 Quarry Ridge Road (Suite 105) .......................735-2166 190 Cundles Road East (Suite 205) ....................722-8036 121 Wellington Street West (Suites 114-115) ....726-4531 480 Huronia Road (Suite 101) ............................739-1028 Our Bone Mineral Density Service A Valid Health CardOsteoporosis is Necessary is fully accredited with Canada & the Ontario Association of Radiologists. Sp e c i a l De l i v e r y 32 ound Ultrasint ment By Appo www. r v h . o n . c a
© Copyright 2024