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How Canada's H1N1 plan delivered for mothers

Jordana Simms plays with her son Nate, 14-months old, in their home in Sylvan Lake, Alta., on Jan. 1, 2010.

jimmy jeong The Globe and Mail

Jordana Simms woke in the middle of the night with the feeling her chest was being crushed. She was two months pregnant, suspected she had H1N1 - and her doctor's advice to get antiviral drugs was ringing in her ears.

When her breathing became more strained, she went to a hospital emergency room in Red Deer, Alta. There, she was given a prescription for oseltamivir phosphate, or Tamiflu, nipping H1N1 in the bud and putting her on the road to a happy ending - a pregnancy now in its 16th week.

"We're just really thankful for everything that happened," Ms. Simms said in a telephone interview from her home in Sylvan Lake, west of Red Deer. "You can't ask for a whole lot more than good health."

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The 23-year-old is the quintessential non-story of the H1N1 pandemic: She is a health disaster averted.

That's because Ms. Simms received prompt medical treatment, encouraged by an initiative of the Society of Obstetricians and Gynecologists of Canada. It recommended to doctors in October something so bold even their American counterparts had not suggested it: to provide advance prescriptions of antiviral drugs to all pregnant women.

"One thing that's good about Canada is the health system is different and the numbers are different as well," said Vyta Senikas, associate executive vice-president of the Society of Obstetricians and Gynecologists of Canada, which received help from the Public Health Agency of Canada. "Certainly we're smaller so we were able to react."

Pregnant patients are particularly vulnerable to severe disease due to H1N1. With obstetrical appointments typically being once a month, doctors were urged to write advance prescriptions, knowing antiviral drugs work best when taken within 48 hours of the onset of symptoms such as fever, cough and sore throat.

In Canada, 250 pregnant women have been hospitalized with H1N1, including 30 who were in intensive care and four who died, according to Public Health Agency of Canada figures from April 12, 2009, to Dec. 19, the latest available.

"They are at a tremendously higher risk for getting severe disease," said Anand Kumar, a Winnipeg-based intensive care and infectious diseases specialist. "… The mothers overall tend to have a worse outcome and the fetuses are lost at a fairly high rate."

That was certainly the experience in Manitoba. There, 27 pregnant women had H1N1, including six who were in intensive care; two of the six died. And the fetuses fared even worse: One did well, but another suffered severe brain damage due to lack of oxygen, and the remaining four died, according to Stephen Lapinsky, site director of the intensive care unit at Mount Sinai Hospital in Toronto, who, along with Dr. Kumar, is writing a paper on caring for pregnant H1N1 patients.

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Treating pregnant patients can be akin to a medical high-wire act: While adults can tolerate low oxygen levels while on a ventilator, fetuses do not. Drugs to support a mother's blood pressure can divert blood away from the uterus and harm a fetus.

"It's a choice between supporting a mother or supporting a fetus," Dr. Lapinsky said. "And the general sort of approach is to do what you can for the mother, because without a mother, the fetus is not going to survive."

As for the SOGC initiative, it is difficult to know, as with any pro-active measure, how many pregnant women's lives were saved.

Some women, such as Tasia Coolen, who was given the prescription but never had to use it, felt better just having it in her wallet. When the vaccination became available, she got inoculated. And on Dec. 30, she gave birth to daughter Gabriella at B.C. Women's Hospital and Health Centre.

"I was happy to go see my family doctor, who talked to me about what the pros and cons are [of antiviral medication] and for me, it wasn't something I thought twice about," said Ms. Coolen, 35, an infant development consultant in Vancouver.

For Ms. Simms, however, it was a lifesaver.

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When she came down with flu symptoms in early November, she saw her obstetrician. At the time, her doctor was on the fence about whether to prescribe it, as it wasn't clear she had H1N1. If her symptoms worsened, her doctor told her to return or go to emergency as she would require antiviral medication.

Ms. Simms's symptoms quickly became more severe. In the middle of the night, her husband Tom Simms woke up the children - Kenyon, 3, and Nate, 14 months - bundled them in the car, and they all drove to the emergency department in Red Deer.

"You feel completely helpless," said Ms. Simms, a retail store manager. "You are terrified for the life of the baby."

At the hospital, Ms. Simms was given a prescription for Tamiflu. Since the pharmacy wasn't yet open, she contacted her obstetrician early the next morning, wondering if it was safe to take while pregnant. Her doctor told her to fill it. She did and, two days later, she was on the mend.

"Even waiting a few hours can make a huge difference on whether you can be … treated or not," Ms. Simms said. "I'm glad we didn't wait."

Now, the only waiting Ms. Simms is doing is for her third child, due in June.

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