Fir Square Program

Twenty-one-year old Jane* needed help. She was a heroin addict. She was HIV positive. She was living in Vancouver’s downtown Eastside, an area with the country’s highest rate of drug abuse, homelessness, and crime. And now she was pregnant.

It was the desire to give birth to and keep this baby that led her from one city hospital to another, seeking the help she knew she needed. Each time, she was treated with methadone and sent back to the streets. On her fourth attempt, she says, a doctor recommended her to BC Women’s Hospital and Health Centre, where a pilot project was taking place for substance-using mothers-to-be. It made all the difference.

“When she arrived here, she was in a bad way, a really bad way, but she sincerely wanted help. She got cleaned up, got medically well, and was sent to a recovery home to stabilize. She delivered her baby here, roomed-in with him, and has been able to keep him,” recalls Sarah Payne, Clinical Nurse Specialist of Socially Complex Admissions for BC Women’s Hospital and Health Centre.

One of several success stories from the pilot project, Jane returned to live with her family and is the proud, loving mother of a beautiful one-year-old boy.

The need to establish an appropriate resource for substance-using pregnant women has repeatedly been demonstrated. The number of women using harmful substances in Vancouver and the Lower Mainland is increasing. There are an estimated 6,000 IV drug users in Vancouver, 35 per cent of these are women. In 1997/98 there were approximately 200 pregnancies in the Lower Mainland where maternal substance abuse was noted at delivery. In 1998/99 this number had risen to nearly 300.

Since 1993, BC Women’s has provided medical stabilization and withdrawal management for pregnant women with substance dependency. It has been working closely with community agencies such as Sheway, a downtown Eastside program providing support and prenatal care to pregnant, substance-using women and women with children up to 18 months of age, the Ministry for Children and Family Development, and the alcohol and drug treatment system. Unfortunately, the program at B.C. Women’s has limited capacity. Most of the women have no access to specialized detoxification services. Many women seeking help are turned away and often the window of opportunity to reach these at-risk women closes forever.

Typically, about 75 per cent of babies born to substance-using moms receive medical treatment. They are given morphine, incubated, and kept in darkness with very little stimulation. During the last year, however, 25 women at B.C. Women’s have been allowed to room-in with their babies, and have been encouraged to cuddle the babies, bonding with them and providing stimulation and skin-to-skin contact. Almost all of these babies were able to withdraw from substance addiction without medication, and the difference in the mothers is remarkable. Many of the 25 participants credit the program not only for helping them become clean, but also for helping them become mothers. Their children, they say, make it all worthwhile.

Based on these results, a new module has been created at BC Women’s. In January 2003, renovations will be complete and Fir Square will reopen, merging the care of substance-using women, substance-exposed newborns, boarder babies (those waiting for adoption or foster care), and babies requiring short-term nursing observation. The consolidated module will be the first in Canada and only the second program of its kind in the world. It will provide excellent teaching and research possibilities, and will help advance BC Women’s goal of keeping mothers and babies together post delivery whenever possible.

Assisting mothers in keeping and caring for their babies is not only more beneficial socially. There are substantial long-term financial savings as well. This type of innovative treatment and follow-up support costs far less than foster care. Still, approximately $945,000 is needed over the next three years to make the Fir Square program a true success. This additional funding is necessary for essentials such as cooking utensils and furniture. The funds are also required to provide some of the most important staff in this new equation: outreach counselors and life-skills teachers.

“If you have been living in chaos, as many of these women have, you don’t know how to live a normal life. You don’t know what normal is. A lot of these women have never been parented themselves. They don’t know that they can sit and cuddle and coo to their babies. It’s all new,” explains Payne.

Without the mentoring and education provided by the Fir Square program, more children will be lost to the foster-care system, and more women may fall back on their old methods of coping – drugs and/or alcohol. At the same time, judgment and prejudice remain huge obstacles in getting treatment to these women.

“I’ve never met a women who wanted to hurt her baby,” Payne states firmly. “We are learning that we need to meet women where they are, not where we think they should be. If we try to write their story for them, we only set them up to fail. It’s a tough road for them. They need all the support they can get.”

For more information about the Fir Square program at BC Women’s Hospital and Health Centre, and how you can help, please visit

*Name has been changed to protect the subject’s identity.

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