455 - Primary Care Access for Newborns: Bridging Gaps through a midwifery-driven neonatal care model

Publication Number: 4446.455

Saisujani Rasiah, St Michael's Hospital - Unity Health Toronto, Toronto, ON, Canada; Michael Sgro, St Michaels Hospital, Toronto, ON, Canada; Alena Moya, Unity Health Toronto, Toronto, ON, Canada; Sloane J.. Freeman, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada

Background: Across Canada, 8.1% of children lack a regular healthcare provider. However, little is understood about primary care access among newborns. In 2018, the Ontario Ministry of Health introduced funding for outpatient midwifery-driven neonatal care to bridge this gap in access and support timely access to primary care providers (PCPs). However, there remains limited evidence on the feasibility and impact of such care models on improving primary care access for newborns.

Objective: Our objective is to assess whether access to a midwifery-driven neonatal care model is feasible and improves newborn attachment to PCPs.

Design/Methods: Between January to October 2025, we conducted a prospective observational cohort study of newborns at a large urban academic hospital with a birth rate of 2,557/year. Caregivers who reported challenges in obtaining a PCP for their newborn at discharge were referred to the midwifery-driven neonatal clinic for ongoing follow-up and support. A pre–post design was employed, where caregivers completed an entry survey at their newborn’s first visit to the midwifery-driven neonatal clinic and a discharge survey approximately six weeks later. The survey data was used to examine changes in PCP attachment following access to care at the midwifery-driven neonatal clinic and to describe caregivers’ experiences with this model of care.

Results: A total of 281 caregivers completed the entry survey, and 96 caregivers (34%) completed the discharge survey. At the time of entry, 148/281 (52%) caregivers self-reported that they did not have a PCP for their newborn. Among these, 68/148 (45%) indicated difficulty finding a PCP, 118/148 (80%) reported living in rental housing, 84/148 (57%) indicated English not being their first language, 66/148 (45%) identified as landed immigrants or individuals with refugee status, and 71/148 (48%) did not have a PCP for themselves. Upon discharge from the midwifery-driven neonatal care clinic, 74/96 (77%) indicated that their newborn was successfully attached to a PCP. Most respondents found the clinic beneficial (92/96, 95%) and would recommend it to others (91/96, 95%).

Conclusion(s): Our study demonstrated a substantially higher proportion of newborns without PCPs compared to children across Canada. We demonstrated a considerable improvement in PCP attachment following care at the midwifery-driven neonatal clinic. These findings will inform policies and sustainable strategies to address the PCP shortage in Ontario and beyond, while laying the groundwork for future population-level research focused on improving equitable access to newborn primary care.