What if postpartum care didn’t end at the six-week checkup? Birth Related Cardiovascular Health Clinics (BiRCH) located at Campbell River Hospital (CRH) and West Coast General Hospital (WCGH) in Port Alberni are creating a model of care that supports mothers long after delivery—when risks to heart health may be just beginning.
“Pregnancy is a unique opportunity to identify and address heart health risks,” said Dr. Jennifer Kask, an Island Health physician who offers maternity care in Campbell River.
Heart disease is the number one preventable cause of death for Canadian women, according to the Canadian Women’s Heart Health Centre at the University of Ottawa. There’s a greater risk of having heart disease or a stroke for women who have experienced pregnancy complications such as high blood pressure, diabetes, placental abruption, premature births, or very small babies.
This link led Dr. Kask and her physician colleague Dr. Valentyna Koval, an internal medicine specialist with Island Health, to explore it in their practices. “It was a question that kept on coming up—why do we keep seeing young women come in with serious heart issues? And is there something we could have done to prevent it?” said Dr. Koval.
As such, what started as a casual conversation between two physicians led to the creation of B.C.’s first BiRCH Clinic at Campbell River Hospital. When Dr. Kask and Dr. Koval joined forces in 2022, they didn’t intend to create a clinic but rather to provide preventative care using pregnancy as a tool to identify women at risk for heart disease. But the more they explored it, an idea started to take shape.
“I believe that being in a smaller community, you should be offered equal health care opportunities to those in larger centres,” Dr. Kask said. Dr. Marius Pienaar, an obstetrician-gynecologist (ob-gyn) in Prince Rupert, B.C. had been doing similar work in that community until he retired. He was doing a locum in Campbell River and met with Dr. Kask and Dr. Koval and encouraged them to bring this work to life in the form of a clinic.
Out of 23 clinics across Canada that specifically focus on pregnancy and delivery complications and heart disease in women, none were located in British Columbia, Dr. Koval said. Fast forward to May 2023, the first BiRCH Clinic was held at Campbell River Hospital, and included a team of administrative staff, nurses, and Dr. Kask, Dr. Koval, and Dr. Brianna Crighton, another physician offering maternity care. Dr Elise Jackson, an internal medicine specialist, has since joined the team.
Here’s how it works: Residents of Campbell River who experienced complications in pregnancy and delivery linked to heart health get referred to the BiRCH Clinic at Campbell River Hospital by their primary care provider, midwife, or ob-gyn. Before the first appointment at six months postpartum, patients have a phone call with a nurse and start with some lab work. On appointment day, women have the option of bringing their babies and family along with them as they meet with a family physician and internal medicine specialist to go over the lab results and discuss next steps. This may include discussions around heart health risks, suggested lifestyle habits and changes, and medication-based treatments.
The clinic also offers patients a six-month check on their babies, including growth measurements, a physical exam, developmental screening, and guidance on immunizations, nutrition, and feeding. However, a major part of the visit is aimed at open conversations about how women can lower their risk of heart disease by staying active, managing body weight, minimizing smoking, and eating a healthy diet. It also includes encouragement around breastfeeding for as long as possible, as breastfeeding can reduce risk of diabetes, high blood pressure and heart disease.
From there, patients work with their primary care provider to monitor lab work, medications, and lifestyle habits long-term. Both Dr. Kask and Dr. Koval continue to make themselves available to any previous patients who may reach out to the clinic with questions or concerns.
The Campbell River BiRCH team is already receiving accolades, including a 2026 BC Quality Award from Health Quality BC (HQBC). Dr. Kask has also presented her data and the benefits from the BiRCH Clinic to conferences both locally in Vancouver and on an international stage at the Institute for Healthcare Improvement’s quality and safety in health care forum in Australia.
While the clinic initially operated out of the Campbell River Hospital, with clinics offered there once a month, Dr. Kask and Dr. Koval began travelling monthly to Port Hardy and Port McNeill to meet with BiRCH patients during those visits as well.
Katie Nelson, a 32-year-old mother of two, became connected to the BiRCH Clinic last year in Port Hardy. Nelson noted that her postpartum experiences following her children’s births in 2022 and 2024 were quite different in terms of the knowledge, support, and care she received. When she was pregnant with her daughter born in 2022, and son in 2024, Nelson said she experienced gestational diabetes and pre-eclampsia, a condition where a pregnant person’s blood pressure is too high and organs start to show signs of stress. If left untreated, pre-eclampsia can lead to seizures, organ damage, or danger to both the parent and baby.
“I didn’t know how much your heart health could be affected in pregnancy,” Nelson said. “I have a blood pressure cuff at home now and can monitor it myself. It’s made me more aware.”
Nelson worked with Dr. Kask throughout both pregnancies and met Dr. Koval at a remote BiRCH Clinic held nearby in Port McNeill after giving birth to her second child. She spoke highly of the experience with the physicians and the BiRCH Clinic as a whole.
“I didn’t feel like I was just another patient, or being judged because I’m a plus-sized person. And it was even more comfortable dealing with female physicians. Dr. Kask and Dr. Koval were quick to say, ‘We’ve been there, pregnancy can be tough, but here’s how you can support yourself and your heart health going forward,’” Nelson said.
Island Health nurse Glenda Bertolucci was at a conference when she met Dr. Kask after her presentation on pre-term birth and education needs. It struck a chord and Bertolucci, now retired, brought the idea of a BiRCH Clinic in Port Alberni back to her colleagues.
“It started as a quality improvement project, as we had some funding from the Rural Coordination Centre of BC,” Bertolucci said. “I really care about proactive care versus reactive care, and one of the highlights of the BiRCH Clinic is thinking down the road of what you could be preventing. The education and lifestyle-change support offered through the BiRCH Clinic can help positively shape the lives of women and their families.”
With the support of the Campbell River team and Island Health funding, Port Alberni offered its first monthly BiRCH Clinic at West Coast General Hospital (WCGH) in November 2024. The team included Bertolucci, internal medicine specialist Dr. Sarah Fraser, nurse Danielle Eely, and perinatal family physician Dr. Anneleen Van Zyl.
Just over a year since launching at WCGH, the team is happy with the way things have progressed so far. “BiRCH patients are always very sincere and grateful for the support they receive from us,” said Eely, a nurse and perinatal educator. “We hope that these women never have a cardiac event, but if they do, they will be stronger advocates for their care to be able to say, ‘I’ve had these complications in my pregnancy which may be related to what’s happening here.’”
The Campbell River team also stressed the importance of women feeling empowered to advocate for their health.
“The most rewarding thing has been to welcome people to participate in their own preventative care, to offer encouragement and hope, and empower them to advocate for themselves,” Dr. Kask said.
And for Dr. Koval, a final message to her patients past, present, and future: “If my patients can hear me, if you or someone you know has gone through pregnancy and experienced complications, please remember to mention it to your current health providers.”
If you or someone you know would like to learn more about pregnancy-related heart health risks or the BiRCH Clinics at CRH and WCGH, visit crbirchclinic.com.