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Maternity care

7 April 2006

Maternity care is strongly linked within the wider health sector

Maternity care has an important place within this country's community health care system and is strongly linked to General Practice and secondary hospital based care, the Ministry of Health says.

The interface between the primary maternity care provided by community based midwives and GPs, and the secondary, or more medically based, care provided for complicated pregnancies was the focus of a Maternity Policy Advisory Group meeting yesterday.

The 10 member Maternity Policy Advisory Group gives advice to the Ministry as part of the long-term development and implementation of maternity services policy.

The Group's Chair is Dr Pat Tuohy, who is also the Ministry's Chief Advisor Child and Youth Health. ?Community based midwives and GPs provide the primary maternity care for most pregnancies. If a pregnancy is more complicated, it may be referred to secondary care to be more closely monitored by hospital based midwives and specialists.?

The relationships between primary and secondary maternity carers are important ones and help to provide continuity during pregnancy, Dr Tuohy says.

As part of yesterday's discussion about the relationships between primary and secondary maternity care, four main areas were covered: Victoria University lecturer, and midwife, Joan Skinner presented her PHD thesis to the Group on how midwives manage risk in maternity care.

Of the 650 midwives surveyed for the research, 97 percent were able to provide continuity of care throughout the woman's pregnancy. The research also found there is uniformity across the country for referring a woman?s pregnancy from primary to secondary maternity care. The majority of LMCs who participated in the study rated the relationships between primary and maternity specialists (such as hospital based obstetricians), as good or extremely good.

The Group finalised the 2003 Report on Maternity which is expected to be released publicly towards the end of this month. The Ministry of Health is also working on the 2004 Maternity Report, which will be available later in the year (around October). Also discussed was the way Primary Health Organisations (PHOs) link in with maternity services.

This focused on what PHOs could learn from the integrated maternity health care model, and in particular the linkages and relationships that have developed between lead maternity carers and other health professionals over the last decade.

Another important issue is the maternity workforce, and the Group agreed unanimously that supporting the existing maternity workforce and other health providers was a high priority for all the participants and every opportunity should be taken to retain them in the sector. In addition, encouraging people to consider midwifery as a career is also a high priority. The Group, which meets every 2 to 3 months, will next get together in June.


Questions and Answers

What is Lead Maternity Care? Lead Maternity Carers or LMCs can be self employed or hospital based midwives, General Practitioners (GP) or obstetricians. The lead maternity carer is responsible for providing and coordinating a woman's maternity care throughout pregnancy, labour and birth and after the birth until 6 weeks. The choice of LMC will depend to some extent on where a woman lives, as the full range of LMC options is not always available in every area. The "Mum 2 Be" nationwide information service for maternity consumers can provide the contact names and phone numbers of lead maternity carers in each area on 0800 MUM 2 BE (0800 686 223).

Maternity care has a place within the wider integrated health care system and is strongly linked to other services such as General Practice, Well Child, sexual and reproductive health and other areas of primary health care, including Primary Health Organisations (PHOs).

The terms and conditions for the provision of maternity services in New Zealand is set by the Section 88 Maternity Services Notice, under the New Zealand Public Health and Disability Act. The Notice provides nationally consistent terms and conditions for primary maternity care and sets out the payments LMCs, such as midwives, GPs and specialists can receive for providing the different maternity care services required during a pregnancy.

What's the difference between primary and secondary maternity care? Primary maternity care is generally provided at a community level by midwives and GPs. Where a pregnancy is more complicated a woman may be referred to secondary, or more medically based care, to be more closely monitored. This includes care by hospital based midwives and specialists, including obstetricians. The process of referring a woman from primary to secondary maternity care is set out under the referral guidelines, which are part of the Section 88 Maternity Services Notice.

Where can I find previous Maternity Reports? Maternity Reports are produced annually and analyse New Zealand's maternity services. They contain information on the outcomes, availability and women's use of maternity services, including numbers of live births and Caesarians. The last Maternity Report 2002 is available on the ministry website: be7e06cc256ecf000a00dc?OpenDocument

The next report, for 2003, is expected to be released late April 2006.

What workforce issues face the maternity sector? The Ministry is aware of an increasing shortage of midwives particularly among LMC midwives in Waitemata, Auckland, Manukau, Lakes, Wellington and Southland. A number of activities aimed at the recruitment and retention of midwives are underway.

Over the last decade there has been a worldwide trend towards GPs moving out of providing maternity care. In New Zealand GPs continue to provide 70% of pregnancy care in the first trimester. What are examples of community based health care organisations? Examples include: Plunket, the Parents Centre, the La Leche League, the Maori Womens Welfare League. These organisations are community based and have close links with maternity services.


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