This annual report - Taranaki District Health Board

need for multidisciplinary interventions during pregnancy that can address women’scomplex physical, social and mental health needs.Adversities During Pregnancy and Pregnancy Outcome ConclusionsThis section has identified a number of adverse outcomes, including increased rates ofinfant mortality, and poorer health and development in children, associated with adversitiesin pregnancy. The underlying causal pathways appear to be complex, involving exposureto a variety of risk factors, as well as poorer access to antenatal care. Adversities such associoeconomic deprivation, family violence, alcohol and drug exposure and mental illnessare linked, supporting integrated approaches that can address complex needs overapproaches that address specific risk factors.Before considering the evidence from the international literature on the effectiveness ofprogrammes and services aimed at addressing these complex issues, the section whichfollows provides an overview of maternity services in New Zealand, including a brief reviewof issues associated with access to services, as well as examples of some local serviceswhich aim to meet the needs of women experiencing multiple adversities in pregnancy.Maternity Services in New ZealandThis section begins with a brief overview of maternity services in New Zealand, beforeconsidering issues associated with the transition from maternity to Well Child/Tamariki Oraservices. Access and uptake of antenatal services in New Zealand are then reviewed, andpotential barriers to antenatal care discussed. The section then considers culturallyappropriate maternity services, before concluding with a brief overview of some localantenatal and postnatal services which have been developed to meet the needs of womenexperiencing multiple adversities in pregnancy.The Development of Maternity Services in New ZealandPublicly funded maternity care in New Zealand provides free or subsidised care to alleligible pregnant women, with the aim of providing antenatal, labour and birth, andpostnatal care, to ensure that the baby will be as healthy as possible [210]. The leadmaternity care model of maternity services - maternity services delivered in the communityby a Lead Maternity Carer (LMC), was established in the mid 1990s under Section 51 ofthe Health and Disability Act (1993) (now Section 88, Primary Maternity Service Notice2007), issued in 1996, with the aim of providing continuity of care for the woman and herbaby [211]. The LMC can be a midwife, obstetrician or a general practitioner with aDiploma in Obstetrics, selected by the woman to provide her lead maternity care [211]. Inpractice, most GPs and obstetricians do not practice as LMCs [211,212]. Primary maternityservices may also be provided directly by DHBs, and the configuration of these servicesvaries around the country.In 2010 54,213 (84.1%) women (out of total of 64,485 women who completed a pregnancythat reached 20 weeks or more gestation and resulted in a stillborn or a liveborn baby in2010) were registered with an LMC at the time of delivery, of whom 91.6% were registeredwith a midwife, 6.6% with an obstetrician, and 1.7% with a GP, suggesting that for themajority of women in New Zealand, maternity services are community-based andmidwifery led [213]. Among women registered with a LMC, younger women, Māori andPacific women and those from more deprived areas were more likely to register with amidwife than another type of practitioner. However, caution must be applied wheninterpreting these findings, as the cohort of women registered with a LMC are notrepresentative of all women giving birth in New Zealand [213]. The remaining womeneither received care through DHB provided services or did not receive primary maternitycare.In the lead maternity care model, the LMC is responsible for providing continuity of care forwomen and their babies, including assessing their needs, planning their care andfacilitating the provision of additional care as required, throughout the pregnancy, duringlabour and birth, and up to six weeks postpartum [211]. LMC midwives work in theIn-Depth Topic: Adversity in Pregnancy - 286