This annual report - Taranaki District Health Board

community to provide antenatal, birth (including accompanying women into secondary andtertiary facilities under a national access agreement set out in the Primary MaternityServices Notice 2007) and postnatal care [212]. A relationship of partnership between theLMC midwife and women aims to enhance informed decision making through sharedinformation and negotiation [212]. The Primary Maternity Services Notice 2007 sets out thefees that will be paid to LMCs for each module of care (group of services for a phase ofpregnancy). The Ministry of Health publishes guidelines for LMCs on consultations withother clinicians, transferring clinical responsibility for care to specialists and transferringcare in emergencies [214]. Ministry of Health Maternity Consumer Surveys suggest thatthe majority of women are satisfied with their maternity care overall with 78% of womenbeing ‘very satisfied’ or ‘quite satisfied’ and 89% being ‘very satisfied’ or ‘quite satisfied’with the overall care provided by the their LMC in the 2011 survey [215]. Response ratesfor the survey were low (41%) and the results are discussed further below.There have been several reviews of maternity services in New Zealand since 1990, whichhave made several recommendations, including improving the relationships andcommunication between providers, a need for national leadership and a maternity strategy,and the introduction of an agreed set of maternity standards [216,217]. In 2011 the Ministryof Health published the New Zealand Maternity Standards (box 2), to provide guidance forthe provision of equitable, safe and high-quality maternity services; and established theNew Zealand Maternity Clinical Indicators, as part of the Maternity Quality Initiative [218].At this stage twelve clinical indicators, focused on the labour and birth period, have beendeveloped [219].Box 2. The New Zealand Maternity Standards [218]Standard 1 Maternity services provide safe, high-quality services that are nationally consistent and achieveoptimal health outcomes for mothers and babies.Standard 2 Maternity services ensure a woman-centred approach that acknowledges pregnancy and childbirthas a normal life stage.Standard 3 All women have access to a nationally consistent, comprehensive range of maternity services thatare funded and provided appropriately to ensure there are no financial barriers to access for eligiblewomen.Guidelines on the Provision of Antenatal CareThe Ministry of Health and the New Zealand College of Midwives provide guidance on theservices that should be provided by the LMC during each stage of pregnancy, labour, birthand the postnatal period [220,221]. While the frequency or timings of antenatal care is notdefined, monthly visits in the first and second trimester, fortnightly visits in the thirdtrimester and weekly visits in the final month are generally accepted [222]. The PMMRChas recommended that all women should commence maternity care before ten weeks, toenable screening to be offered, education to be given, at risk women to be identified andappropriate referrals to be made [138]. This recommendation assumes that early bookingfor antenatal care is associated with improved outcomes, through mechanisms such asearly dating ultrasound scanning and early screening [139].Similarly, the Royal Australian and New Zealand College of Obstetricians andGynaecologists (RANZCOG) “Standards of Maternity Care in Australia and New Zealand”recommends that all pregnant women should have had their first full booking visitcompleted by 12 weeks of pregnancy [223]. The RANZCOG standards include a numberof recommendations for developing services to ensure access, early engagement andcontinuing support and care for women with social factors linked to poor outcomes formothers and babies, for example: inter-agency protocols for information sharing and a leadprofessional to ensure that women from disadvantaged groups have adequate support;flexible, accessible and culturally sensitive services; that women with significant drugand/or alcohol problems should receive their care from a multi-agency team; and specialistservices for pregnant teenagers [223].In the UK the 2008 Antenatal Care National Institute for Health and Clinical Excellence(NICE) guidelines recommend that the booking visit should occur ideally occur by tenweeks and an ultrasound scan should be offered between 10 weeks 0 days and 13 weeksIn-Depth Topic: Adversity in Pregnancy - 287