This annual report - Taranaki District Health Board

6 days to determine gestational age and to identify multiple pregnancies [224]. A scheduleof ten appointments is considered adequate for nulliparous women with uncomplicatedpregnancies, or seven appointments for parous women with uncomplicated pregnancies.NICE has also published a set of evidence-based guidelines on service provision forpregnant women with complex social factors (www.nice.org.uk/guidance/CG110), whichare discussed in more detail below.LMC to Well Child/Tamariki Ora transitionWhile early booking is encouraged to improve the quality of maternity care, the transitionfrom maternity care to early childhood services has also been recognised as an importantarea. Early childhood development has a determining influence on subsequent health andopportunity for children to fulfil their potential [136,137]. Increasing investment in the earlyyears has been identified as having one of the greatest potentials to reduce healthinequities [136]. The World Health Organization has called for a continuum of care frompre-pregnancy, through pregnancy and childbirth, to the early years for mothers andchildren, emphasising the importance of the transition from LMC care to Well Childservices [225]. This increasing international interest in integration of services is reflected inthe prioritisation of service integration by the Ministry of Health [226].In New Zealand, LMCs are responsible for ensuring that women receive a daily visit whilereceiving inpatient postnatal care, five to ten home visits including one within the first 24hours of discharge from postnatal care, and a minimum of seven postnatal visits [227]. TheSection 88 Maternity Notice sets out the contractual arrangements and obligations for thetransfer of care of babies from the LMC to Well Child/Tamariki Ora (WC/TO) services. TheLMC must give a written referral to a WC/TO provider before the end of the fourth weekfollowing birth and transfer of care must take place before the baby is six weeks old [227].Concurrent WC/TO services can be arranged from two weeks if the baby has high needs.The postnatal period is of critical importance, for example, in New Zealand between 2004and 2008 SUDI mortality was highest among infants aged four to seven weeks [164].Plunket data from July 2007 to June 2012 revealed that the proportion of Plunket childrenreceiving their Core 1 contact (before six weeks of age) had increased from 75.5% to83.5%, with improvements across all ethnic groups (see page 171). However, a Ministry ofHealth review of the WC/TO Framework, published in 2010, found that a range of WellChild providers indicated that there were problems with delayed referrals from LMCs insome areas [84]. As a result of this review, a pilot project was commissioned to evaluatethe new needs assessment and care planning process (NACP) [84]. The NACP involvesenhanced communication of information gathered during pregnancy by LMCs to WC/TOproviders to help guide decisions about the need for additional contacts and referrals toother services [228]. The pilot project was completed in 2011, but as yet a report has notbeen published.Culturally Appropriate ServicesIn New Zealand, ethnic disparities in adverse birth outcomes emphasise the need forculturally appropriate maternity services. Culturally competent care has been defined as asystem of care that “acknowledges and incorporates, at all levels, the importance ofculture, the assessment of cross-cultural relations, vigilance towards the dynamics thatresult from cultural differences, the expansion of cultural knowledge, and the adaptation ofservices to culturally unique needs." [Cross, et al., 1999, cited in 229]. Durie argues thatcultural competence “focuses on the capacity of the health worker to improve health statusby integrating culture into the clinical context” [230]. Unequal access to healthcare isrecognised as one of the underlying inequalities in health between Māori and non-Māori[231]. Barriers to healthcare among Māori include organisational barriers such as: timingand availability of services, universal Western approaches, the under-representation ofMāori in the health professions, and the lack of appropriate educational and promotionalmaterial; human resource barriers such as: perceptions of non-Māori staff about Māoripatients; and communication difficulties; and individual and community level barriers suchas: the socioeconomic position of many Māori and affordability of healthcare; and patientIn-Depth Topic: Adversity in Pregnancy - 288