Changes that could be made TODAY

The New Zealand Maternity System

AIM believes that New Zealand’s maternity service will not improve substantially unless there is both a comprehensive independent review or commission of inquiry, along with better data collection in the form of an independent perinatal database. However, recognising that these changes would take time to undertake and to implement, here are some short term systematic changes that we believe will make maternity safer for all New Zealand families in the meantime:

Seven low or no cost suggestions to improve maternity safety

Please note: the following suggestions were presented to the Minister of Health in mid-2009 by our group. Our network is heartened to note that by mid 2010, at least three of these suggestions are being pursued by health officials as possible improvements to the system.

1. Standardised documentation: Information transfer between practitioners and institutions especially in emergency maternity situations is a common problem in Health and Disability Commission case note files. The Maternity Payment system to all lead maternity carers (LMCs) should be dependent on standardised documentation as a service specification.

2. Standardised, evidence-based monitoring: To improve the overall quality and safety, the Maternity Payment system to all LMCs should be dependent on standardised, evidence-based monitoring in both pregnancy and labour as a service specification.

3. Removal of bonus and incentive payments: Women have never been informed about the bonus and incentive payments to midwife LMCs which have no clinical basis and which undermines women’s open choice of birth venue. Midwife LMCs are paid a bonus of $256 for each birthing unit birth. This bonus payment, and also the bonus payment to midwife LMCs of $61 (and the $31 a doctor LMC is paid) if the woman goes home straight from the labour ward, should be removed. Similarly, the incentive payment on top of these bonuses which is paid by some birthing units to midwives if they ensure that at least 50% of their clients give birth in these birthing units should cease.

4. Post natal care quality and choice: Currently, postnatal care is paid as one lump sum of $553 to a midwife LMC for a minimum of 7 postnatal visits to each woman. There is no system that ensures each woman receives her 7 visits. In fact, repeated Health Ministry consumer satisfaction surveys consistently show that at least one woman in four does not. Since 1996 it has been illegal for a GP doctor or their practise nurse to provide routine postnatal care. No reasoning has been given for this exclusion by the Ministry of Health. Allowing a woman to choose her carer would vastly improve the postnatal options and support for families.

5. Independent Survey of Maternity Consumer Satisfaction: Parents of the 600-700 babies who have died each year have been excluded from three previous Health Ministry maternity consumer satisfaction surveys, yet the public has never been informed that the survey results have excluded large groups with some of the worst outcomes. In 2011 for the first time ever, the Health Ministry first surveyed bereaved parents. This survey was carried out as a result of the 2009 submission by AIM which advocated for a voice for these parents. Prior to that, bereaved parents had been specifically excluded from every previous maternity consumer satisfaction survey, thereby falsely skewing any results. A more accurate satisfaction survey carried out by an independent organisation, and reflecting the views of all parents, is more likely to point out the flaws of our current system as seen by consumers.

6. Wider Coverage of the Maternity Consumer Feedback Forms: The same independent organisation could act as the repository for the maternity consumer feedback forms, which could be included in every Well Child Tamariki Ora Health Book given to all new parents. The PMMRC could ensure that these forms were also sent to all bereaved parents to facilitate their feedback. Currently not every family is given the opportunity to express their satisfaction, or otherwise, via a formal process.

7. Independent review of maternal deaths: An independent review (beyond the investigation of the PMMRC) of the high number of maternal deaths which occur in New Zealand is vitally important.