Abstract:
Topic area, including element of originality Imagine a national maternity system which is centred on childbearing women in the community and not hospitals, where continuity of carer for the whole maternity journey is a core tenet, and where midwives are the lead caregivers for 75% of the population. Midwives practice autonomously and independently, and are funded and insured to be with women wherever they give birth. New Zealand’s maternity system is unique. It is not a pilot programme or regional trial, but the organisation of a whole country’s maternity care, and has been for over 20 years. It’s not nirvana, but its focus is on primary care and normal birth, despite the international climate of medicalisation and fear. The system is not known or understood by most midwives outside our small south pacific country. The successful elements of New Zealand's maternity system can be viewed as a vehicle for promoting normal birth. Description of innovation Unique aspects of New Zealand’s maternity system include: ‘continuity of care’ in NZ means continuity of carer for the entire maternity journey from the beginning of pregnancy, including labour and birth, until six weeks after the birth for most women, even if specialist referral is required, or if a woman planning to give birth at home birth needs to transfer to hospital during labour. Traditional demarcation lines between antenatal, labour and postnatal periods, the community and hospital or primary and secondary care do not apply. Lead Maternity Carer (LMC), describes the practitioner who is central to the provision of primary maternity care, and may be a midwife, family doctor (GP) or obstetrician. All pregnant women choose an LMC who is professionally and clinically responsible for providing or coordinating their maternity care journey. Midwives are now the LMC for over 75% of women. The system of LMCs is complimented by public hospital employed practitioners, which include midwives, as well as a range of medical specialists, such as obstetricians, physicians and paediatricians; along with some independent service providers. The hospital based staff provide support for LMCs, care for ‘inpatients’ and specialist skills and equipment for at risk or unwell women and/or their babies. Primary level care is defined by national legislation and contains a comprehensive set of minimum care requirements, referral guidelines and transfer protocols, a generic hospital Access Agreement and payment schedules. These will be summarised with a description of their application in practice. Discussion The structure of maternity care in New Zealand facilitates a normal (midwifery) model of care. The midwifery profession has developed a robust system of documentation which allows for continual evaluation of quality and safety. The physiological management of the third stage of labour is an example of this. The maternity system has not completely protected New Zealand from the global trends such as the increase in caesarean section, however, the rate of rise is significantly lower than other resource rich nations. Factors that contribute to this will be discussed. Conclusion Several aspects of New Zealand’s maternity system are both unique and innovative, but anecdotally they are poorly known and/or understood outside of the country. What is important is that the overall policy setting is one which enables care and choices which do not exist in these combinations elsewhere.