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Maternity care model working for most NZ mothers

Two decades after New Zealand introduced a woman-centred community of care model of primary maternity care, the vast majority of expectant mums enrol with a carer early in their pregnancy and most of them are happy with the choices available, according to the latest research from Growing Up in New Zealand.

Yet despite high overall satisfaction, the study also found persistent inequalities between ethnicities, age groups and socioeconomic status with regard to the timeliness and uptake of maternity services, and the choice women experience when looking for a lead maternity carer (LMC).

“We know that if a woman engages early and continuously with quality antenatal care it is likely to improve her health and that of her unborn child, as well as improve outcomes for her and her baby says Dr Judith McAra-Couper, Associate Professor and Head of Midwifery at Auckland University of Technology. Dr McAra-Couper Chair of the Midwifery Council which is the regulatory body set up to protect the public by making sure midwives are competent and fit to practise.

“Maternity guidelines recommend that mothers-to-be register with an LMC in their first trimester of pregnancy. By engaging early, we can ensure that women get information, assessment and tests to help ensure the best outcomes for both mother and baby.”

The Growing Up in New Zealand study follows the lives of almost 7000 children from before birth into adulthood. The study interviewed the children’s mothers around the seventh month of their pregnancy and asked a range of questions about their experiences with maternity care. The findings were published in a recent edition of the Australian and New Zealand Journal of Obstetrics and Gynaecology.

New Zealand has a unique  primary maternity care model, introduced in the early 1990s. Pregnant women choose one lead professional to provide and coordinate care throughout pregnancy and for 4-6 weeks after birth. This service is funded by the Ministry of Health. The LMC can be a community or hospital based midwife, general practitioner or private obstetrician and delivers services such as counselling and psychological support, education and advice on all things related to pregnancy and birth, health promotion, antenatal screening, risk assessment and treatment where required.

Nearly all women (98 percent) in the study had an LMC for their pregnancy, and most women (88 percent) reported that they had their preferred choice of carer. Around 90 percent of women in the study report engaging a carer within the recommended time, with around 60 percent of women saying they were able to engage a carer almost immediately after they began to look.

Most mothers chose midwives as their LMC (community based midwives: 66 percent, hospital midwives: 15 percent), others chose private obstetricians or shared care between midwife and GP. Less than one percent opted for GP-only care.

Of the women who reported they were not able to have their first choice of carer, more than a third indicated that they wanted the same type of carer but couldn’t have a specific person they had in mind - for example a midwife used in a previous pregnancy, or someone who spoke their language.

The study also shows women’s experience of timely access to the LMC of her choice was not the same for everyone. Mothers whose access to a maternity carer was delayed were more likely to be Māori, Pacific and Asian, women younger than 20 years, women in their first pregnancy and those in lower socio-economic households.

Twice as many pregnant women under 20 years old experienced delay in access to care compared with women 30 years or older.

 “We are delighted the findings of this survey show that  the maternity system introduced nearly 20 years ago is working well for the majority of New Zealand women,” says Sharron Cole, Chief Executive/Registrar of the Midwifery Council.

“But we are concerned that there are still barriers to access and choice for younger and first-time mothers, those from more deprived households and women from non-European ethnic groups. It is clear that we still have work to do to improve access to maternity care. This survey, along with other data from the Perinatal Maternal Mortality Review committee, the national Maternity Monitoring Group, Maternity Quality an Safety Programme and the DHBs provides useful information so we can work with other health professionals to shape policy that will improve access to quality maternity care for all New Zealand women. 

At a glance:

  • 98% of women reported they were enrolled with a lead maternity carer (LMC), with percentages slightly lower for Māori (95 %), Pacific (95 %) and Asian (98 %) women compared to European women (99 %) and for those in areas of socioeconomic deprivation (96 %), and slightly higher for first-time mothers, those between 30-39 years of age, and those with a secondary or tertiary qualification.
  • Most mothers chose community-based  midwives as their lead maternity carer (66 %), followed by hospital midwives (15 %), private obstetricians (8 %), shared care between a midwife and a general practitioner (5%) and GP-only care (less than 1%).
  • 12 % of mothers reported not experiencing choice and 11 % not receiving their first choice of LMC. Mothers in these groups were more likely to be non-European, younger than 20 years, women in their first pregnancy, and those in lower socio-economic households.
  • Some mothers reported confusion about the difference in responsibility between their GP and LMC and about the role the LMC played after referring the mother-to-be to a specialist.
  • Between 86 and 92 %of women engaged their LMC before reaching the tenth week of their pregnancy as recommended.
  • Non-European women, mothers younger than 20 years, and those living in socioeconomically deprived areas were more likely to delay engaging with their LMC until after reaching week 10 of their pregnancy. Those cared for by a hospital midwife or who had a combination of care options were less likely than those cared for by an independent midwife to engage an LMC within the recommended time..