Improving OutcomesKaren Guilliland CEO New Zealand College of Midwives

Integrated service Can mean different things to different

people;

Woman and/or her baby can move appropriately and effectively from one level of service to another as required

Each service provider recognises, respects and supports the others respective roles in an integrated service

Current New Zealand Health Service (2011)

.Ministry of Health(Health funding)

District Health Boards

Lead MaternityCarer (midwife/gp/ob)

Employed doctors

Employedmidwives

Maternity Hospital and ObstetricServices

Self- employedMidwives

LMCs

Self- employedDoctors

LMCsBirthing units & Obstetric Hospitals

Community

The three delays

WHO, UNFPA, ICM, FIGO identify three delays or aspects of the maternity service which can interfere with the woman and/or baby receiving an effective integrated service.

State of the Worlds Midwifery, 2011. Delivering Health, Saving Lives.

Community a delay in seeking care and/or a delay in recognising a problem

The first delay

52 Primary Birthing units in New Zealand

* Midwifery led unit

* Obstetric hospital

Place of birth in New Zealand

Home births~ 3-4%

52 Primary Birth Centres~ 14%

18 Secondary hospital births~40%

6 Tertiary hospital births~43%

The second delay

Getting to the next level of service required in a timely manner

Transport….ambulance, retrieval Geography Weather

The third delay Getting the right care from the right

people when the woman, and/or her baby, arrives at the referral hospital/or is an inpatient and consultation is requested

Significance of delay to outcomes

Delay one is often significant

Delay two is the less significant

Delay three is the most significant

What does make the difference for midwifery?

WHO/ICM/FIGO/ say investment in an educated midwifery workforce working closely with the community and responsive, skilful and respectful obstetric referral systems.

(The State of the Worlds Midwifery; Delivering health, Saving lives, 2011; FIGO,2010,………)

NZ has this community midwifery-based integrated primary to tertiary service model.

Recognition of this integrated service needs to be more internalised by all providers and together we can find ways to decrease delays and improve services even more.

Priorities

Continual investment in quality ongoing education of all midwives and doctors working in the sector (education is often the first cut made).

Reliable ongoing support & investment in appropriate obstetric & midwifery staff levels and skill mix in referral hospitals.

Support for community sector as an intrinsic part of the integrated maternity health

service (ie a transfer from primary to secondary service is not a failure on anyone's part)