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 persued 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, in fact, have no clinical basis and which subvert women's open choice of birth venue. Midwife LMCs are paid a bonus of $250 for each birthing unit birth (The baseline birth fee is for a midwife $1,090.00 for care of a first time mother through a labour and birth and for a doctor $470.00; slightly less in each case for a subsequent birth). This bonus payment, and also the bonus payment to midwife LMCs of $60 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 District Health Boards to midwives if they ensure that at least 50% of their clients give birth in birthing units should cease.
4. Fee-for-service postnatal care: The three Health Ministry consumer satisfaction surveys in 1999, 2002 and 2007 consistently show that at least one woman in four is not receiving her minimum entitlement of visits from her midwife LMC. Currently the postnatal care is a modular payment of $540 to a midwife LMC for a minimum of 7 postnatal visits to each woman. Doctors along with their practice nurses have been barred by law from providing any routine postnatal care since 1996 with no explanation being given by the Health Ministry for this exclusion. Arranging and funding post natal care according to a woman's choice of carer would improve the postnatal care options and support for women.
5. Maternity Consumer Satisfaction Survey by an independent organisation: Parents of the approximately 600 - 700 babies who have died each year have been excluded from each of the three 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. 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 of the case notes of the very high number of maternal deaths (15) noted in 2006 by the Perinatal and Maternal Mortality Review Committee (PMMRC) is a matter of urgency.
