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Improving Outcomes Karen Guilliland CEO New Zealand College of Midwives

Improving Outcomes Karen 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

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Improving Outcomes Karen Guilliland CEO New Zealand College of Midwives

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  1. Improving Outcomes Karen Guilliland CEO New Zealand College of Midwives

  2. 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

  3. Current New Zealand Health Service (2011) Ministry of Health (Health funding) . Lead Maternity Carer (midwife/gp/ob) Maternity Hospital and Obstetric Services Community District Health Boards Self- employed Midwives LMCs Self- employed Doctors LMCs Birthing units & Obstetric Hospitals Employed doctors Employed midwives

  4. 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.

  5. The first delay Community • a delay in seeking care and/or • a delay in recognising a problem

  6. 52 Primary Birthing units in New Zealand * Midwifery led unit * Obstetric hospital

  7. 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%

  8. The second delay • Getting to the next level of service required in a timely manner • Transport….ambulance, retrieval • Geography • Weather

  9. 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

  10. Significance of delay to outcomes • Delay one is often significant • Delay two is the less significant • Delay three is the most significant

  11. 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.

  12. 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)

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