Electronic connection To improve maternity care and service interface, this DHB is currently working with primary health organisations to identify a secure way for LMCs to connect electronically with GPs. Whanganui DHB Access to information In order to engage consumers, Whanganui DHB are in the process of establishing a Maternity Resource Centre which will provide a drop-in service where women and their families can access maternity information and support, including contacting of an LMC. Provision of culturally appropriate services Whanganui DHB is also developing a Whānau Ora contract with a Māori provider to promote all pregnant women enrolling with an LMC by 10 weeks. Preterm births Our focus To investigate the consistency in the rate of preterm births across New Zealand. The reasons for variation, and ways to reduce preterm births, need to be explored in relation to service delivery. This priority reflects the NMMG’s role in overseeing the implementation of Standard 1 of the National Maternity Standards, particularly to ensure that maternity services achieve “optimal health outcomes for mothers and babies”. We wanted to monitor late preterm births (births between 34 and 36 weeks’ gestation) because research has found that worldwide late preterm births are increasing. It is argued that this may be due to increases in planned birth, ie, when the risks to the mother or baby of continuing the pregnancy are perceived to outweigh the risk of early birth. This may be related to changes in obstetric decision-making. However, late preterm births may have a number of consequences, including: higher neonatal and maternal mortality and morbidity long-term health effects on babies such as poorer neurodevelopmental and educational outcomes, more hospital admissions and increased general disease burden in childhood3, late preterm birth is also associated with greater use of health resources.3, The period from 34–36 weeks is the period when there is most benefit in prolonging the pregnancy. Because prolonging pregnancy results in better neonatal outcomes and less health
What we found We noted that there has been some regional inconsistency in the implementation and effectiveness of the Referral Guidelines: In many DHBs, copies of the Referral Guidelines had been disseminated to DHB staff and LMCs working in the district. Most DHBs had held meetings with various health professionals involved in the maternity sector to discuss the updates to the Guidelines and promote awareness. Unfortunately, only a small number of DHBs plan to use the maternity clinical governance/steering groups developed as part of the MQSP to monitor the implementation of the Guidelines and develop local Emergency Transport Plans. Many DHBs noted that updates to these policies need to be completed in conjunction with St John and other ambulance services. The changes we expect to see 1 DHBs should be using MQSP governance groups to monitor the implementation of the Referral Guidelines. 2 The Referral Guidelines should be communicated effectively to maternity consumers, making processes more transparent. 3 Updates to referral policies need to be completed in conjunction with St John and other ambulance services. 4 We want to see that DHBs are engaging with ambulance services to improve the emergency transport of women in labour. Good example of referral guidelines implementation Southern DHB Southern DHB has worked hard to implement the revised Referral Guidelines, particularly in relation to emergency transport. It has that the revised guidelines have been used as an opportunity to develop relationships with our St John colleagues both in urban and rural localities. It notes that this has led to greater understanding of the emergency transport process for DHB clinicians, LMCs and St John staff. It has also led to new transfer information forms to ensure effective communication occurs. Furthermore, relationships between rural providers and local St John staff have been enhanced through encouraging LMCs to contact St John staff early in a ‘heads-up’ manner so St John can consider information such as driving hours and the location of volunteer staff. This helps reduce delays when a call is made to transfer patients.
c) Inpatient services Only a number of DHBs (Auckland, Counties Manukau and Canterbury) have the ability to deliver inpatient secondary maternal mental health services where mother and baby can be placed together. Some DHBs have small areas separate to the main adult mental health wards which can be used by mothers and babies if required. Canterbury DHB provides the largest and most comprehensive service of this kind in the country in its Mothers and Babies Unit. We note that surrounding DHBs have access to these inpatient services. We note that the Government has allocated $18.2 million over four years to improve acute maternal mental health services. We have sought updates from the Ministry on work with DHBs to implement this funding, and will continue to do so. d) Education Some DHBs provide education programmes for mothers with a prior history of mental illness. For the most part, this is provided postnatally. e) Alcohol and other drug services Auckland and Canterbury DHBs provide specialist regional services for pregnant women with alcohol or other drug addiction. Other DHBs have access to these services as necessary. 2 Waiting Almost all of the DHBs stated that there are currently no waiting times for their service. For those where there were waiting times, the largest was the Canterbury Mothers and Babies Unit, with a four-month waiting time. Auckland DHB’s specialist maternal mental health team quoted a two to three month waiting time. 3 Referrals from LMCs to primary mental health services Many DHBs stated that they do not have access to the number of referrals from LMCs to primary mental health services. However, those that did have this information reported referrals from LMCs ranged from 14.3% to 24.5% of total referrals to primary mental health services. The percentage of referrals from LMCs to specialist maternal mental health services ranged from 3% to 71% of total referrals to these services. This information shows significant variability in access to services for pregnant women. The changes we expect to see 1 We want all DHBs to promote access to services for women with maternal mental health issues. This will require better linkages between these services and maternity care providers. 2 Knowledge of mental health services available to the maternity sector must improve.