Contents Chair’s Introduction 3 About the National Maternity Monitoring Group (NMMG) 3 Background 3 NMMG members 3 The NMMG Work Programme for 2012/13 3 An Overview of NMMG Recommendations 3 The Second Annual Report of the National Maternity Monitoring Group 3 Registration with a Lead Maternity Carer 3 Our focus 3 What we’ve done this year 3 In 2013 we recommended ... 3 What has changed then? 3 Good examples of promoting timely LMC registration 3 Variation in Gestation at Birth 3 Our focus 3 What we’ve done this year 3 In 2013 we recommended ... 3 What has changed since then? 3 Good examples of investigating variation in gestation 3 National Consistency in Provision of Coordinated Maternal Mental Health Services 3 Our focus 3 What we’ve done this year 3 What we recommended in 2013 3 What has changed since then? 3 Good examples of promoting maternal mental health 3 Maternity Ultrasounds 3 Our focus 3 What we’ve done this year 3 In-depth feedback from care providers 3 Good example of investing in ultrasounds 3 Connecting and Supporting Maternity Consumer Members of the Maternity Quality and Safety Programmes 3 Our 3 What we’ve done this year 3 Good example of promoting consumer engagement 3 trial
Sue Belgrave (ex officio) Sue is the current of the Perinatal and Maternal Mortality Review Committee (PMMRC). She is a consultant obstetrician and gynaecologist at North Shore and National Women’s Hospitals; Clinical Director of Obstetrics, Waitemata DHB, and a private gynaecologist at Shore Women. She is a RANZCOG training supervisor and is the Chair of the Auckland training committee. Sue is a local coordinator at Waitemata for the PMMRC and is an advisor on ultrasound in Obstetrics and Gynaecology. Bronwen Pelvin (ex officio) Bronwen is the Ministry’s Principal Advisor on Maternity. A midwife with more than 30 years of experience, Bronwen has worked as a domiciliary midwife, a community- based LMC, a core midwife and a maternity manager. She worked as the national Midwifery Advisor for the New Zealand College of Midwives and was also the Professional Midwifery Advisor for Nelson Marlborough DHB before moving into her current role. ONZL (secretariat) ONZL provides secretariat and support services to the NMMG. It works across a range of sectors including health, education, ICT and telecommunications. ONZL has extensive experience working with New Zealand industry associations and government departments to deliver their organisational goals by providing board and governance support, meeting facilitation, analysis services, project management, finance management and administrative support.
In 2013 we recommended ... Last year, we focused on preterm births. While this focus has changed to variation in gestation at term birth this year, our recommendations are still relevant. In 2013 we requested that: 1 All DHBs audit preterm births in their region, particularly births at 34, 35 and 36 weeks. 2 Factors that can be changed may include elective or planned deliveries and the clinical reasons for 3 DHB should cover the subject of preterm births in its next MQSP Annual Report. This should include information about interventions that have occurred as a result of information contained in the NMMG report in relation to late preterm births. What has changed since then? We were impressed by the quality of comments from DHBs on the information we provided about births at 37, 38 or 39 weeks and preterm births. Some noted that they had already focused on preterm births following the publication of the 2013 NMMG Annual Report and that this additional information provided further value for them to consider clinical decision making and rationale for births occurring at these gestations, either by elective caesarean or following induction. The information we received included: Reasons for trends in their region Many DHBs assured the NMMG that increases in their region for early term caesarean sections and inductions of labour are in accordance with best practice guidelines but that it did make them review and consider this from a quality perspective. Demographic changes It was noted by some that increases are due to changes in demographics at birth, eg, older mothers and associated risk, as opposed to obstetric decision-making. This needs to be debated further in relation to evidence. Clinical evidence Some that increased caesarean sections and inductions performed at early term (37–38 weeks’ gestation) may be due to better clinical evidence regarding when these should be done for specific clinical cases. (For example, increased awareness of the importance of antenatal recognition of Small for Gestational Age babies and, for expedited delivery, if there is a risk to the baby.) VBAC Others that this increase has been due to a decrease in Vaginal Birth after Caesarean (VBAC). They believe this is an area where more education and consensus is required between professionals but also in relation to information for women to consider VBAC.
Appendix One: of Reference for the National Maternity Monitoring Group, 2013–2016 Introduction 1 This document sets out the: a) and responsibilities of the National Maternity Monitoring Group; b) work programme and reporting requirements; c) composition of the National Maternity Monitoring and d) and conditions of appointment. Background 2 The New Zealand Maternity Standards (Ministry of Health 2011) consist of three high-level strategic statements to guide the planning, funding, provision and monitoring of maternity services: a) Standard 1: Maternity services provide safe, high- quality services that are nationally consistent and achieve optimal health outcomes for mothers and babies b) Standard 2: Maternity services ensure a woman- centred approach that acknowledges pregnancy and childbirth as a normal life stage c) Standard 3: All women have access to a nationally consistent, comprehensive range of maternity services that are funded and provided appropriately to ensure there are no financial barriers to access for eligible women. 3 These high-level statements are accompanied by specific audit criteria and measurements of these criteria. One of the criteria is that a National Monitoring Group be established to oversee the maternity system and the implementation of the Standards. Role of the National Maternity Monitoring Group 4 The role of the National Maternity Monitoring Group is to oversee the New Zealand maternity system and to provide strategic advice to the Ministry of Health on priorities for improvement. 5 Standard 1 of the New Zealand Maternity Standards states “a National Monitoring Group, consisting of a small number of clinical sector experts and consumer representatives . provides oversight and review of national maternity standards, analysis and reporting. The National Monitoring Group provides advice to the Ministry on priorities for national improvement based on the national maternity report, nationally standardised benchmarked data, the audited reports from DHB service specifications, Maternity Referral Guidelines, and the Primary Maternity Services Notice 2007”.
Payment of meeting fees and travel costs 36 A fee of $325.00 (exclusive of GST) will be paid for attendance at face-to-face meetings and is based upon a full day meeting including travel time. Other work carried out as part of the National Maternity Monitoring Group will be reimbursed on a pro rata basis at the rate of $325.00 per day (exclusive of GST). 37 Public servant/state servants/ employees of Crown bodies are not paid for meetings of the National Maternity Monitoring Group. A public servant/state servant/employee of a Crown body should not retain both the fee and their ordinary pay where the duties of the outside organisation are undertaken during ordinary department or Crown body hours. 38 Payment of meeting and fees will be in accordance with the latest Cabinet circular on fees and guidelines for appointments for statutory bodies, which can be found at: all/files/circulars/coc-12-06.pdf 39 Travel to meetings and, if necessary, flights and accommodation will be arranged. Meal expenses (without alcohol) will also be paid, but other hotel charges including phone calls and items from the ‘mini bar’ will not be paid. Any additional travel expenses incurred will be reimbursed, including taxis, mileage (at the rate of 0.62c per km, GST not applicable) and parking. A valid receipt must accompany claims for expenses. Conflicts of interest 40 Members of the National Maternity Monitoring Group should document their conflicts of interests and identify any conflict of interest prior to a discussion of a particular issue. The National Maternity Monitoring Group will then decide what part the member may take in any relevant discussion, and will identify whether the conflict needs to be escalated to the Ministry of Health for consideration. Guidance can be found in the document ‘Conflict of Interest Protocol for Ministry of Health Advisory Committees’. Confidentiality 41 The National Maternity Monitoring Group will maintain other matters forwarded to them unless otherwise specified. 42 Members of the National Maternity Monitoring Group are not to represent themselves as agents of the Ministry of Health, and by reason of their membership of the National Maternity Monitoring Group, are not permitted to speak on behalf of the National Maternity Monitoring Group or the Ministry of Health. 43 If a member receives a media request or enquiry relating to the work of the National Maternity Monitoring Group, they must inform the Ministry of Health including the Ministry’s Health Communications Manager. Any media communication will be via the Ministry of Health.