Media Releases

NHC review finds maternity services safe but urges more co-operation

29 September 1999

Large numbers of women in New Zealand are satisfied with maternity care services. Separate surveys conducted by the National Health Committee, the National Council of Women and the Health Funding Authority between February and July 1999 show:

• 88 to 94 percent of women were satisfied or highly satisfied with the care they received while pregnant

• 86 to 88 percent were satisfied with their labour and birth care

• 75 to 93 percent were satisfied with their postnatal care.

While satisfaction with maternity services is high, safety also appears to be. There is no evidence to suggest any reduction in recent years in the safety of maternity care that women are receiving.

“Faced with such findings the National Health Committee sees no reason to recommend major changes to the current system of maternity care in New Zealand,” says Maggie Barry, who chaired the NHC's review of maternity services. “That said, there are certainly areas where improvements can be made.”

The first concerns information gathering to monitor and improve performance. There are no systematically collected and analysed data linking care during pregnancy, labour and birth and subsequent health outcomes. The absence of such data restricts the HFA from managing performance and identifying quality and safety problems in this critical area of health care. It would appear that the HFA lacks the capacity to address these issues adequately. It is hampered by only having two full time equivalent staff working in maternity services.

The second area for improvement is to do with the choice women have of who will care for them. Many women's experiences of maternity services has amounted to an ‘either/or' choice of provider throughout their pregnancy with about a third unable to get the lead maternity carer they wanted. These women wished to have a GP and a midwife involved in their care. As well, they were concerned about the apparent tension and lack of communication among providers.

In recent years relatively large numbers of general practitioner obstetricians have stopped providing maternity services. The NHC has not found the justification – neither does it have the mandate under the review's terms of reference – to recommend significant new expenditure to reverse the changing makeup of the maternity service's workforce.

Instead of the increasing separation between professional disciplines that has marked maternity services in recent years, the NHC restates the request from many women for there to be more willing co-operation between medical care and midwifery. A key position adopted by the NHC is that no health professional should work in isolation. At the very least they should be connected to a network of care. To encourage professionals to work together in teams the NHC is recommending that an entity rather than just an individual be able to hold financial accountability for a woman's maternity care. It is also recommending that a woman be able to visit her GP five times during her pregnancy - if she feels the need – in an attempt to better integrate her pregnancy into her usual primary health care.

“I am enormously grateful for the willing contribution mothers made to this review and their honesty in sharing their personal experiences has been essential in shaping our recommendations to the Minister of Health.

“In commissioning this review the Minister of Health wanted to know if the system was meeting women's needs and if not, what could be done about that,” says Maggie Barry. “I am confident the NHC has been able to hear the voices of a wide cross-section of New Zealand women.

“While the review was deliberately ‘women-centred', the NHC sought and received submissions from the various groups of health professionals involved in providing maternity care. Their passion and commitment to high quality services was a key factor in the overall satisfaction women expressed in the existing maternity services.

“It is my sincere hope that the co-operation that has been evident in conducting this review will continue so that the measures we have recommended can be adopted to ultimately improve the experiences of future mothers and babies of New Zealand,” says Maggie Barry.