Lead maternity carer system working for most New Zealand mothers

August 4, 2015

Two decades after New Zealand introduced a choice-based model of primary maternity care, almost all mothers-to-be enrol with a carer early in their pregnancy and most are happy with the choice of carers available.

The results in brief

Ninety-eight percent of women reported to be enrolled with a lead maternity carer (LMC), with percentages slightly lower for Māori (95 percent), Pacific (95 percent) and Asian (98 percent) women compared to European women (99 percent) and for those in areas of socioeconomic deprivation (96 percent), and slightly higher for first-time mothers, those between 30-39 years of age, and those with a secondary or tertiary qualification.
Most mothers chose independent midwives as their lead maternity carer (66 percent), followed by hospital midwives (15 percent), private obstetricians (eight percent), shared care between a midwife and a general practitioner (five percent) and GP-only care (less than one percent).
Twelve percent of mothers reported not experiencing choice and 11 percent not receiving their first choice of LMC provider. Mothers in these groups were more likely to be non-European, younger than 20 years, women in their first pregnancy, and those in lower socioeconomic households.
Some mothers reported confusion about the difference in responsibility between their GP and the lead maternity carer, and about the role, the LMC played after referring the mother-to-be to a specialist.
Between 86 and 92 percent of women engaged the carer before reaching the tenth week of their pregnancy as recommended. Non-European women, mothers younger than 20 years, and those living in more socioeconomically deprived areas were more likely to delay their engagement with their maternity carer until after reaching week 10 of their pregnancy. Those cared for by a hospital midwife or who had a combination of care options were less likely than those cared for by an independent midwife to engage an LMC within the recommended time.

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Yet, despite high overall satisfaction, the study also found persistent inequalities between ethnicities, age groups and socioeconomic status with regard to the timeliness and uptake of maternity services, and the choice women experience when looking for a lead maternity carer.

“Early and continuous engagement with antenatal care is an important element of policy. It has been shown to improve the health of both the pregnant woman and her unborn child, reduce the number of deaths before and around childbirth and enable early enrolment of a child with healthcare services,” says Growing Up in New Zealand Associate Director and Starship paediatrician, Associate Professor Cameron Grant from the University of Auckland.

“It is recommended that mothers-to-be register with a Lead Maternity Carer (LMC) in their first trimester of pregnancy.

“By engaging early, we can ensure that women get information, assessment and tests to help ensure a healthy pregnancy for mum and baby.”

The Growing Up in New Zealand study follows the lives of almost 7000 children from before birth into adulthood. The study interviewed the children’s mothers around the 7^th month of their pregnancy and asked a range of questions about their experiences with maternity care.

The findings were published in the latest editions of the Australian and New Zealand Journal of Obstetrics and Gynaecology (ANZJOG).

The strength of this research is that it captures the experience of groups of women usually under-represented in maternity research, including Māori and Pacific mothers, and women from lower socio-economic backgrounds.

Nearly all women (98 percent) in the study had an LMC for their pregnancy, and most women (88 percent) reported that they had a choice of carer. Additionally, around 90 percent (86-92 percent depending on the estimate used) of women in the study report engaging a carer within the recommended time. In fact, nearly 60 percent of women reported that they were able to engage a carer almost immediately from when they began to look.

Most mothers chose midwives as their LMC (independent midwives: 66 percent, hospital midwives: 15 percent), followed by private obstetricians (eight percent), shared care between a midwife and a general practitioner (five percent) and GP-only care (less than one percent).

Of the women who reported they were not able to have their first choice of carer, more than a third indicated that they wanted the same type of carer (e.g. a midwife) but couldn’t have a specific carer they had in mind - for example an LMC used in a previous pregnancy, or someone who spoke their language.

More general practitioner maternity care would have been the preference of 15 percent of the women who were not able to have their first choice of care, and more private obstetrician care would have been preferred by 16 percent. However, there are issues with the availability and cost for women.

Women’s experience of timely access to a maternity carer of her choice was not the same for all groups of women in the study.

Overall mothers whose access to a maternity carer was delayed were more likely to be those identifying as Māori, Pacific and Asian, women younger than 20 years, women in their first pregnancy, and those in lower socioeconomic households.

In comparison with European women, at least twice as many women identifying as Māori, Pacific and Asian experienced delay in accessing maternity care.

In comparison with women living in the least deprived 30 percent of households, at least twice as many women living in the most deprived 30 percent of households experienced a delay in accessing maternity care.

Twice as many pregnant women under 20 years old experienced delay compared with pregnant women 30 years or older.

Improvements in access and experience of maternity care for all these groups of women could have positive impacts for the pregnancy health of mothers and the health of new-born babies, as well as the ongoing health of both the mothers and children.

“Our findings suggest that the choice-based lead maternity carer system introduced nearly 20 years ago is working well for the majority of New Zealand women. Yet we also noticed barriers to access and choice for younger and first-time mothers, those from more deprived households and women from non-European ethnic groups,” says Growing Up in New Zealand Director, University of Auckland Associate Professor Susan Morton.

“These barriers have been reported in earlier studies from the 1990s and early 2000s. That they still persist today for those mothers who are potentially most vulnerable is a cause of concern and an indication that further improvements in access to maternity care are needed.

“We hope that our results can provide pointers for policy on where to focus their initiatives to improve access to lead maternity care for every New Zealand mother-to-be,” says Dr Morton.

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About New Zealand’s primary maternity care system

New Zealand has a unique choice-based model of primary maternity care, introduced in the early 1990s. Pregnant women choose one lead professional, called a Lead Maternity Carer, to provide and coordinate care throughout pregnancy and for 4-6 weeks after birth, funded by the Ministry of Health.

The carer can be an independent or hospital-based midwife, general practitioner or private obstetrician and delivers services such as counselling and psychological support, education and advice on all things related to pregnancy and birth, health promotion, antenatal screening, risk assessment and treatment where required.

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Media coverage

New Zealand Herald

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