challenges in addressing perinatal mortality in New Zealand Perinatal related mortality rates Our Perinatal Mortality rates similar to UK NZ rate not increased in past year Still ID: 830494
Download The PPT/PDF document "Beyond the Numbers Midwifery" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Beyond the Numbers
Midwifery
challenges in addressing perinatal mortality in New
Zealand
Slide2Perinatal
related mortality rates
Our Perinatal Mortality rates
similar to UK
.
NZ rate
not increased
in past year.
Still
birth
rate has
decreased
from 6.3/1000 to 5.2/1000 total births.
Same
factors
in
previous PMMRC reports and other
New Zealand research: socioeconomic
deprivation,
ethnicity, smoking
, drug and alcohol
use, age
(<20
) and barriers to accessing and engaging with maternity services.
Slide3The Challenge
The
most complex
challenge
posed to midwives (and in fact
to
all
providers
of maternity services) by
this
report continues to be the
contribution of the
social
determinants
of health
to perinatal mortality.
Slide4The Challenge…
2012 Report:
“The
higher proportion of vulnerable mothers among the birthing population in the CMDHB region compared to other regions is responsible for the
significantly higher
crude
perinatal related mortality rate in
CMDHB”
(PMMRC 2012)
Slide5The Challenge…
“Thus
a reduction in crude perinatal related mortality rate might be achieved in the Counties Manukau region
by addressing the social and health needs
of Maori and Pacific and
socioeconomically deprived
mothers.”
(
PMMRC 2012
).
Slide6The Challenge…
W
e have to address the social
deteriminants
of health that impact on perinatal mortality and maternal health and well being.
Slide7Contribut
ing
factors and potentially avoidable perinatal deaths
2012 PMMRC Report urges key stakeholders providing health and social services to women at risk to work together and identify:
1. Reasons
for barriers
to accessing
and engaging with
maternity care
2. Interventions
to address these barriers
NB: No progress in the last four years!
(PMMRC 2012).
Slide8The Challenge…
Midwifery and Medicine cannot meet this challenge on their own.
Solutions require infrastructure of service provision and delivery.
Address areas where women are most at risk.
Slide9A RESPONSE
to the Challenge
Snapshot from
two different research projects
in Counties Manukau within past 12 months.
Both projects relate to the specific issue of an accessible and appropriate maternity service as identified in PMMRC report.
Both projects present insights and solutions for accessing and engaging with maternity services.
Slide10Project carried
out for the Ministry of Health in
2011: ‘
A
Successful Lead Maternity Care Midwifery Practice In Counties
Manukau
.’
(Priday
and McAra
-Couper, 2011)
Slide11Response to The Challenge:
Project Researching Midwifery Practice
Mixed method research project.
Qualitative
data
collected
using
narrative,
interviews and written feedback.
Quantitative
data
from
reports, client evaluations and statistical maternity reports, including
Midwifery and Maternity Provider Organisation (MMPO) reports and Perinatal
Maternal Mortality Review R
eport
2011.
Slide12Response to the Challenge…
Research: “Barriers to Initiation of Antenatal Care Amongst Pregnant Women at CMDHB”.
Conducted by Drs Sara Corbett & Kara Okesene-Gafa (2012)
Background: Fifth
Annual PMMRC report (July 2011)
for
the first time
analysed factors
contributing to perinatal mortality.
Common factor:
barriers to accessing or engaging with maternity and health
services.
Slide13Response to the Challenge…
Aim of
this
Study:
To
identify barriers to initiation of antenatal care and predictors of inadequate care
for
pregnant women presenting to CMDHB maternity services
.
Surveys
were offered to all women
presenting to the
hospital
and maternity units.
826
women were included in the
analysis. 136 (16.5%)
were classified as late
bookers (> 18 weeks gestation) and 151 (18
%) were determined to have received
inadequate care (< 6 antenatal visits)
during their pregnancy.
Slide14Response to the Challenge…
.
Some of the
principal
barriers for women who book late, or who receive fewer than six antenatal visits can be summed up in two words:
NOT
KNOWING
(
Corbett and Okesene-Gafa, 2012)
Slide15Response to the Challenge…
.
NOT KNOWING:
the
need to choose and book with an
LMC
t
he importance of
getting care
early
in
the
pregnancy
that they
needed
any care at all, as
they
“could look
after
themselves”
how the maternity service system worked
(
Corbett and Okesene-Gafa, 2012)
Slide16Practical
Barriers
to
A
ccessing
and
E
ngaging
in Maternity Services
1.
Rigidity
of time
structures at some clinics
2.
Cultural
priority
of family needs over women’s own
health
3.
Lack
of knowledge about
options
available in choosing a
midwife
4. Cultural
expectation that
all
midwifery care is
hospital
based
5. Belief that
there is a
fee
attached to having a
midwife
6. Difficulty in
contacting
a midwife
(
Priday
and McAra-Couper 2011)
(Corbett and Okesene-Gafa, 2012)
Slide17More Barriers…
7.
Shyness
or discomfort phoning a stranger
8.
Lack
of
landline or credit
for cell phone
9. Belief that
a
sking
for a service is
culturally inappropriate
and disrespectful
10.
Language
difficulties creating lack of
understanding
11.
Childcare
difficulties for large
families
12.
No
midwife
on site at
their health centre
, creating fear of unknown service
location and personnel
(Priday
and McAra-Couper 2011) (Corbett and Okesene-Gafa, 2012)
Slide18And More Barriers…
13.
Lack
of health knowledge
and limited literacy in
English
14. D
octor
or midwife
hard to
understand
15.
Lack of
money and /or transport
to
attend clinic and
scans
16.
No
phone (or phone credit) to
make
appointments
(
Priday and McAra-Couper 2011) (Corbett and Okesene-Gafa, 2012)
Slide19Further Research from “A Successful LMC Midwifery Practice in Counties Manakau”:
The Midwifery Practice (TMP)
C
lientele
of
TMP:
Pacific (62%) &
Maori
families (15%)
High deprivation
(75
% of women
from deprived areas – decile 10).
Large
families
Complex
needs
Significant
co-morbidities
Poor
utilisation of health services
Slide20The Midwifery Practice (TMP)
: Perinatal Mortality 2009 - 2011
Slide21The Midwifery Practice:
(TMP)
Response to the Challenge
Continuity of Care
Informed Consent
The midwife
acting
as navigator and advocate
Midwife upholding the
woman, her family
and
her
culture
(Priday and McAra-Couper 2011)
Slide22TMP Response to the Challenge
:
Continuity of Care…
Continuity
of
C
are
allows for
greater knowing,
develops
trust,
and encourages
open communication.
..
Continuity of
Care
keeps women and babies safe.
(
Priday and McAra-Couper 2011)
Slide23Response to the Challenge
:
Continuity of Care…
Those who were
most satisfied
were women who had
Continuity of Car
e.
The women who had to see different midwives and different GPs at each antenatal visit were
least satisfied
.
Women said they would rather have
one person
caring for them throughout the pregnancy and it would be ideal if they had the
same midwife
to look after them throughout subsequent pregnancies.
(Corbett and Okesene-Gafa, 2012)
Slide24TMP
Response to the Challenge: Continuity of Care…
Feedback from a Samoan woman translated into English:
“This
is my first baby in NZ. I had my doubts of what kind of midwife that would be looking after me. I never thought and could not believe how thorough... was right from when she first saw me up to the time I had my baby...it was all good work she did for me and my baby...words are not enough for me to express how grateful me and my family are, for the care that I received from the beginning of my pregnancy up until and after my baby was born. I didn’t believe this was how a
Palangi
would care for someone like me Samoan...thank you for your
professionalism…”
(
Priday and McAra-Couper 2011)
Slide25TMP
Response to the Challenge:
Midwife as Navigator and Advocate
Help
navigate through
the health
system
– appointments, referrals, triage.
Educate
woman, family and community
Utilise
other health
services
in area
Read
hospital correspondence and instructions for tests
Keep
an eye on ‘big picture’ –
whole family health
Speak
up
on behalf of woman
Slide26TMP
Response to the Challenge: Midwife as Navigator and Advocate
“On
Good Friday I had a call from a very distressed woman who had found my number in the back of the W
ell Child
book. I had looked after her daughter in her last pregnancy (1 year ago). She told me her daughter was away and she had the three children but had no food and no money and could I help her. I told her I would get back to her or get someone to contact her by midday. Luckily even on Good Friday the Salvation Army were able to assess the situation and within three hours had food to that very needy family. Often we find ourselves in the position of navigator of social
services -
way outside of the midwifery role in one sense
.”
Slide27Slide28TMP
Response to the Challenge: Midwifery a Service Integrated into the Community
Data from Receptionists at
local
Medical Centres:
“…
just having them
[midwives] here in the clinic just to go and knock
on the door
[when we needed a midwife or midwifery advice] was
really
good.”
“…
the LMCs have worked a long time in
this
practice with Pacific women...the feedback we get from the women themselves is just fantastic...
.the midwives
are considered part of the community
…”
“…
referrals back to
the [
GP’s] practice was really important; you were assured of competent care and that is why it worked really well at our Practice…well recommended Rolls Royce care here, getting those letters back, getting those results back...we work together -
good
collegial
relationships the midwives and GP’s.”
Slide29TMP Response to the Challenge:
Informed Consent
Ensure all information is
fully understood
Fear of the unknown is a barrier to access
Knowledge reduces anxiety
Information fully explained and translated if required
(
Priday and McAra-Couper 2011)
“
Slide30TMP
Response to the Challenge: Informed Consent
“
What is
about
the
woman
is
never
without
the
woman.”
Feedback
written in
Tongan
–
translated:
“She’d
never leave me
unattended;
she even explained all the details of treatment before doing anything, even she asked me questions so I fully can understand....so once I gave birth to my baby girl I decided to name
her (after the midwife) for
her appreciation and great thanks because I have nothing to repay you for your kindness and caring
...”
Slide31TMP
Response to the Challenge: Practical Steps Emerging from the Research
Replicate
this successful model of Lead Maternity Care (LMC
)
Actively
recruit
to increase significantly
the number of LMC midwives
in areas where women are most at risk
DHBs employ
Clinical Mentors for
Practices
, to
facilitate
new graduates and new midwives
to
transition
to working in
highly
complex
communities
.
Develop
strong links with a range of community services
and providers such as Maori and Pacific health teams.
Provide
appropriate and effective
referral systems
to LMC midwives
Publish a
leaflet in multiple languages
to be given to every pregnant woman, encouraging her to access local LMCs
Provide
community education
to ensure that women are aware of their
entitlement
for maternity care, and ways to access this in a confidential and appropriate way
.
Slide32More Practical Steps…
8.
Translate
consumer feedback forms.
Women who have English as a second language must have the opportunity to provide written feedback in their first language.
9. Develop
a pilot project in
area
to establish a
link midwife for pregnant teens,
to enable them to access care that is acceptable to them, and is tailored to meet their specific needs.
10. Designate
a
link midwife whose cell phone number and website appears on posters
at local school health clinics, bus stops, WINZ, Housing NZ, MacDonald’s, Family Health Centres, Family Planning clinics etc.
11. Develop
antenatal and parenting education
tailored to meet the needs of
specific
groups
of
women
.
12. Create
media campaign
on early pregnancy care.
Slide33Response
to the Challenge:
Practical Steps Identified by Women.
M
ore
up-to-date
information from their GP
on LMCs, for their
GP to assist
in finding an LMC, and for appointments to be arranged for them.
A
midwife
attached to the GP
clinic
. Many felt
that being looked after by an independent midwife and being visited at home was the best type of care
.
A
website
giving LMCs’ contacts, location, their experience / expertise / specialty
An
0800 number
for finding an LMC, for making appointments, and for contacting their midwife.
Slide34More Practical Steps Identified by Women…
Make
home visits for antenatal
care
. Those
who had been seen at home rated this highly.
Provide a
pick-up
and
drop-off
service
, or mobile clinics that are easy to get to.
Give enough
notice (at least 2 weeks) to
organise
a carer
for other children
.
Flexibility
with bringing other children to appointments and having a sitter would be helpful.
Slide35Midwifery care can only be safe and meaningful if it includes holistic attention to the sociological frameworks of the woman and family.
Slide36Continuity of midwifery care for vulnerable communities will see positive health gains far beyond the current pregnancy.
Slide37Poverty is
con
sistently found to be the most significant
barrier to accessing and engaging
in
health care.
A
community based midwifery service
reduces this
barrier and increases the utilisation of health
services, thus greatly
improving health outcomes.
Slide38The challenge for midwifery and service providers is to ensure that
every
woman
has access to such a model of
maternity care: a model which
is
integrated
in the community, is well accepted by the local
population -
both consumer and
professional - and
leads to good outcomes for
women, babies and their families.
Slide39The Challenge is Clear!
The challenge to midwives and to all providers of maternity services is to
ACT!
We must not be sitting here in a year’s time with the contributing and avoidable factors once again clearly presented, having taken no steps to reduce barriers for women to access and engage with the maternity services.
Slide40The Challenge is Clear!
The Practical Steps are:
DO–ABLE!
NOT complicated
NOT expensive
They take us “
B
eyond the Numbers”
and provide the challenge that service providers
must
meet if they are to make this vital difference to perinatal mortality and maternal health and wellbeing.