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Maternity clinical indicators help benchmark Waikato DHB performance

The New Zealand Maternity Clinical Indicators report was released by the Ministry of Health yesterday, giving Waikato DHB the opportunity to compare itself to other peer DHBs on maternity outcomes.

The report is based on births in 2013, the most recent available data on all births across the country.

The report gives DHBs the prompt to look at where they appear to have better outcomes or areas where they are not reaching the national level. This difference may be because of the health of women in the area and the average age of women birthing, but it may also mean a DHB needs to look more closely at the service they are delivering to women and their clinical practices.

One of those indicators is the percentage of women who register with a midwife in their first trimester (first three months of pregnancy). This is important because early engagement with a midwife enables opportunities for health screening to detect problems and issues in pregnancy earlier rather than later.

In 2013 69 per cent of Waikato women registered with a midwife in their first trimester, an increase from the previous year and higher than the national average of 64.9 per cent.

Jackie Reetz, Hamilton midwife and lead maternity carer, says that one of the most proactive things a woman can do towards a healthy pregnancy is register with a midwife early in pregnancy before twelve weeks. This gives the best opportunity to identify risk factors, gather information and help to improve outcomes.

Waikato clinical midwife director Corli Roodt adds that “It’s great that we are tracking well on this indicator, but we are concerned about the 30 per cent of women who register with an lead maternity carer (LMC) later in pregnancy and miss out on early pregnancy care – our message is the sooner the better.”

The report demonstrates that in 2013 women in Waikato had a lower significant blood loss following caesarean section delivery with less women requiring blood transfusion. Waikato women had a similar rate to the national rate for blood transfusion following vaginal birth.

A number of the indicators analyse the birth outcomes of first time mothers (who are the fittest and healthiest women in the country and so would be expected to have similar clinical outcomes, which means DHBs can make clear comparisons). In this group Waikato performs well. Outcomes on average are better in Waikato DHB’s district than some of our peer DHBs for a number of the indicators used for this group of women. Waikato DHB has:

• higher than national rate of women having a spontaneous birth without any intervention.
• lower than national rate of women undergoing a caesarean section
• similar to national rate of induction of labour
• significantly higher than national rate of women with an intact lower genital tract

Corli Roodt says that primary birthing facilities play an important role in the Waikato.

“Waikato DHB covers a sizeable geographical area and we are fortunate to have a wide range of primary birthing facilities where 30% of our uncomplicated births occur, enabling healthy women to birth nearer their home.”

The report also outlines the number of women smoking during the postnatal period. Waikato’s rate of smoking has been reducing in the last few years, however the DHB still has 17.9 per cent of women smoking following birth, which is higher than national rate. Young women, Maori women and women living in lower socio economic circumstances are more likely to smoke.

Waikato’s Hapu Mama Smokefree Pregnancies programme is one initiative to lower this rate. The programme aims to ensure all women are asked about their smoking status early and offered support to quit smoking at any stage during pregnancy.

Midwife Gina Chaney advises women who smoke to seek help to quit as soon as they can. “Smoking is harmful to the blood vessels of the placenta, lowering the oxygen and food supply to the growing baby. It is never too late to give up smoking in pregnancy,” she says. By quitting, the woman can help reduce the risk of premature birth, SIDS (Sudden Infant Death Syndrome), stillbirth and low birth weight.

Maternal obesity is also becoming a significant health issue in pregnancy, and 8.4 per cent of Waikato pregnant women were obese – slightly higher than the national average of 8.2 per cent.

Dr Penelope Makepeace, clinical director of Obstetrics says: “Maternal obesity can result in negative outcomes for both women and her unborn baby. The fetus is at risk for stillbirth and congenital anomalies and the women at risk of a number of pregnancy complications”.

Preterm birth is among the top cause of death in infants worldwide. Waikato’s preterm birth rate has dropped over recent years to 6.6 per cent, lower than the national rate of 7.4 per cent.

The indicators also show that Waikato has a higher than national rate of babies that are small for gestational age – Waikato’s rate is 4.5 per cent and the national rate is 3.1 per cent at 37 – 42 weeks. Waikato has a rate of 2.4 per cent of babies born at 37 weeks plus needing respiratory support, slightly higher than the national average. Fetuses small for gestational age are at risk of still birth and infants born small for their gestational age are at increased risk of poor health. Placenta disease and smoking are common causes of poor fetal growth.

The report has a section focusing on severe complications for the women. Looking at

  • eclampsia (high blood pressure with severe complications that can lead to serious illness or death)
  • hysterectomy performed to save the woman’s life
  • ventilation for the women greater than 24 hours

the number of these cases is very small and the report highlights the need for all DHBs to review each of these cases to look if there were opportunities for prevention.

Ruth Galvin, Maternity Quality Safety lead in Waikato says the report features a national comparison in a number of areas and gives Waikato a benchmark to identify where it is performing well and where we can focus our attention on quality improvement.

“There is always room for improvement and the Waikato Maternity Quality and Safety Programme will focus on key areas such as Waikato’s higher rate of the use of general anaesthetic in caesarean sections and the increase in women having an instrumental delivery (use of vacuum and forceps).”

Read the Ministry of Health New Zealand Maternity Clinical Indicators 2013 report here

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