BEYOND THE NUMBERS MIDWIFERY CHALLENGES IN ADDRESSING PERINATAL MORTALITY IN NEW ZEALAND.

Slides:



Advertisements
Similar presentations
Pregnancy and complex social factors
Advertisements

Improving access for Australians who are Deaf, have a hearing impairment or a chronic disorder of the ear Nicole Lawder Deafness Forum of Australia.
Hillingdon Community Health Improving Breastfeeding prevalence with partnership working Jennifer Taubman Breastfeeding Coordinator.
Supporting Family Carers National Consultation with Family Carers on the enhancement of Carer Support Groups 29 th March 2014.
Assessment and eligibility
Working with you for Better Health Family Nurse Partnership Jayne Snell Family Nurse Supervisor Clare Brackenbury Family Nurse.
Mike Keen, CEO, Kent LPC. Why is change needed? NHS England states that: Primary care services face increasingly unsustainable pressures Community pharmacy.
Update from West Suffolk Hospital Breast feeding rates and the peer support service Colleen Greenwood West Suffolk Hospital.
Solutions to Child Poverty: Our Initial Proposals: Health Nikki Turner Expert Advisory Group September 2012.
Church Road Surgery Patient Feedback Questionnaire August 2013.
BREAKOUT 1: Identifying the Gap (or Journey) (13.45 – 15.00)
The Power of Cultural Safety When Different Worlds Meet Giving midwifery care to migrant mothers and their babies Elsie Gayle
2.1 Parenting and Families
TRANSITION PROJECT LEARNING NETWORK WORKSHOP 3 AISLING PROJECT: TRANSITION PROJECT.
Pre & Post Maternity Services for Migrant Women Presentation by Monica Tolofari Consultant Midwife in Public Health 11th November 2010.
Creating a service Idea. Creating a service Networking / consultation Identify the need Find funding Create a project plan Business Plan.
Making pregnancy safer: can we do better? A PMMRC workshop on improving outcomes for New Zealand mothers and babies.
Midwifery Programme Overview Health and Well Being Sheffield Hallam University.
Integrated Therapy Service for Children and Young People Frances Rowe, Service Manager – October 2013.
SEN 0 – 25 Years Pat Foster.
Baby Extra: “The birth of a baby is a unique moment in the life of parents. It makes parents more capable than they ever thought they would be.”
Qualitative Evaluation of Keep Well Lanarkshire Alan Sinclair Keep Well Evaluation Officer NHS Lanarkshire.
Maternity Strategy Where are we now……and where do we want to get to????
11 November 2011 Midwives- making a difference. Joyce Leggate Belinda Morgan Family Health Project NHS Fife.
The Role of the Midwife in Public Health Julie Foster Senior Lecturer University of Cumbria.
Impact of NHS Health Reforms FWT – A Centre for women Presented by Christine McNaught – FWT Centre Manager Noreen Bukhari – MAMTA Programme Manager FWT.
Engaging Pregnant Women to Stop Smoking – Creating Effective Referral Pathways and Increasing Quit Rates By Hayley Bates and Catherine Sixsmith.
Commissioning Self Analysis and Planning Exercise activity sheets.
Objectives Methods ‘ Whooley’ questions were provided to all clinical staff from July Retrospectively, a random sample of patients who presented.
Embracing Child and Maternal Health FWT – a centre for women By :Noreen Bukhari (MAMTA Manager) Date: Migrant Workshop Jan 2014.
The Broader Impact of Incentive Schemes to Enable Smoking Cessation in Pregnancy Tina Williams June 2015.
The 2010 PMMRC Report: an overview Perinatal Mortality Maternal Mortality
Niall McVicar Children’s Trust Unit, Service Manager City of York Council.
Maternity Patient Experience at Morecambe Bay 2014/15 Results All women who give birth are given our Maternity Patient Experience Questionnaire. This questionnaire.
DeKalb County Youth Service Bureau YSB assists youth as they build healthy lives & relationships with their family, friends, & community. YSB …for the.
Evidence into Practice Using a Strength Based Approach in Family Nurse Partnership (FNP) Gail Trotter FNP Implementation Lead, Scotland.
StagesOf Assessment Stages Of Assessment. The Stages of Assessment for the Single Assessment Process §Publishing information about services. §Completing.
People Group The Care Act 2014 David Soley Service Manager Social Care and Support Warwickshire County Council
Striving Towards Excellence in Comprehensive Care: What do Children Need? July 10, 2007 Christopher A. Kus, M.D., M.P.H.
Perinatal Mental Health Sue Atherton, Specialist Midwife for Drugs, Alcohol and Mental Health Manchester Specialist Midwifery Service.
Post natal clinic Barkerend Midwives, Bradford Teaching Hospitals, UK Presented by Julie Walker, Midwifery Matron.
Reproductive Health class#2 Safe motherhood. Women’s Health Key facts.
Practice-based interprofessional peer-learning between medical and midwifery students – a pilot study Celia Woolf¹ & Adele Hamilton² ¹Institute of Health.
Understanding and responding to the determinants of maternal deaths Photo by Renee Bourque, Bright Star Consultants,
NOT TO BE USED UNTIL 12 NOON FRIDAY #Takingcharge in Greater Manchester Health and Social Care Devolution key messages.
Sally Johnson, Head of Service (Maternal health) Identifying vulnerability and enabling access to services.
Initial Project Aims To increase the capacity of primary schools in partnership with parents to implement a sustainable health and sexuality education.
3.6 Working together © Pearson Education Printing and photocopying permitted Level 3 CYPW Unit Working Together for the Benefit of Children.
Specialist Perinatal Mental Health Service NHS Lanarkshire Mental Health and Learning Disabilities 4 th February 2015.
Health Visiting Presentation January Background of a Health Visitor Qualified Nurse or Midwife with experience Additional year training at degree.
Walsall Holiday Childcare Provision Pilot. Project Aims Address and better understand poor take up of holiday childcare Improve business acumen and capability.
Middle Managers Workshop 2: Measuring Progress. An opportunity for middle managers… Two linked workshops exploring what it means to implement the Act.
Families and Disability. At the beginning… Watch the following video and think about the following questions: What do you think the needs of these parents.
Shared Responsibility in Action- Whole Family Teams August 2012.
Maternity Services Text message service to increase attendance at antenatal clinics.
ACCESSING AND ENGAGING IN MATERNITY SERVICES. Effective Midwifery Care for woman in vulnerable populations Continuity of CareInformed consent Midwife.
National Early Years Conference Edinburgh Conference Centre Heriot Watt Campus October 2010.
IMPROVING THE HEALTH AND WELLBEING OF YOUNG CHILDREN.
Powys teaching Health Board: Laying the Foundations for Good Health Our approach to delivering prudent healthcare By engaging with our population, and.
Factors that Affect Pregnancy Part One. Introduction There are three aspects of pregnancy that one should look at when considering how they want their.
Working Together for the Benefit of Children and Young People
SOUTH PACIFIC NURSES FORUM
Experiences of disabled women with pregnancy, childbirth and early parenting services: implications for occupational therapy. Bethan Collins, Jenny Hall,
Smoking in Pregnancy Addressing the Pregnancy Challenge
SEFTON MASH The Decision Making Process of MASH and how the current restructure will affect MASH.
Your unborn baby has been diagnosed with a heart problem
Early Start Bereavement Pathway
Matching the Best in the World
Children, Young People and Maternity Workstream
A Support in mind youth initiative
Presentation transcript:

BEYOND THE NUMBERS MIDWIFERY 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 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.

The 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.

The 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)

The 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).

The Challenge… We have to address the social deteriminants of health that impact on perinatal mortality and maternal health and well being.

Contributing 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).

The 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.

A 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.

Project carried out for the Ministry of Health in 2011: ‘A Successful Lead Maternity Care Midwifery Practice In Counties Manukau.’ (Priday and McAra-Couper, 2011)

Response 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 Report 2011.

Response 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.

Response 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.

Response 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)

Response to the Challenge…. NOT KNOWING: the need to choose and book with an LMC the 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)

Practical Barriers to Accessing and Engaging 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)

More Barriers… 7. Shyness or discomfort phoning a stranger 8. Lack of landline or credit for cell phone 9. Belief that asking 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)

And More Barriers… 13. Lack of health knowledge and limited literacy in English 14. Doctor 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)

Further Research from “A Successful LMC Midwifery Practice in Counties Manakau”: The Midwifery Practice (TMP) Clientele 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

The Midwifery Practice (TMP): Perinatal Mortality

The 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)

TMP Response to the Challenge: Continuity of Care… Continuity of Care allows for greater knowing, develops trust, and encourages open communication... Continuity of Care keeps women and babies safe. (Priday and McAra-Couper 2011)

Response to the Challenge: Continuity of Care… Those who were most satisfied were women who had Continuity of Care. 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)

TMP 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)

TMP 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

TMP 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 Well 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.”

TMP 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.”

TMP 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) “

TMP 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...”

TMP Response to the Challenge: Practical Steps Emerging from the Research 1.Replicate this successful model of Lead Maternity Care (LMC) 2.Actively recruit to increase significantly the number of LMC midwives in areas where women are most at risk 3.DHBs employ Clinical Mentors for Practices, to facilitate new graduates and new midwives to transition to working in highly complex communities. 4.Develop strong links with a range of community services and providers such as Maori and Pacific health teams. 5.Provide appropriate and effective referral systems to LMC midwives 6.Publish a leaflet in multiple languages to be given to every pregnant woman, encouraging her to access local LMCs 7.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.

More 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.

Response to the Challenge: Practical Steps Identified by Women. More 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.

More 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.

Midwifery care can only be safe and meaningful if it includes holistic attention to the sociological frameworks of the woman and family.

Continuity of midwifery care for vulnerable communities will see positive health gains far beyond the current pregnancy.

Poverty is consistently 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.

The 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.

The 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.

The Challenge is Clear! The Practical Steps are: DO–ABLE! NOT complicated NOT expensive They take us “Beyond 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.