Potentially avoidable deaths – what can maternity planners do to help Bronwen Pelvin Senior Advisor, Maternity Services Clinical Leadership, Protection & Regulation Ministry of Health

Maternity Planners Society Women and their families/whanau Health professionals Health administrators Public servants Governments

The system we have Sector & consumer engagement Framework for maternity services Contracting for services Funding – lead maternity care – facilities – secondary & tertiary care Quality improvement Evidence based Midwifery-led Community based

Maternity Quality Initiative Quality and Safety programme Revised Referral Guidelines National shared maternity information Rebuilding national maternity datamart

Quality and Safety programme National New Zealand Maternity Standards National Clinical Indicators National Maternity Guidelines Clinical Leadership - Integrated DHB & LMC clinical leadership to drive quality improvement Clinical Networking with all local maternity practitioners Revised DHB maternity service specifications Local monitoring of local data Identification of local quality improvement priorities Local mortality reviews & healthcare incident management Education sessions for all practitioners Greater consumer involvement in planning and quality improvement

National Maternity Standards Standard 1: Maternity services provide safe, high quality services that are nationally consistent and achieve optimal health outcomes for mothers and babies Standard 2: Maternity services ensure a woman- centred approach that acknowledges pregnancy and childbirth as a normal life stage Standard 3: All women have access to a nationally consistent, comprehensive range of maternity services that are funded and provided appropriately to ensure there are no financial barriers to access for eligible women

Clinical indicators 1. Standard Primipara who have a spontaneous vaginal birth 2. Standard primipara who undergo induction of labour 3. Standard primipara who undergo an instrumental vaginal birth 4. Standard primipara undergoing caesarean section 5. Standard primipara with an intact lower genital tract (no 1st—4th degree tear or episiotomy) 6. Standard primipara undergoing episiotomy and no 3rd—4th degree perineal tear 7. Standard primipara sustaining a 3rd—4th degree perineal tear and no episiotomy 8. Standard primipara undergoing episiotomy and sustaining a 3rd—4th degree perineal tear 9. General anaesthesia for all Caesarean sections 10. Postpartum haemorrhage and blood transfusion after vaginal birth 11. Postpartum haemorrhage and blood transfusion after Caesarean section 12. Premature births (delivery between 32—36 weeks)

National clinical guidelines Two guidelines almost completed – Management of postpartum haemorrhage Care of mother & baby in the immediate postpartum Further two in 2011/12 plus Review of breech & vaginal birth after Caesarean guidelines

Improving relationships partnerships women & health professionals health professionals & health professionals Ministry of Health, maternity sector & women health professionals, managers, planners & funders health professionals ‘at the coal face’ professional colleges

Revised referral guidelines Expert working group Criteria evidence revised New categories developed – Primary (P) Consultation (C) Transfer (T) Emergency (E) Process maps drawn

Shared maternity information National Health IT Board Maternity sector governance group Software developer Two pilot sites DHB maternity IT system project

Rebuilding the national maternity data mart It’s done !! National Minimum Data Set (NMDS) LMC claim data This month – testing Publish clinical indicators DHB primary maternity data project Resume MoH Maternity publications

Budget allocations Quality & Safety programme implementation Referral guideline implementation Service specification implementation Clinical guideline development DHB Primary maternity data collection Consumer education & information