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
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Society
Women and their families/whanau
Health professionals
Health administrators
Public servants
Governments
The system we have
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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
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Quality and Safety programme
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Revised Referral Guidelines
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National shared maternity information
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Rebuilding national maternity datamart
Quality and Safety
programme
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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
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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 womancentred 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
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Standard Primipara who have a spontaneous vaginal birth
Standard primipara who undergo induction of labour
Standard primipara who undergo an instrumental vaginal birth
Standard primipara undergoing caesarean section
Standard primipara with an intact lower genital tract (no 1st—4th degree
tear or episiotomy)
Standard primipara undergoing episiotomy and no 3rd—4th degree perineal
tear
Standard primipara sustaining a 3rd—4th degree perineal tear and no
episiotomy
Standard primipara undergoing episiotomy and sustaining a 3rd—4th degree
perineal tear
General anaesthesia for all Caesarean sections
Postpartum haemorrhage and blood transfusion after vaginal birth
Postpartum haemorrhage and blood transfusion after Caesarean section
Premature births (delivery between 32—36 weeks)
National clinical guidelines
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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
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partnerships
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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
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Expert working group
Criteria evidence revised
New categories developed –
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Primary (P)
Consultation (C)
Transfer (T)
Emergency (E)
Process maps drawn
Shared maternity information
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National Health IT Board
Maternity sector governance
group
Software developer
Two pilot sites
DHB maternity IT system project
Rebuilding the national
maternity data mart
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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
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Quality & Safety programme
implementation
Referral guideline implementation
Service specification implementation
Clinical guideline development
DHB Primary maternity data collection
Consumer education & information