A study in New Zealand is providing valuable insight on how maternity care can affect a child’s life after birth.
The Growing Up In New Zealand study is following almost 7,000 children from before birth into adulthood.
Research from the study has shown New Zealand’s unique maternity care system is working well, providing women-centred maternity services with excellent outcomes.
Like most Western countries, New Zealand's maternity care had historically been provided by midwives at home until the early 1900s. Birth then became a medical event, managed by doctors in hospital. In the 1970s, midwives were not allowed to attend births without a doctor present.
Yet, social movements challenged the control the medical profession had over birth, and over time, they successfully lobbied for New Zealand women’s rights in birth.
In the late 1980s, midwives regained their autonomy, and were able to attend childbirth without a doctor in the room. Not long after this, the Lead Maternity Care (LMC) model of care was introduced to New Zealand.
What Is The LMC Model Of Care?
Every pregnant woman chooses a lead maternity professional, who coordinates and provides care during pregnancy, birth and for 4-6 weeks after birth. This model of care is funded by the New Zealand government’s Ministry of Health, and eligible women receive the service for free.
Each lead maternity carer is provided with a set budget from the government. This budget covers pregnancy care, birth support and care, and postpartum care from 4-6 weeks. The budget is the same for every LMC, regardless of where they are employed or if they are independent. If there is more than one health professional providing care to a woman, they must share the budget.
Private obstetricians may charge over this payment for their services, and it will be an out of pocket expense to the woman.
Who Can Be A LMC?
LMCs are chosen from independent or hospital based midwives, GPs with a diploma in obstetrics, and obstetricians. Women choose the LMC that best fits with their pregnancy circumstances (low or high risk pregnancy) and preferences.
The Growing Up In New Zealand study reveals that 88% of women had more than one option for their LMC choice.
Over 80% of women choose midwives as their LMC (66% independent and 15% hospital midwives).
Only 8% of women choose private obstetricians as their LMC, in comparison to Australia where around 30% of women birth in the private maternity system.
Where Is LMC Accessed?
New Zealand women are able to choose where they give birth, whether that might be at home, in a birthing centre, maternity unit, or in hospital. The LMC will advise if there are any pregnancy complications that would put a woman and her baby at risk if birthing at home. But in most cases, choosing to birth at home is widely encouraged and accepted. The New Zealand government Ministry of Health website provides information about birth choices and states:
“Home birth is a safe choice for many women. Women who have home births use less pain relief and have fewer caesarean sections and forceps than women who give birth in hospital.”
Home birth statistics have started to rise in New Zealand, with between 3-5% of births occurring at home. In Australia, fewer than 1% of babies are born at home.
How Does This System Benefit Women?
The LMC system provides a women-centred service for pregnant women and their families. Women make their own choice of maternity carer instead of having one appointed to them. The choice of LMC is made based on preference and personal needs. This leads to a collaborative relationship between women and their LMC, with women taking responsibility for being informed about their choices and planning their birth.
Health professionals sharing the care of a particular woman must work collaboratively, as they are not ‘in competition’ with each other. The woman in their care is the main focus and they are responsible for ensuring she is provided with the best, safest care possible in the setting of her choice.
There is a high demand for midwives as LMCs, demonstrating that women prefer the midwifery led model of care, which views pregnancy and birth as a normal life event. Research has proven time again that a normal, undisturbed birth provides the healthiest beginning for mothers, babies and their families. Midwifery led care is associated with higher normal birth rates and lower intervention rates, at the same time providing safe woman-centred care.
What Does the Study Tell Us?
The Growing Up In New Zealand study is quite unique, in that it starts following children before they are born, to determine what impact pregnancy care and health impacts on their future. When the children’s mothers were about seven months pregnant, the researchers asked a series of questions about their maternity care experience. Almost 100% of the women had a LMC for their pregnancy and approximately 90% of the mothers had engaged a LMC in the first trimester.
Having a LMC from an early stage in pregnancy provides women with access to a range of services. LMCs support pregnant women in developing a care plan for pregnancy and birth. They provide advice on health during pregnancy and refer women for tests and assessments as needed. Midwives will work with doctors if the woman in their care has need of more specialist care during pregnancy, birth or postnatally.
During labour and birth, the LMC midwife provides support or arranges a back up midwife in the event the primary is not available. If obstetric care has been chosen, they will arrange for midwifery care during labour and attend during the birth.
After the birth, the LMC provider will visit at least 7 times (at least 5 times in the family’s home) to ensure all is going well. This support is invaluable in terms of helping new parents to adjust to having a newborn, supporting new mothers in breastfeeding, and identifying what support is needed as early as possible.
The study provides valuable insight in the sort of maternity care that New Zealand is providing to childbearing women. Continuity of care is more accessible and home birth is widely accepted as a normal choice for women if they are not at risk of complications. An increase in midwifery-led models of care reduce the rate of interventions, while keeping mothers and babies safe. Ultimately women are satisfied with their care, their birth experience and have support in the post partum period than enables to them to access services as needed.
For a country only a few hours from Australia and with a fantastic maternity system setup, it's a shame Australia can't learn more from our neighbours. Women (and men too!) are happier when they have options and choices.