In New Zealand
> Midwifery in New Zealand
> Contexts for Practice
Contexts for Practice
The maternity service in New Zealand is an integrated system of primary, secondary and tertiary maternity care. All maternity care is free except if a woman chooses a private obstetrician, who may charge the woman on top of the set fee the obstetrician receives from the government.
Primary maternity care is provided by Lead Maternity Carers (LMCs) who work under Section 88 of the New Zealand Public Health and Disability Act 2000. LMCs are selected by women to provide their lead maternity care, LMCs can be either midwives, general practitioners with a diploma in obstetrics or obstetricians. LMCs take responsibility for the care provided to women throughout pregnancy and the postpartum period including the management of labour and birth. One LMC is expected to take responsibility for all modules of care (registration, second trimester, third trimester, labour and birth, services following birth) so that each woman receives continuity of care.
The Section 88 notice sets out the terms and conditions under which LMCs are paid by Government and details the minimum service specifications to which all LMCs must work. All LMCs are paid the same as all are expected to provide the same level of service. Midwives and GPs cannot charge women on top of the fee they receive from the government.
Women in New Zealand can give birth at home, in primary maternity facilities or birthing centres, or in secondary maternity hospitals. Primary facilities are often in rural settings although there is a move to establish more primary facilities in urban centres so that women have more options for normal birth. Secondary facilities have cesarean section capabilities. There are five tertiary maternity facilities in New Zealand that also provide tertiary neonatal intensive care units.
LMCs provide care to women within maternity facilities under a generic access agreement. Copies of this access agreement can be found in the Section 88 Notice. The maternity facilities provide a certain level of service to women birthing in the facilities and a certain level of support to the LMCs. These expectations are set out in the Maternity Facility Specifications.
Some primary maternity facilities and all secondary and tertiary facilities employ midwifery staff. These employed midwives may be employed as LMCs to provide continuity of care for their own caseload of women, in which case they must meet the DHB Funded Primary Maternity Service specification. Midwives may also be employed on shifts to provide core midwifery services. This care includes 24-hour care to women and babies in the facilities and working in collaboration with LMCs. These midwives are often referred to as ‘core’ midwives because they provide the core essential care to women in hospital.
In the secondary and tertiary facilities core midwifery may also provide essential midwifery care to women who require secondary obstetric care and whose LMCs have handed care over to the secondary service. Secondary maternity care is free to women; obstetricians employed in the facilities provide this service with the core midwives. Maternity facilities are funded by the Government for all women who use them. There is an additional budget for the secondary and tertiary level services they provide for some women. The services that they are required to provide are described in the Secondary and Tertiary Maternity Services Specification.