The maternity service in Aotearoa New Zealand is an integrated system of free primary, secondary and tertiary care, which means personal, practical and professional care from midwives from early pregnancy, labour and birth, and up to four to six weeks after the baby is born. After a pregnant woman has chosen and booked with a Lead Maternity Carer (LMC) midwife, the midwife will coordinate all maternity care and support women with their decisions about place of birth.
Place of birth options
Where to birth your baby is an important consideration. Women in Aotearoa NZ can choose to give birth at home, in a small maternity unit (primary care) or in a larger maternity facility (secondary or tertiary care). Most primary, and all secondary and tertiary facilities (obstetric hospitals), employ midwifery staff (core midwives) who provide midwifery services and twenty-four hour care to the women using the facility. The core midwives collaborate and communicate with lead maternity carer midwives to provide this midwifery care. Once the baby is born, women can stay in the facility for a few days and core midwives will assist with birth recovery and feeding. Lead maternity carer midwives have access agreements with maternity facilities which enable them to continue to provide care to women who have booked with them. If women require specialist care from an obstetrician the LMC midwife can transfer part, or all of the labour and birth care, as necessary.
Some women may have medical health issues such as diabetes, or they or their baby may develop pregnancy complications, which mean they may be advised to give birth in a secondary or tertiary maternity hospital where there is specialist obstetric and paediatric support either on site 24/7 or available within a short time frame. These women may also have care from an obstetric specialist as well as a midwife.
The midwife will support pregnant women to not only choose their birth place from the options available in the area, but also help if plans need to change about place of birth for whatever reason.
This map shows the maternity facilities that are available in each region –
Well women and babies are more likely to experience a normal vaginal birth at home. Women can choose the support people they would like and it’s also easier to involve the baby’s siblings in the process if desired. Birthing pools are available (in most areas) for use in the home environment and midwives support women to organise what they need for a birth at home. Home birth is often described as an empowering and positive experience by women and their families. For women who have had a previous difficult birthing experience, a homebirth can provide a healing process. The lead maternity carer midwife will attend the women during labour and birth and will call a midwife from her practice as a second midwife when the woman is getting close to birthing so that there are two pairs of skilled practitioner’s available for both mother and baby. Ideally women will have met this 2nd midwife during pregnancy. Two midwives are expected to be present at a home birth.
If there is a need for a referral to a secondary or tertiary maternity facility from home for any reason during labour, the midwife will arrange this in consultation with the woman and her family.
Small local maternity facilities – Primary birthing units
In many regions of Aotearoa NZ, small birthing centres are available as an option for birthing women who do not have any pregnancy complications. As in the homebirth situation, women who birth in these smaller units also use less pain relief and are more likely to have a normal vaginal birth. The lead maternity carer midwife continues to provide labour and birth care in these units, and the units are also staffed with other hospital employed midwives who provide postnatal care during the days after birth. Lead maternity carers visit their clients on a regular in these units and continue the postnatal care once women have been discharged home. The primary units try and provide a comfortable and homely atmosphere which is less like a hospital environment. Women are encouraged to take personal items into the units with them, such as extra pillows, to create a comfortable space. These units usually also have birthing pools.
Larger maternity facilities – secondary or tertiary hospitals
Secondary and tertiary maternity facilities provide care for women who may have complex medical or pregnancy complications, and who may require specialist care alongside their midwifery care. These facilities have caesarean section capabilities. There are obstetric, anaesthetic, paediatric, midwifery and nursing services available in tertiary facilities. There are six tertiary maternity facilities in Aotearoa New Zealand and all provide a neonatal intensive care service. Special care baby units are available in secondary facilities. These baby units are staffed by specialist doctors and nurses who provide medical care to preterm and unwell babies. Tertiary or secondary maternity facilities may be used by well women in some regions where access to primary birthing facilities is unavailable. Transfer to primary units for women after birth happens in many regions when women have well babies and have not had birth complications. Women generally transfer to a primary unit within twelve hours of a normal birth.
What the research says
The evidence clearly identifies that the safest place for well, healthy women and babies who do not have any complications to achieve a healthy birth is in a primary birthing unit or at home. Giving birth in a familiar and comfortable environment with a midwife means that less pain relief is needed and intervention rates are reduced.
A primary birth setting means more chance of;
- a spontaneous normal birth
- less intervention including episiotomy and medication
- less forceps or surgical births
- less blood loss
- less infection
- increased breastfeeding rates
- more well women and well babies