1. Improving Outcomes Karen Guilliland CEO New Zealand College of Midwives

2. Integrated service Can mean different things to different people; Woman and/or her baby can move appropriately and effectively from one level of service to another as required Each service provider recognises, respects and supports the others respective roles in an integrated service

3. Current New Zealand Health Service (2011). Ministry of Health (Health funding) District Health Boards Lead Maternity Carer (midwife/gp/ob) Employed doctors Employed midwives Maternity Hospital and Obstetric Services Self- employed Midwives LMCs Self- employed Doctors LMCs Birthing units & Obstetric Hospitals Community

4. The three delays WHO, UNFPA, ICM, FIGO identify three delays or aspects of the maternity service which can interfere with the woman and/or baby receiving an effective integrated service. State of the Worlds Midwifery, 2011. Delivering Health, Saving Lives.

5. Community a delay in seeking care and/or a delay in recognising a problem The first delay

6. 52 Primary Birthing units in New Zealand * Midwifery led unit * Obstetric hospital

7. Place of birth in New Zealand Home births~ 3-4% 52 Primary Birth Centres~ 14% 18 Secondary hospital births~40% 6 Tertiary hospital births~43%

8. The second delay Getting to the next level of service required in a timely manner Transport….ambulance, retrieval Geography Weather

9. The third delay Getting the right care from the right people when the woman, and/or her baby, arrives at the referral hospital/or is an inpatient and consultation is requested

10. Significance of delay to outcomes Delay one is often significant Delay two is the less significant Delay three is the most significant

11. What does make the difference for midwifery? WHO/ICM/FIGO/ say investment in an educated midwifery workforce working closely with the community and responsive, skilful and respectful obstetric referral systems. (The State of the Worlds Midwifery; Delivering health, Saving lives, 2011; FIGO,2010,………) NZ has this community midwifery-based integrated primary to tertiary service model. Recognition of this integrated service needs to be more internalised by all providers and together we can find ways to decrease delays and improve services even more.

12. Priorities Continual investment in quality ongoing education of all midwives and doctors working in the sector (education is often the first cut made). Reliable ongoing support & investment in appropriate obstetric & midwifery staff levels and skill mix in referral hospitals. Support for community sector as an intrinsic part of the integrated maternity health service (ie a transfer from primary to secondary service is not a failure on anyone's part)