An overview of the most recent maternity frameworks or initiatives produced by state and territory governments is given in Table C.1.
New South Wales
New South Wales Framework for Maternity Services
- This document38 provides strategic objectives for the development and implementation of future services over a five year period. Strategies supporting this Plan were structured around the following goals:
- consumer choice and access to culturally sensitive maternity care
- safety and quality
- collaboration amongst maternity care professionals
- recognition of birth as a normal process
- availability of a range of models of care, including continuity of care
- a competent and flexible workforce.
Maternity — Towards Normal Birth in NSW (June 2010)
This policy directive provides the current maternity services policy. It provides the following ten steps to promote, protect and support normal birth:
- Have a written normal birth policy/guidelines, along with other relevant policies, that are routinely communicated to all health care staff.
- Train all health care staff in skills necessary to implement this policy.
- Provide or facilitate access to midwifery continuity of carer programs in collaboration with GPs and obstetricians for all women with appropriate consultation, referral and transfer guidelines in place.
- Inform all pregnant women about the benefits of normal birth and factors that promote normal birth.
- Have a written policy on pain relief in labour that includes the use of water immersion in labour and birth.
- Have a written post-due-date policy/guideline that is routinely communicated to all health care staff.
- Provide or facilitate access to vaginal birth after caesarean section operation (VBAC) that is supported by a written vaginal birth after caesarean section operation policy/guideline, and provide health care staff with the skills necessary to implement this policy/guideline.
- Provide or facilitate access to external cephalic version.
- Provide one to one care to all women experiencing their first labour or undertaking a VBAC, vaginal breech or vaginal twin birth.
- Provide formal debriefing in the immediate postpartum period for all women requiring primary caesarean section operation or instrumental birth with the opportunity for further discussion and information transfer.
Maternity and Newborn Capability Framework
- This framework guides health services in planning and providing appropriate levels of maternity and newborn care in the community.
- Maternity enhancement funding has been provided over four years to 2011–12 in response to the increased birth rate. Maternity services have been requested to reform maternity services including:
- increased continuity of carer programs
- increased access to VBAC, external cephalic version and vaginal breech birth where appropriate
- ensuring maternity health professionals have the skills to implement this policy
- increased support for women including the postnatal period ($42.8 million over four years)
- Policy directives provide consistent strategic directions for maternity services in NSW.
- PD2006_045 Maternity — Public Homebirth Services
- PD2006_012 Breastfeeding: Promotion, Protection and Support
- PD2007_024 Maternity — Timing of Elective or Pre-Labour Caesarean Section
- PD2009_003 Maternity — Clinical Risk Management Program
- PD2009_058 Maternity — Early Pregnancy Complications
- PD2010_ 019 Maternity — Breastmilk: Safe management
- PD2010_022 Maternity — National Midwifery Guidelines for Consultation and Referral
- PD2010_040 Maternity — Fetal Heart Rate Monitoring
- PD2010_045 Maternity — Towards Normal Birth in NSW.
- Maternal and Perinatal Health Priority Taskforce provides strategic policy and operational advice to the Department of Health. This Taskforce hosts annual statewide seminars about topical issues. NSW Maternal and Perinatal Committee reviews maternal and perinatal mortality and provides advice to the Department of Health and the Minister for Health ($30,000)
Models of care
- Stand alone midwifery managed programs are linked to nearby maternity services (tertiary in these instances). They have associated specialist obstetricians for consultation and referral. There are three in NSW.
- Public funded homebirth programs are operated midwifery group practices within mainstream maternity services. There are four publicly-funded homebirth services.
- A variety of services are provided through birth centres, including caseload care, team midwifery and traditional care. There are at least seven birth centres in NSW.
- Women with normal, moderate and high risk factors are provided care in continuity models including team midwifery and caseload care. Some of this care is provided through birth centres.
- The NSW Government committed $3.6 million over four years to 2011–12 to support high-risk maternity services to further enhance the care provided to women with more complicated pregnancies.
- In NSW, health services have been offering care to pregnant women with substance use problems for at least 25 years. Some of the services are standalone treatment services, others are merged with maternity or drug and alcohol. $1.5 million has been provided between 2007–08 and 2009–10 for some of these services under the dedicated Drug Budget 3. However, this does not represent total investment in these services.
- New specialist perinatal mental health teams in three areas will provide specialist assessment and intensive short-term mental health care in-reaching to maternity and across community settings. Mental Health and Drug & Alcohol professionals attend SAFE START multidisciplinary case discussion meetings in maternity settings to assist midwives in care coordination for women with complex antenatal risk factors. A SAFE START Consultation–Liaison position has been funded for each Area Health Service (eight new positions).
- Neonatal and paediatric Emergency Transport Service (NETS) ($6,739,940)
Early pregnancy care
- Major rural referral and some metropolitan hospitals have implemented early pregnancy units in Emergency Departments and Early Pregnancy Assessment Services (EPAS) to expedite the treatment of women experiencing lower abdominal pain or vaginal bleeding in early pregnancy. ($3 million recurrent p.a. from 2008–09). The EPAS are provided on a daily basis (Mon-Fri) as an outpatient service staffed by midwives and obstetricians.
- The introduction of more public antenatal clinics in over 40 rural towns has increased access to public antenatal care. This includes 1.5 hours for comprehensive first visit, medical and midwifery clinics ($1.3 million recurrent p.a. from 2008–09). The service delivery model for the provision of public antenatal is one of shared pregnancy care where the midwife shares care with the GP/GP obstetrician/obstetrician.
- Redevelopment of hospitals (including maternity services) will provide more integrated services and improve relationships, including maternity services:
- Orange, Narrabri and Manilla (in construction)
- Royal North Shore Hospital (redevelopment).
- Funding announced to complete planning and start work on the redevelopment of Tamworth Hospital including planning to relocate women’s and children’s services.
- Funding for redevelopment at Dubbo.
- The NSW Statewide Breastfeeding and Infant Nutrition Reference Group (RG) meet at NSW Health on a quarterly basis and is chaired by the Nursing and Midwifery Office. The RG was established to support the implementation of NSW Health Policy Directive- PD2006_012 Breastfeeding in NSW: Promotion, Protection and Support and to encourage a collaboration and coordination of effort. It has representation from NSW Health, Area Health Services, Baby Friendly Health Initiative NSW, Midwifery and Neonatal Professional Bodies and the Australian Breastfeeding Association.
Aboriginal Maternity and Infant Health Service (AMIHS)
- The AMIHS is a maternity service that was first established in 2000 providing continuity of care in the antenatal and postnatal periods for Aboriginal women and babies. It has expanded to over 30 services across NSW. AMIHS has a preferred referrer pathway to the Community Services’ early intervention program Brighter Futures ($8.865 million p.a.). AMIHS provides care for around 75% Aboriginal mothers and babies in NSW. It is predominantly rural, but there are four services in metropolitan Sydney.
- AMIHS suite of resources include a generic brochure, a safe sleeping brochure, and a brighter futures brochure; calling cards, poster and media pack ($24,684). The printing and distribution cost is $10,000. The Healthy Pregnancy for a Healthy Baby is being revised to update the clinical content and provide a generic statewide resource ($100,000).
- AMIHS data set development and collection ($30,000).
Training and Support Unit (TSU) for Aboriginal Mothers and Babies
- This is being re-established in the NSW Institute for Clinical Services and Training. Its purpose is to provide training and support for the AMIHS ($2,187,000 p.a.).
Aboriginal Mothers and babies
- The Indigenous Early Childhood Development National Partnership Agreement Element 2: Increased access to antenatal care, pre-pregnancy and teenage sexual and reproductive health has been funded by the Australian Government for a total of $26.7 million over five years. Element 2 has two components:
1. 1. The antenatal component is to provide secondary mental health, and drug and alcohol services to Aboriginal Maternity and Infant Health Services (AMIHS) families, where appropriate. Eight mental health, and eight drug and alcohol services are to be implemented. Funding provides for clinical positions, including Aboriginal Traineeship positions. In addition to these positions, funding provides for training, education, social marketing and workforce development strategies.
2. 2. The aim of the sexual and reproductive health component is to increase the proportion of young Aboriginal people (i.e. 12–19 years) accessing sexual and reproductive health programs and services. There will be 10 services implemented as part of this component. Funding is available for positions, education activities, social marketing and workforce development strategies. All the sexual and reproductive health positions are identified as Aboriginal specific positions.
- A smoking cessation support program called Quit for New Life will be implemented in all AMIHS to support pregnant Aboriginal women and their families to quit smoking and remain smoke-free. The program includes a range of tailored resources and tools. The Quit for New Life program aims to build the skills and capacity of maternal health staff to offer smoking-cessation support. All staff will have access to brief intervention training and resources to assist in the provision of smoking-cessation intervention to their clients.
NSW Aboriginal Nursing and Midwifery Cadetship
- The NSW Government has made a commitment to increase the number of midwifery cadetship positions by 6 annually and nursing cadetship positions by 18 annually. There is also funding for 40 enrolled nursing cadetships annually (Total = $752,000).
- An international advertising campaign to attract specialist Obstetricians and Gynaecologists to NSW was launched in March 2010. The advertising campaign directs potential applicants to a new recruitment website listing current vacancies in Obstetrics and gynaecology in NSW. To date, this has resulted in positions being viewed by 1,300 potential applicants from 60 countries. The cost of the campaign to date is approximately $122,000.
- Birthrate PlusŪ (midwifery workload measurement tool for maternity services) being tested for adoption across all NSW public maternity services ($165,000p.a).
- Centralised application process for:
- new graduate midwives in their first year of registration. 150@$1,000 ($15,000p.a)
- postgraduate midwifery students designed to monitor and increase the availability of clinical training places in NSW.
- Scholarships available:
1. 1. Undergraduate midwifery students in Bachelor of Midwifery courses leading to registration as a midwife ($50,000 p.a.)
2. 2. Postgraduate midwifery students who are registered nurses undertaking a Graduate Diploma or Masters courses leading to registration as a midwife. 120@$8,000 ($960,000p.a)
3. 3. Rural Placement Grants to assist undergraduate and postgraduate midwifery students to undertake a clinical placement in a rural maternity service. 11@$500 ($5,500p.a)
4. 4. Rural Clinical Midwifery Consultant Scholarships will provide financial assistance for the four Clinical Midwifery Consultants meetings/ year ($30,000p.a)
5. 5. Rural Midwifery Scholarships to fund a number of external courses taken out to approximately 630 midwives in rural NSW including Advanced Life Support in Obstetrics (ALSO, Active Birth and Family Partnerships Training ($150,000 p.a.)
6. 6. Clinical Supervision to provide training scholarships for midwives to undertake Clinical Supervision training in the four rural Area Health Services ($200,000)
7. 7. Aboriginal Post Graduate Scholarship Program — Up to $500,000 over the next three years is available for Aboriginal nurses and midwives for postgraduate scholarships, particularly focusing on maternity, early childhood, paediatrics, drug and alcohol and mental health.
- Funded the update into CD version and the distribution of a Midwifery Refresher Package for currently practicing or returning to practice midwives employed by NSW Health ($20,000).
- Midwifery Connect is a supported return to practice program. To date, 36 (26 rural and 10 metro) midwives have been employed through the program ($120,000).
NSW Aboriginal Nursing and Midwifery Cadetship continued
- Masterclass vacuum extraction – the NSW Department of Health will fund four masterclasses targeting senior clinicians to standardise and increase the uptake of vacuum extraction. Some clinicians will then become trainers across the State to ensure sustainability ($13,500).
- Under Caring Together: The NSW Health Action Plan a new specialist obstetrician/gynaecologist position has been funded in western Sydney at a cost of $177 000 p.a. for four years.
- NSW categorises health services by the Guide to the role delineation of Health Services (2002) which identifies a service level from 1 to 6. This identifies the level of complexity that can be supported by the health facility.
- NHMRC research partnership to assess impact of role delineation on clinical services ($200,000).
- NSW collects centralised data through the Midwives Data Collection and provides data to the National Perinatal Statistics Unit. Perinatal outcome data for public and private maternity services is published in the annual NSW Mothers and Babies Report, a Public Health Bulletin. Maternity services with ObstetriX (maternity information system) are able to run local reports to examine trends in outcomes and for risk management purposes. Electronic data collections are being expanded through the provision of hardware and Year 1 set-up costs to implement the maternity information system, ObstetriX ($96,706).
- Implementing an electronic system to notify births in NSW public hospitals in accordance with NSW Registry of Births, Deaths & Marriages policy.
- The Clinical Excellence Commission publishes a biannual safety report on the incidence, trends and actions in response to reporting to the Incident Information Management System (IIMS).
- Print resources: Having a Baby is provided to every pregnant woman who books into a public maternity service. It provides an introduction to the many and varied subject areas across maternity care and organisation, directing women and their families to more comprehensive information and help ($200,000 p.a.). This publication has been translated in full into five community languages ($130,000). It is available free of charge on the internet.
- Early Pregnancy Care project:
- Thinking of having a baby — planning a pregnancy and becoming pregnant: Provides factual, simple information for women to prepare for pregnancy and tips on keeping healthy while pregnant
- Early pregnancy — when things go wrong: A booklet for women experiencing complications in early pregnancy, including information on what to do if you are having a miscarriage, types of miscarriage and support services available These resources are in the process of being translated into 10 languages ($50,000)
- An information brochure has been developed for women and families experiencing a stillbirth about the post-mortem examination of a stillborn baby.
- The distribution of major publications is automated so as to ensure just-in-time provision and a guaranteed supply.
- SIDS and Kids NSW are conducting 10 Early Pregnancy Loss Workshops across NSW (six in rural areas and four in metropolitan Sydney) over 2010–11. The project aims to increase the awareness of grief and loss associated with miscarriage and early pregnancy loss up to 19–22 weeks (including still birth) ($28,240).
- Pregnancy and Newborn Services Network (including the Perinatal Advice Line) (PSN) ($0.975 million).
Future Directions for Victoria’s Maternity Services
- This plan39 documents a framework for gradual but strategic change that will guide developments over the next five to ten years.
- The policy focus is to provide primary maternity services within local settings, provide women with greater control of their birthing experience and establish maternity service models that promote continuity of care. It comprises four key principles:
- Women have informed choice, continuity and safety in their pregnancy, birthing and postnatal experiences.
- Primary maternity care is the most appropriate model of care for the normal life events of pregnancy and birthing.
- Access to appropriate specialised care when required is integral to providing safe, high-quality maternity care.
- A collaborative, interdisciplinary team approach to the provision of maternity care requires education, training and development.
|Maternity and Newborn Capability Framework
- This framework guides health services in planning and providing appropriate levels of maternity and newborn care in the community.
|Maternity and Newborn Clinical Network (MNCN)
- Maternity services are active participants in the network, supporting consistency in practice, collaboration and partnerships.
- Specific MNCN projects include a statewide standard for induction of labour, vaginal birth after caesarean section (VBAC) and a Special Care Nursery project to keep mothers and babies together.
Rural Maternity Initiative (RMI)
- $9.6 million has been allocated from 2003–11 through RMI to support sustainable rural maternity services including developing new service models, collaborative alliances, quality and safety initiatives and workforce training and development.
- RMI has funded the implementation of continuity of midwifery care models, service reviews, model-of-care redesign, upskilling of clinicians, collaborative partnerships, and quality and safety initiatives to support sustainable rural maternity services.
Maternity Emergency Education Program (MEEP) and Pregnancy Care Program (PCP)
- State funding supports regular, collaborative, team-based training, education and professional development to facilitate optimal maternity care team functioning.
|Models of care
- Since the introduction of Future Directions in 2004, Victorian women have more maternity care options available to them, including publicly funded homebirth as well as caseload and team midwifery. These models are increasingly available in metropolitan, rural and regional areas and promote continuity of midwifery care for low-risk women.
- Ongoing work is under way to provide all women with access to appropriate levels of maternity care and equitable access to primary models of maternity care where clinically appropriate.
- Smaller rural facilities are able to provide antenatal, postnatal and support services in partnership with larger subregional and regional services that provide birthing options.
- Health services facilitate consultation and referral processes from primary to secondary and tertiary models of care to enable women to move seamlessly through the levels of care they require.
- The Victorian Maternity Record (a handheld record) is being implemented across the state.
- Maternity workforce funding promotes recruitment and retention and optimal use of workforce skill mix.
- 2009–10 funded projects included changes to maternity care models, maternity skill development and training, development of workforce skill mix across maternity and neonatal care, support for regional workforce collaboration, development of a midwifery common assessment tool and a midwifery fellowship model of employment.
Victorian Maternity Services performance indicators
- Health services review their performance and benchmark their maternity care through the Maternity Services Performance Indicators.
- These services also seek support for education, training and skill development where performance can be improved, such as areas with high intervention rates.
- Since 2007–08, $45.85 million has been committed to increase maternity and neonatal bed capacity and maternity service provision across Victoria.
- In 2008–09, $30.5 million in capital funding was allocated to accommodate an additional 2800 births per year.
|Maternity and Newborn Services in Queensland Work Plan
- Queensland Health is implementing this plan56 to address the priorities for maternity reform.
- A dedicated Maternity Unit and a statewide Maternity and Neonatal Clinical Network have been established to guide the reform agenda.
- Under the leadership of the clinical network, Queensland is:
- developing clinical indicators to monitor maternity and neonatal clinical outcomes such as caesarean section and induction rates
- undertaking service improvements in relation to midwifery-led discharge
- developing statewide maternity and neonatal clinical guidelines
- developing a handheld pregnancy health record.
|Universal Postnatal Contact Services Initiative
- Queensland has invested almost $30 million over four years to ensure all Queensland mothers receive follow-up from a health professional after the birth of their baby.
- The initiative has:
- supported the establishment of community-based Newborn and Family Drop-in Services in around 20 communities
- supported the expansion, upgrading and integration of the Child Health Line with 13HEALTH
- supported the universal antenatal screening for tobacco, drug and alcohol use, psychosocial wellbeing, domestic violence and depression
- improved community partnerships and service networks to ensure appropriate referral for families identified at risk.
|Maternity Services Enhancement Program
- Queensland has invested $9 million over four years from 2008–09 for this program.
- It includes the Rural Maternity Initiative, which aims to develop or enhance continuity models of maternity care to increase the range of options for women in rural Queensland and provide services closer to where they live.
- In 2009–10, $1 million from this program was allocated for the development of new or expanded services providing more midwifery continuity of care in nine communities.
Queensland Centre for Mothers and Babies
- Queensland has allocated $7 million over four years to provide evidence-based information and resources for consumers and maternity carers.
- The centre is conducting an annual survey of women’s experiences of maternity care.
- Ongoing stakeholder and consumer consultation and collaboration are being undertaken via a Maternity Care Collaborative forum.
- In 2009–10, the Queensland Government committed $42.7 million over three years for maternity and child health care.
- The program includes nine new drop-in clinics, the rural maternity initiative, $25 million to expand the neonatal intensive care unit at the Townsville Hospital and an additional $9 million to provide advanced care for premature newborns and others with respiratory problems in north Queensland.
- Queensland Health has birth centres operating in Townsville, Mackay, Brisbane and the Gold Coast. An additional $1 million capital funding was provided in 2009–10 for a new birth centre in Toowoomba.
Queensland’s Clinical Services Capability Framework
- From 2010–11, this framework will assign maternity services a level from 1 to 6 according to their capacity to provide care, from antenatal and postnatal care only, to primary midwifery-led low-risk birthing care, to tertiary and super-specialty services.
Indigenous Early Childhood Development National Partnership Agreement
- Under this agreement Queensland is investing in a range of new and enhanced services for Aboriginal and Torres Strait Islander mothers and babies.
Flying Obstetrics and Gynaecological Service (FOGS)
- This service provides outreach to women in remote North and Western Queensland.
Models of care
- Queensland Health has developed an Implementation Guide for Midwifery Models of Care and has expanded the scope of midwifery practice to include the ordering of routine medications for maternity clients.
- Some rural Queensland Health facilities are investigating reopening sustainable birthing services through midwifery-led and shared care models.
- Queensland undertakes workforce surveys and is trialling improved and flexible working conditions to foster the retention of the maternity workforce.
- Direct-entry midwifery courses have been established at two universities and Queensland is funding a range of scholarships for student midwives and those wishing to return to practice.
- Queensland has developed a rural GP specialty, with equivalent remuneration to other medical specialities, to promote a rural GP workforce, including GP obstetricians.
- Queensland targets rural school leavers showing a propensity towards a career in the medical workforce. A screening tool has been developed to identify propensity to remain in rural Australia, as well as scholarships, mentoring and rural clinical placements to provide a pathway to rural practice.
- A doula program in far north Queensland has been developed, which focuses on educating female Aboriginal and Torres Strait Islander elders to encourage and support young Aboriginal and Torres Strait Islander women with their maternity care.
South Australia’s Health Care Plan 2007–2016
- The plan70 has been developed to meet future challenges in health care. It outlines the government’s investment in the New Royal Adelaide Hospital, a new hospital in metropolitan Adelaide, as well as other major hospitals. It also focuses on health promotion and illness prevention, providing community services and keeping people out of hospitals.
- South Australia is seeking to consolidate maternity services into larger and more modern sites that are better equipped to care for mothers and babies. There are moves to expand shared care models with GPs in metropolitan areas, and to give women the choice of midwifery-led care.
- Obstetric services at four country general hospitals will be maintained with support from the state’s Maternal and Neonatal Clinical Network.
- The establishment of a maternal and neonatal statewide clinical network.
- South Australian regional and rural health services are being supported to ensure they are equipped to provide planned delivery for low-risk births.
Models of care
- South Australia has a focus on expanding GP-shared care models throughout the state, as well as providing options to women for midwifery-led models of care.
- South Australia offers universal home visits for the first post natal visit as a standard of care.
- South Australia is developing GP Plus health centres with the capacity to provide antenatal and postnatal care in the community.
- South Australia has established midwife clinics in local shopping centres to facilitate easy engagement with young and teenage mothers.
- Birthing centres are associated with major public hospitals and are in high demand.
- A public homebirth program has been established.
A universal home visiting program
- This program offers a home visit by a community nurse to every newborn baby, and a Family Home Visiting Program offering extra support for families who need it during the first two years of life.
- South Australia has developed new IT systems, including handheld obstetric records, to enable consistent access to patient records.
- South Australia has developed direct-entry midwifery courses.
Standards of care
- South Australia implements the Robson audit which is a tool for auditing interventions against clinical indicators.
- South Australia has developed complete perinatal practice guidelines.
Improving Maternity Services: Working together across Western Australia
- This plan41 is the result of a comprehensive statewide consultation process, which will guide the development of maternity services over a five-year period.
- The policy framework incorporates seven main goals, each supported by objectives and strategies. These goals are to improve:
- health outcomes for Aboriginal and Torres Strait Islander women and babies
- health and wellbeing of women and their unborn babies through better preconception and early pregnancy care
- women’s experience of pregnancy
- women’s experience of childbirth
- health and development of infants and address the needs of new parents
- safety and accountability in all maternity services
- sustainability of the maternity care workforce and promote clinical leadership and collaboration.
Models of Maternity Care: A Review of the Evidence (2007)
- Western Australia has invested in research, including a review71 investigating the various outcomes and cost-effectiveness of a range of models of maternity care, and advocated for an increased range of models of maternity care and increased midwifery-led maternity care.
The Women’s and Newborn’s Health Network
- Collaborate with Telethon Institute of Child Health Research to undertake research into maternity service provision in Western Australia
- Developed consumer information website
- Developed statewide guideline for the management of co-sleeping
- Developed statewide guideline for the use of water for labour / birth
- Developed statewide policy and guideline for breastfeeding in hospital and health services with maternity inpatient facilities including promotional and educational package.
Postnatal Depression Service
- Western Australia has invested $2 million to expand the statewide service to provide integrated mental health and maternity units at the King Edward Memorial Hospital, as well as an Aboriginal and Torres Strait Islander perinatal mental health model providing outreach from Carnarvon to central Western Australia.
Perinatal Mental Health Unit
- A comprehensive state service targets culturally and linguistically diverse communities, Aboriginal and Torres Strait Islander communities and rural and remote communities.
Models of care
- There is one birthing centre co-located on the tertiary hospital site that is in constant high demand.
- Public homebirth program established and being expanded within metropolitan area. Similar model being considered to the South West region.
- Western Australia is reviewing referrals to its tertiary hospital to redirect low-risk women to secondary centres to enable birthing closer to home.
- A significant proportion of antenatal and postnatal care is provided by Area Health Services through hospital-based midwives and some community-based midwives.
- Western Australia has conducted research into the cost-effectiveness of a range of models of care, concluding that sustainable and cost-effective midwifery-led models of care can be provided to low-risk women.
- Birth rates in many of the birthing services in Western Australia are too low to sustain a full-time obstetrics specialist. GP Obstetricians play an important role in providing maternity care outside Perth.
- Visiting medical staff also play a critical role in providing maternity care to women in Western Australia.
- Approximately 90% of all families have contact with a child health nurse within 10 days of hospital discharge.
- King Edward Memorial Hospital (Perth) reviewing models of care provision, with plans to introduce Group Practice continuity of midwifery care models.
- There are statewide specialised clinics available for women with diabetes mellitus, maternal fetal medicine complications, teenage pregnancy, women with substance misuse and women with complex mental health problems.
- Statewide coordination of neonatal beds is currently under way.
- A Next Birth after Caesarean clinic established at King Edward Memorial Hospital (Perth), being developed in some secondary services.
- Western Australia has made significant progress with the development of e-records with unique patient identifiers already assigned to a large proportion of the population.
- Statewide roll out of STORK (perinatal database).
- The number of GPs trained in obstetrics in Western Australia is increasing.
- A GP Obstetrics mentoring scheme has been successful in bridging the gulf between completion of the Diploma of Royal Australian and New Zealand College of Obstetricians and Gynaecologists (DRANZCOG) and providing new GP obstetricians with the confidence to practice autonomously.
- A diploma for nonproceduralist GPs in women’s health, which includes a maternity care module, has been introduced in Western Australia.
- Direct- entry midwifery courses have been established.
- The King Edward Memorial Hospital (Perth) in Western Australia provides educational videoconferencing to most maternity services in the state.
- Maternity workforce leadership is provided through the statewide Obstetric Support Unit and the Women’s and Newborn’s Health Network.
- The Medical Specialist Outreach Assistance Program funds education programs to rural areas, although this is limited by short-term funding.
- Double degree commenced in 2010.
- Statewide e-learning packages developed by SOSU and WNHN (BFHI, Perinatal Loss, Neuraxial Blockade).
- Implementation of statewide education program – K2.
Statewide Obstetric Support Unit
- In collaboration with WNHN, developed MANSMap database of workforce and service provision for all Western Australia maternity service providers
- Developed outreach education committee to determine the education needs of all service providers.
- In collaboration with WNHN, developed e-Learning packages for Perinatal Loss Service, Neuraxial Blockade, BFHI.
- Implemented statewide roll out of K2 on-line fetal monitoring education package.
Indigenous maternity services
- Aboriginal women receive care through clinics for Aboriginal women, either within Aboriginal Medical Services/Aboriginal Controlled Community Health Organisation, or in mainstream services and birthing at local regional or secondary hospitals.
- Midwives at Derby Hospital provide excellent culturally supportive care for women.
- The Aboriginal Maternity group practice in Carnarvon has an excellent program in perinatal mental health.
- Good linkage and established relationships with Indigenous stakeholders supports culturally appropriate and safe maternity care programs.
- Armadale Health Service provides the Boodjari Yorgas Program in collaboration with Derbarl Yerrigan Health Service, and is a caseload model of maternity care.
- Aboriginal Maternity Services Support Unit is being established at King Edward Memorial Hospital (Perth), under COAG’s Closing the Gap initiative, in collaboration with Aboriginal Maternity Group Practice models of care under the same initiative.
- The Aboriginal Health Council of Western Australia (AHCWA) have undertaken a Strength & Needs Analysis of all Maternal and Child Health Services within the Aboriginal Community Controlled Health Sector (ACCHS). This analysis has resulted in 29 recommendations, which provide direction to the development of appropriate models of care for local regions.
True Care True Culture Program
This program has been implemented through Closing the Gap, but is limited by short-term funding.
National Partnership Agreement on Indigenous Early Childhood Development
This agreement supports improved antenatal, pre-pregnancy health for Aboriginal women, especially teenagers, and increased access and use of child and parent health services by Aboriginal families.
Strong Women, Strong Babies, Strong Culture Program
This program works with senior Aboriginal women in participating communities to provide and direct support to pregnant women and their families.
- Western Australia categorises health services by the Clinical Services Capability Framework, which assigns services a level from 1 to 6 according to their capacity to provide care.
- Western Australia Country Health Service has recently completed an audit and analysed data sources that have informed services of safety, quality and governance priorities by region.
- MANSmap (Maternity and Newborn Services map) data collection system including information related to workforce, models of care, education requirements collected and updated annually by SOSU in collaboration with WNHN.
Tasmania’s Health Plan
- This plan72 is a blueprint for Tasmania’s health services reform into the future. It comprises the Primary Health Services Plan, focusing on health services provided in the community, and the Clinical Services Plan, focusing on services provided in the major hospitals and by the ambulance service.
- This plan does not make detailed reference to maternity services, but it does articulate relevant issues and principles of care.
- The key principles for Tasmania’s health services are for it to be:
- accessible and as close as possible to where people live, providing services can be provided safely, effectively and at an acceptable cost
- appropriate to community needs
- client and family focused
- integrated through effective service coordination and partnerships between providers
- designed for sustainability.
Models of care
- Birthing centres are associated with major public hospitals and are in high demand.
- A tertiary centre in Tasmania provides monthly outreach antenatal clinics to three regions within a 30 km radius of the service.
- Hospitals in Tasmania provide specific clinics for teenage mothers and their families or nominated support to provide education and antenatal care in a group setting.
- Clinical networks are under development.
- Handheld obstetric records have been developed in Tasmania.
The Maternity Services Review in the Northern Territory
- This review led to the development of a framework for services required to optimise the accessibility, safety, effectiveness and efficiency of maternity services for Territorians. The Integrated Maternity Service Framework42 continues the evolution and service development of a range of new initiatives aimed at improving services and the health and wellbeing of mothers and babies.
- Key elements of this framework include:
- the new leadership model to develop the way forward
- defined referral pathways and protocols for care whether women are low or high-risk
- continuity of carer through a designated team
- electronic shared care record and/or handheld record
- a skilled and supported workforce
- consumers and professionals working together
- Aboriginal community-controlled organisations as lead providers of culturally appropriate maternity care
- recognition of private options as a component of the framework.
Advanced Life Support in Obstetrics
- The Northern Territory contributes $30,000 per annum to support obstetricians to undertake training in advanced obstetric care.
Models of care
- Establishment of a range of new models of care, including:
- a community midwifery program in Darwin
- a birthing centre at the Royal Darwin Hospital
- homebirth services in Darwin and Alice Springs
- a maternal and child health strategy
- the introduction of a midwifery group practice for remote women who come into town for birth under the Closing the Gap initiative.
- Remote area nurse/midwives and Aboriginal health workers also provide antenatal care in community settings, including outreach.
- The Northern Territory successfully reinstated and has retained maternity services at Gove District Hospital through the recruitment of three GP obstetricians.
- Alice Springs and Darwin Hospitals provide outreach at considerable distances to remote communities.
- The Northern Territory Integrated Maternity Services Framework identifies defined referral pathways and protocols for care of low and high-risk women.
- There are Aboriginal Community Controlled Primary Health organisations such as Congress Alukura in Alice Springs, which features a Grandmothers Advisory Committee.
- Provision of care through midwifery group practices working with Aboriginal health workers from Darwin and Alice Springs.
- The development of remote area midwife positions with the potential to provide outreach maternity care, including education, antenatal and postnatal care, and provision for homebirth and birthing on land for Aboriginal and Torres Strait Islander women.
Standards of care
- The Northern Territory uses the South Australian perinatal clinical practice guidelines in acute settings and the Women’s Business Manual in remote settings.
- Midwives use the Australian College of Midwives’ National Midwifery Guidelines for Consultation and Referral.
- The Northern Territory Department of Health and Families, and Congress Alukura (Aboriginal Community Controlled Organisation) are supporting the education of five Aboriginal women undertaking a Direct Entry Midwifery Program.
Australian Capital Territory
A Pregnant Pause: The Future for Maternity Services in the Australian Capital Territory
- In 2003, the Australian Capital Territory (ACT) Standing Committee on Health undertook an inquiry into maternity services.55 The report made some 20 recommendations to improve the maternity service system, including fundamental infrastructure changes to the operation of areas of the ACT public hospital system and the provision of community midwifery.
- The ACT Government’s response to this review indicated support for some, but not all, recommendations.
|ACT Maternity Shared Care Guidelines
- These guidelines73 provide the framework for public maternity care in the ACT. They enable the territory to apply a consistent approach to maternity care from the confirmation of a pregnancy with a GP, through to maternity care and referral processes within the ACT.
- The primary health shared care arrangements are suitable for a healthy woman with an uncomplicated singleton pregnancy. Women requiring additional care from an obstetrician or a fetal medicine unit specialist are referred through to the secondary and tertiary services within the ACT.
IMPACT Program (Integrated Multi-Agencies for Parents and Children Together)
- This innovative program is a partnership between ACT Health and The Office for Children, Youth and Family Support, general practice and community pharmacy to provide intensive and coordinated care for vulnerable families.
- The aim of the IMPACT Program is to improve outcomes for pregnant women or those with children up to two years of age who have been identified with a significant mental health issue or who are receiving opioid replacement therapy by providing a coordinated cross-agency system response to the needs of families.
ACT Breastfeeding Strategic Framework
- The ACT has allocated $250,000 over three years to develop and implement this framework.
Aboriginal Midwifery Access Program
- The ACT provides culturally appropriate care to Aboriginal and Torres Strait Islander women through the program, which is delivered by the Winnunga Nimmityjah Aboriginal Health Service.
- The new tertiary referral Women’s and Children’s Hospital will facilitate the move to a new model of care.
- There are three maternity facilities in the ACT: the Canberra Hospital, Calvary Public Hospital and Calvary Health Care. The Canberra Hospital maternity unit is the largest public maternity unit in the region, and provides general and specialist care to a population of over 500,000 from the ACT and the surrounding region. The maternity unit provides a comprehensive range of services, including midwifery-led care, obstetrician-led care, fetal medicine services and the Canberra Midwifery Program.
- Development of a new Women’s and Children’s Hospital on the Canberra Hospital Campus is under way with construction expected to be completed in late 2012. The hospital will co-locate maternity, gynaecology, neonatal intensive care and paediatric services. This tertiary referral centre will provide additional midwifery-led models of care and increased neonatal services, expansion of maternal–fetal medicine facilities and establish a Maternity Assessment Unit. A new model of care has been developed with the following key principles included
- family-centred care
- developmental care frameworks
- continuity of care and carer
- integrated and multidisciplinary care and treatment
- provision of research and information resources for clinicians, primary care providers, patients and their carers.
- ACT Health has a Service Funding Agreement with the Canberra Mothercraft Society to manage the Queen Elizabeth 11 (QE11) Family Centre. The QE11 Centre provides residential primary health care and parenting programs for families with young children who are experiencing complex health and behavioural difficulties in the first three years of an infant’s life. QE11 provides assistance with complex lactation and other feeding problems, failure to thrive, unsettled babies, postnatal depression, children at risk or with special needs, and parent and grandparent support.
- ACT Health and the Greater Southern Area Health Service have established a medical retrieval service for critically ill newborns. The service is a satellite unit of the New South Wales Neonatal Emergency Transfer Service(NETS) established at the Canberra Hospital (NETS-ACT).
- The capacity of maternal–fetal medicine services has been expanded through re-accreditation as a training site for the maternal–fetal medicine subspeciality and increased scanning capacity by enhancing the sonographer workforce.
- The Canberra Hospital has received Baby Friendly Hospital Initiative accreditation for the fourth time.
- The newborn screening program has now been extended to include all infants born in the ACT.
Models of care
- The ACT Government is committed to providing women in the ACT with continuity of care in a range of birthing options.
- Specific models of care have been developed to meet the needs of adolescent women, women from culturally diverse backgrounds, and women who have additional risk due to social, drug and alcohol use, mental health or economic factors.
- The Maternity Unit has expanded its services to provide more antenatal care to women in the local community setting providing a valuable link to the community following the birth of their babies.
- The popularity of the Canberra Midwifery Program has led to the Maternity Unit exploring other models of midwifery care that will meet the demand for continuity of care and complement the services provided in the new Women’s and Children’s Hospital.
- Maternal and child health nurses offer a universal home visiting service to families residing in the ACT.
- The Canberra College Cares program is a partnership between ACT Health and the ACT Department of Education and Training to provide education, support and antenatal care to pregnant teenagers and young parents on campus.
- Planning is in progress for the commencement of specialist antenatal clinics for obese pregnant women, the expansion of diabetes in pregnancy services and dedicated medical disorders in pregnancy clinics.
- The establishment of a perinatal loss coordinator/high-risk midwifery position will improve services for women and families who experience perinatal loss.
- The establishment of a vaginal birth after caesarean (VBAC) clinical pathway has shown a direct benefit in increasing the rate of VBAC.
- Direct-entry midwifery courses have been established in the ACT.
- Workforce planning across all disciplines has been a key component in the development of the new Women’s and Children’s Hospital.