National Maternity Services Plan

Australian maternity services in an international context

Significant reform in maternity services has occurred in New Zealand, the United Kingdom (UK) and Canada in recent years. A number of national action plans, strategic frameworks, policy statements, clinical practice guidelines and jurisdictional policy documents from these countries have been considered to provide an international context for maternity service reform in Australia.

Page last updated: 2011

Many of these documents were produced through consultation and an appraisal of evidence in each jurisdiction in a similar process to that informing maternity service reform in Australia.

The challenges faced in Canada, New Zealand and the UK include workforce shortages, low population density and remoteness in Canada and New Zealand, addressing service integration, rising intervention rates, providing a consistent approach to the provision of care and targeted initiatives for Indigenous and other disadvantaged population groups.

Continuity of care has been identified as an important feature of maternity care, particularly emphasised in New Zealand and the UK where a wellness paradigm for pregnancy and childbirth is promoted. New Zealand and the UK have also identified woman-centred care, access to a range of models of maternity care, and a capacity for women to make informed choices about their care as underlying principles to guide reform.46 47 Differences across provinces in Canada include the regulation status of midwives to attend births, prescribe drugs and order tests.48 Achieving national consistency has been identified by the Canadian health system as a priority. Recent developments in Canada include the promotion of collaborative interdisciplinary maternity care.49

Access to maternity services for women in rural and remote locations remains a challenge for New Zealand and Canada.49 50 Canada has developed family birth centres in remote areas in response to community demand and community control of health funding. The implementation of these successful models uses community development approaches and the education of local Indigenous women as midwives.51 Timely transfer and access to specialists are also key aspects of these innovative models. Aboriginal communities in Canada have been engaged to develop an Aboriginal Birthing Strategy, including midwifery-managed ‘birthing on country’ models.51

To achieve high-quality and consistent midwifery care that fully utilises the midwives’ scope of practice, the UK has a well-developed system of ‘midwifery supervision’.52 Supervisors of midwives are senior clinicians or managers who undertake training to enable them to ‘supervise’ other midwives, as part of their core role.

The UK has invested in the development of a national evidence base and standards for maternity care, including clinical practice guidelines.53 The national evidence base is more fragmented in New Zealand and Canada.