National Maternity Services Plan

Priority 2 — service delivery

Information about the delivery plan of the Maternity Service

Page last updated: 15 June 2012

Action 2.1 Ensure Australian maternity services provide high-quality, evidence-based maternity care
Action 2.2 Develop and expand culturally competent maternity care for Aboriginal and Torres Strait Islander people
Action 2.3 Develop and expand appropriate maternity care for women who may be vulnerable due to medical, socioeconomic and other risk factors

Action 2.1 Ensure Australian maternity services provide high-quality, evidence-based maternity care
Action

(Aligned with Principles 1, 2, 3, 4, 8, 10)

Australian governments are working collaboratively to develop an evidence base to inform decision making and quality improvement for maternity services through the development of national frameworks and guidelines.

As a result of the COAG meeting of 19–20 April 2010, the Commonwealth and all states and territories, except Western Australia, agreed to the National Health and Hospitals Network Agreement.5 A core element of this agreement will be strong national standards and transparent reporting through a new performance and accountability framework.

It is intended that a permanent Australian Commission on Safety and Quality in Health Care (ACSQHC) will develop national clinical quality and safety standards, and work with clinicians to ensure the appropriateness of services being delivered in particular settings. Arrangements for the permanent ACSQHC will be subject to detailed agreement on the scope and financial implications by Health Ministers.

A new National Performance Authority (NPA) will be established from 1 July 2011 as an independent Commonwealth statutory body. The NPA will, through new Hospital Performance Reports and Healthy Communities Reports, provide clear and transparent regular public reporting of the performance of every Local Hospital Network, the hospitals within it, every private hospital and every Medicare Local.

During the transition to these new arrangements, from 1 July 2010, states and territories will make public and private hospital-level data on performance publicly available through a website that will be developed by the Australian Institute of Health and Welfare. Health Ministers will set the timeline and data to be published.

The national safety and quality system for Australian maternity care will consider and build on several current AHMAC initiatives (Appendix A), including:
  • National Evidence-Based Antenatal Care Guidelines
  • Core Competencies and Educational Framework for Maternity Services in Australia Project
  • National Maternity and Perinatal Mortality and Morbidity Reporting
  • National Maternity Services Capability Framework
  • National Core Maternity Indicators
  • National Woman-Held Pregnancy Record
  • Australian National Breastfeeding Strategy 2010–2015
  • National Perinatal Depression Initiative
  • National e-Health Strategy
Actions detailed in the Plan will also contribute to other safety and quality initiatives, including:
  • consideration of other national clinical practice guidelines for perinatal care
  • development of national interdisciplinary maternity consultation and referral guidelines
  • targeted research, including research on clinical indicators and outcomes for mothers and babies
  • collection of nationally consistent maternal and perinatal mortality and morbidity data and mechanisms to improve outcomes for mothers and babiesTop of page
    The initial yearThe middle yearsThe later yearsSigns of success
    2.1.1 AHMAC endorses National Evidence-Based Antenatal Care Guidelines for the first trimester.AHMAC endorses the full set of National Evidence-Based Antenatal Care Guidelines.
    Australian governments implement the National Evidence-Based Antenatal Care Guidelines for the first trimester.
    Australian governments implement the full set of National Evidence-Based Antenatal Care Guidelines.
    AHMAC considers the development of other national perinatal clinical practice guidelines.
    Maternity professionals utilise the National Evidence-Based Antenatal Care Guidelines.
    2.1.2 AHMAC considers the recommendations of the National Maternal Mortality and Morbidity reporting project.AHMAC recommends a national maternal mortality and morbidity review process to ACQSHC for continuous improvement of maternity care.ACSQHC continues to work with AHMAC on a national maternal mortality and morbidity review process for continuous improvement of maternity care.A national maternal mortality and morbidity review process is established.
    National maternal and perinatal mortality and morbidity reports are produced.
    National systems and processes will drive improved performance in private and public maternity care.
    2.1.3AHMAC agrees to recommend to ACSQHC that systems and processes are developed to use statistics, core maternity indicators, and the maternal and perinatal mortality and morbidity review to improve public and private maternity care.ACSQHC considers the recommendations of AHMAC. Systems and processes for review are formulated to utilise the evidence base resulting from national standardisation, data and reporting.National systems and processes will drive improved performance in private and public maternity care.
ACSQHC = Australian Commission on Safety and Quality in Health Care; AHMAC = Australian Health Ministers’ Advisory Council

Action 2.2 Develop and expand culturally competent maternity care for Aboriginal and Torres Strait Islander people

(Aligned with Principles 1, 2, 3, 4, 5, 7, 10)

Aboriginal and Torres Strait Islander women and babies continue to experience poorer maternal and perinatal outcomes compared with their non-Indigenous counterparts. Australian governments have implemented a range of initiatives developed through community engagement to meet the needs of these women and babies, such as Closing the Gap.

In addition to establishing community-based and community-controlled primary maternity care, the cultural competence of hospital services is critical to the willingness of Aboriginal and Torres Strait Islander women to access services, and to ensuring a positive outcome for both mother and baby.

Partnerships between workers, such as Aboriginal Health Workers, community-based Indigenous workers and Strong Women Workers, medical practitioners and midwives will enable clinically safe and culturally competent care to be provided for Aboriginal and Torres Strait Islander people. Aboriginal Community-Controlled Organisations will be key partners in the provision of such care.

Recognising the significant investment being undertaken through COAG, the Plan focuses on identifying, and, if appropriate, expanding on successful initiatives to assist Aboriginal and Torres Strait Islander women and babies. Strategies to support an Aboriginal and Torres Strait Islander maternity workforce are presented in Priority 3.

Tools to inform future planning will underpin maternity service planning and delivery in rural and remote communities (see Action 4.2.1).

Further related actions can be found in Action 1.4.1.
The initial yearThe middle yearsThe later yearsSigns of success
2.2.1 AHMAC identifies the characteristics of culturally competent maternity care for Aboriginal and Torres Strait Islander people.AHMAC undertakes a stocktake of access to culturally competent maternity care for Aboriginal and Torres Strait Islander people.
Australian governments expand programs providing culturally competent maternity care for Aboriginal and Torres Strait Islander people.
AHMAC identifies mechanisms for evaluating cultural competence in all maternity care settings.
AHMAC evaluates culturally competent maternity care for Aboriginal and Torres Strait Islander people.
AHMAC evaluates cultural competence in all maternity care settings.
Increased numbers of Aboriginal and Torres Strait Islander people have access to culturally competent maternity care.
Increased numbers of maternity services demonstrate culturally competent maternity care.
2.2.2 Health Ministers recommend to all the National Boards, through the National Registration and Accreditation Sub Committee, that cultural competence is a component of all training, education and ongoing professional development of the whole maternity workforce.All the National Boards consider cultural competence as a component of all training, education and ongoing professional development of the whole maternity workforce.All the National Boards evaluate the inclusion of cultural competence training, education and ongoing professional development of the whole maternity workforce.All training, education and ongoing professional development includes a cultural competence component.
2.2.3 AHMAC undertakes research on international evidence-based examples of birthing on country programs.Australian governments develop a framework, including an evaluation framework, for birthing on country programs.
Australian governments develop a pilot for a birthing on country program that includes a consultative selection process with Aboriginal and Torres Strait Islander communities and local maternity care professionals to identify initial birthing on country sites.
Australian governments establish birthing on country programs.Birthing on country programs for Aboriginal and Torres Strait Islander mothers are established.
Top of page AHMAC = Australian Health Ministers’ Advisory Council

Action 2.3 Develop and expand appropriate maternity care for women who may be vulnerable due to medical, socioeconomic and other risk factors

(Aligned with Principles 1, 2, 3, 4, 5, 9, 10)

Specific groups of Australians with particular cultural and clinical needs may experience poorer maternity outcomes than the general population. These groups include (but are not limited to) culturally and linguistically diverse (CALD) women; women with pre-existing medical conditions; adolescent mothers; older mothers; obese women; women using cigarettes, alcohol and illicit substances; women experiencing mental illness; and women in prisons.4 Each of these groups has specific maternity care needs.

Women experiencing domestic violence are at greater risk of complications during pregnancy, such as inadequate weight gain, infection, miscarriage, haemorrhage and low birth weight. Such women are slower to make contact with health services for antenatal care than women who are not exposed to violence, and their babies are more likely to have a problem diagnosed after birth.58

Women who have experienced some forms of female genital cutting experience significant problems in pregnancy and birth, including perineal tears, wound infections, separation of repaired episiotomies, postpartum haemorrhage and sepsis.59 The World Health Organization also recognises the greater risk of newborn deaths among these women.60

A range of strategies, which are not addressed specifically in this Plan, have been developed in jurisdictions to meet the needs of vulnerable women and their babies. These strategies include (but are not limited to) the need for maternal and perinatal pathologists, anaesthetists and other tertiary and quaternary specialists. Services also require a sound consultation and referral framework enabling the provision of appropriate advice, ongoing management and escalation (as required) to ensure that access to specialist care occurs seamlessly to maintain continuity of care for these at-risk women (see Action 4.1). These strategies may also apply across broader population groups than those listed above.

Broader strategies, including the National Preventative Health Strategy, the National Breastfeeding Strategy37 and the National Perinatal Depression Initiative,61 include initiatives to improve the maternal and perinatal outcomes of at-risk women and babies.37 62

The Plan focuses on identifying and, where appropriate, expanding successful maternity care initiatives for at-risk women.
The initial yearThe middle yearsThe later yearsSigns of success
2.3.1 Australian governments expand screening for perinatal depression arising from the National Perinatal Depression Initiative.

Australian governments ensure that training, mentoring and supervision of staff undertaking perinatal mental health screening is provided.
States and territories offer perinatal mental health screening for all women.

Australian governments continue to provide training, mentoring and supervision of staff undertaking perinatal mental health screening.
AHMAC evaluates the National Perinatal Depression Initiative, including the provision of training, mentoring and supervision of health professionals undertaking perinatal mental health screening.Universal screening is available for all women.

Health professionals undertaking perinatal mental health screening are trained, mentored and supervised.
2.3.2 States and territories establish formal referral pathways for women experiencing depression and mental illness with perinatal mental health services.
States and territories develop options to overcome separation of mothers from their babies when receiving mental health care.
States and territories expand formal referral pathways for women experiencing depression and mental illness.
States and territories expand options for overcoming separation of mothers from their babies when receiving mental health care.
States and territories evaluate formal referral pathways for women experiencing depression and mental illness.
States and territories evaluate options for overcoming separation of mothers from their babies when receiving mental health care.
Women experiencing depression and mental illness have timely referral to appropriate professionals by maternity services.
There are decreased rates of separation of mothers from their babies when receiving mental health care.
2.3.3 Australian governments progress investigation of evidence-based maternity care models for at-risk women, including:
pregnant adolescents
women with pre-existing medical conditions
CALD communities
women in prison
obese women
women using cigarettes, alcohol and illicit substances
older women
women experiencing domestic violence
women who have experienced various forms of female genital cutting.
Australian governments implement and expand evidence-based maternity care models for at-risk women.Australian governments evaluate evidence-based maternity care models for at-risk women.Improved perinatal outcomes for at-risk women and their babies.
AHMAC = Australian Health Ministers’ Advisory Council; CALD = culturally and linguistically diverse Top of page

Document download

This publication is available as a downloadable document.

National Maternity Services Plan(PDF 997 KB)

Document help

When accessing large documents (over 500 KB in size), it is recommended that the following procedure be used:

  1. Click the link with the RIGHT mouse button
  2. Choose "Save Target As.../Save Link As..." depending on your browser
  3. Select an appropriate folder on a local drive to place the downloaded file

Attempting to open large documents within the browser window (by left-clicking) may inhibit your ability to continue browsing while the document is opening and/or lead to system problems.

To view PDF (Portable Document Format) documents, you will need to have a PDF reader installed on your computer. A number of PDF readers are available through the Australian Government Information Management Office (AGIMO) Web Guide website.