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Pregnancy care plans
How does the New Zealand Maternity system work?
New Zealand's maternity system is based on a primary care model and was introduced in the early 1990's. Pregnant woman are cared for by a health professional, called a "Lead Maternity Carer" or LMC, who provides care for them throughout their pregnancy. Pregnant woman can choose this LMC themselves, and options include comunity or hospital based midwives, GPs, or private obstetricians. The Ministry of Health provides funding for the LMC to care and support the woman in her pregnancy and for 6 weeks after birth. Most women choose midwives, either community or hospital-based, as their LMCs.
For women wanting a self-employed midwife as an LMC, this website can help them locate an LMC in their area.
As the model is primary care based, specialist referral may be indicated in pregnancy if a woman has risk factors for complications, or if complications arise. This occurs in approximately 30% of pregnancies in New Zealand. Referral guidelines are in place in law (called "Section 88") and these outline the conditions that need further input. If you are interested in reading these guidelines, they can be found here.
Women with risk factors or complications in their pregnancy are often cared for in "shared care" arrangements, where they continue primary care with their LMC, but have additional specialist input throughout their pregnancy. A woman's LMC can also change during pregnancy, if she chooses to change her LMC or if complications develop that place her entirely under specialist care.
How do we develop a care plan for pregnancy?
Taking a thorough history and examination of the woman are the guiding factors here. Both of these will help identify factors which need to be taken into consideration for the care plan development and may influence the choice of the LMC. The agreed care plan may need to be changed if new risk factors arise during the pregnancy.
Not all obstetric complications are predictable. However, we do know that women who are not seen in their pregnancy, or who are poor attenders for their care plan, have poorer pregnancy outcomes. Regular antenatal visits are recommended throughout pregnancy. These visits are used to screen for new complications, provide education and support, and assess progress through pregnancy. The frequency of visits depends on the risk factors in each pregnancy. In an uncomplicated pregnancy, where no specialist input is required, a woman should be seen at least 8-10 times.
