Why are we exploring this question?
The population in the Central Otago/Wanaka area has been growing rapidly, and the numbers of women who are pregnant and having families in the area has been increasing. The current configuration of primary maternity facilities has evolved through historical circumstances. The need to look at the maternity facilities of the whole Southern health district led to Southern DHB creating the Integrated Primary Maternity System of Care.
This recognised the configuration of facilities in the Central Otago/Wanaka area needed to be addressed, along with the shortage of LMC midwives practising the in the area.
We developed a strategy to allocate our resources in a more equitable way across the district. To better support LMC midwives across all our rural areas we paid them more (over and above the funding they receive from the Ministry of Health) and supported paid time off.
We also established maternal and child hubs in Wanaka, Te Anau and Lumsden.
With the growing population in Central Otago/Wanaka, we knew we needed to do more. The Central Lakes Locality Network was established to help advise on health needs for this part of the district. One of their first priorities is to advise on the best configuration of primary maternity facilities.
Who are the Central Lakes Locality Network?
The creation of Locality Networks was outlined in the Primary and Community Care Strategy and Action Plan, with the purpose of ensuring models of care align with population health needs and service requirements in different areas of the district. The network plays a vital role in prioritising and planning health services so they meet the needs of local communities and are well-integrated with the broader health system. Central Lakes Locality Network (CLLN) is the first of these networks to be established. Helen Telford, Queenstown resident and expert health consultant and programme manager is the Chair of the Network. Other members include local residents including patients and healthcare consumers, general practitioners and rural hospital clinicians, a general practice nurse and a health promotion advisor. Further information about the network and its members can be found https://www.southernhealth.nz/publications/central-lakes-locality-network-members-appointed.
What are primary maternity facilities?
Primary maternity facilities are locations that support maternity care that is provided outside of a secondary hospital. In the Southern district, these include:
PRIMARY BIRTHING UNITS
- Antenatal assessment
- Labour and birth care to women having a normal pregnancy
- Postnatal care for women and babies who have birthed at the primary unit, or who have birthed at home or hospital and then transfer to the primary unit for an inpatient stay
Care provided by:
- The woman’s LMC midwife, supported by staff (usually a midwife or a nurse).
What are units not designed for?
- Care that requires secondary or specialist support, such as epidurals, forceps delivery, blood transfusions or Caesarean sections.
MATERNAL AND CHILD HUBS
- Antenatal assessment
- Telemedicine consult with obstetrician (available in Wanaka only currently)
- Accessible to midwives 24/7 in case of rapid births
Care provided by:
- The woman’s LMC midwife, supported by hub coordinator (a midwife or nurse)
What are hubs not designed for?
- Planned place of birth or inpatient care; care that requires secondary or specialist support.
What primary maternity facilities are already in the Central Otago/Wanaka area?
Currently there is a primary birthing unit in Alexandra (Charlotte Jean), and at Lakes District Hospital in Queenstown. There are maternal and child hubs in Wanaka and Ranfurly.
What are the principles for making a decision?
We have undertaken extensive consultation in recent years about the needs of a whole of district primary maternity system of care. This led to creating the Integrated Primary Maternity System of Care.
During this process we established principles for a reformed configuration of services, and we will be continuing to apply these as we develop options for the Central Otago/Wanaka area. These are:
- Critical mass – this means understanding our populations and birthing numbers across the district; meeting Ministry of Health birthing population standards; and ensuring there are sufficient numbers for a viable service and sustainable workforce, supported by a transfer/transport system
- Equity for disadvantaged communities
- Acceptable travel distances to a facility – in the context of improved support for home birthing and acknowledging the preference for travel towards secondary care locations.