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The data shows the high risk birth group has kept increasing over time, whereas the primary birth figure has continued to decline (Figure 9). The primary birth and at risk birth groups account for the majority of the decrease in deliveries in 2013, however high risk births remain largely unchanged. While data for self-employed LMCs shows a lower case mix due to the data limitations identified above, half of their cases would still be considered at risk, and around half of the high risk women are still cared for by self-employed LMCs (Figure 10). This supports the contention that midwives in CM Health tend to look after more complex cases than would be expected in other parts of the country1. There was no particular pattern seen by ethnicity, deprivation or ward in relation to the proportion being assessed as at risk or high risk. Figure 11 shows risk by mother’s ethnicity in 2013.

Figure 12 shows CM Health facility caesarean deliveries by risk group from 2006 to 2013. There is a clear increasing trend for women in the at risk and high risk birth groups to have caesarean sections. The increase is particularly evident in women cared for by self-employed LMCs where increases have been observed for 4 consecutive years (Figure 13). It is hard to determine if the increased caesarean section rate is due to personal choice or not, as the current system does not capture this information. Whilst the number of caesareans among European/Other and Maaori women did not grow much between 2006 and 2013, the number of caesareans among the Asian and Pacific groups increased substantially (Figure 14 and Figure 15). For instance, between 2006 and 2013, the number of caesareans in the Asian group rose by 71% while the proportion of caesareans on women in this group increased from 15% to 21% of total caesareans (Figure 16).

The increase in high risk births and the growing rate of caesareans means greater demands on maternity services and has a multiplying effect on the workload for midwives, obstetric surgeons and others in the maternity team. The health sector requires the capability to manage complex births, and must be able to provide access to appropriate support services.

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2014 2015 maternity quality and safety programme  

This Annual Report (2014-2015) covers the continued progress and initiatives undertaken over the last 12 months as part of the Maternity Qua...

2014 2015 maternity quality and safety programme  

This Annual Report (2014-2015) covers the continued progress and initiatives undertaken over the last 12 months as part of the Maternity Qua...