Early pregnancy midwifery care

It is well documented that stillbirth and neonatal mortality are significantly higher for women who live in areas of high deprivation and are associated with late access to midwifery care.

Finding a lead maternity care midwife can be challenging for women, which can delay decision-making and result in their not being registered with a midwife in the first trimester of pregnancy.*

Many women in the Counties Manukau Health region confirm their pregnancy at their GP practice, and subsequently find themselves lost traversing between the GP and midwifery services. Research† has confirmed the need for these women to be supported in early pregnancy to find a midwife.

As a result, two early pregnancy midwifery care clinics have been established by Ady Priday, both co-located at GP practices, one in Otara, the other in Mangere. Midwife Linda Burke has since established two early pregnancy clinics, one in Mangere the other in Papatoetoe. These midwifery-led services have proved to be very popular and have addressed many of the needs of women early in their pregnancies. The service also extends to home visiting women who have challenges with transport.

At the clinics, women are provided with information about maternity services and the options available for birthing, i.e. home birth, primary birthing units, hospitals (Middlemore and Auckland) and private obstetric care. Also discussed, is the latest research about the benefits, for healthy low-risk women, of commencing their birthing process at a primary birthing unit. Experience shows that women appreciate a midwife discussing this information with them, and that it

* Priday, A., & McAra-Couper, J. (2016). A successful midwifery model for a high deprivation community in New

Zealand: A mixed methods study. International Journal of

Childbirth, 6(2), 78-92. DOI:10.1891/2156-5287.6.2.78 † Priday, A. (2018). A daunting journey: Accessing a lead maternity care midwife. Master’s thesis. Retrieved from https:// openrepository.aut.ac.nz/bitstream/handle/10292/12356/

PridayAD.pdf?sequence=3&isAllowed=y ADRIENNE PRIDAY 

Community LMC Midwife and AUT University Educator Midwifery

helps women to understand and take-up the primary birthing unit option. In the past 18 months, in Ady Priday’s Otara and Mangere clinics alone, 36 per cent of women have opted for a midwife who cares for women at a primary birthing unit.

Another real benefit of this service is that it allows women to speak openly about their preferences for a midwife and birthing facility, something that is not possible when they are phoning around to see if a midwife has space and find out more about that midwife. To have the confidence to ask qualifying questions, so that women can establish if they want a particular midwife, is easier when facilitated via an early pregnancy service.

Within the early pregnancy midwifery care service, women are provided with an holistic health assessment, obstetric history review, numerous screening options, and bloods and ultrasounds, as required.

Most women are seen between 6- and 9-weeks’ gestation, and get to see their permanent lead maternity carer within the next couple of weeks. Some women will experience miscarriage over this time, and the service is able to provide more supportive care when this happens. Some women have heard about these clinics via word of mouth and attended very late in their pregnancy care. We would like to think they have felt safe to ask for our support at such a late stage in their pregnancy, and we assist them with immediate care requirements and an urgent referral to a employed hospital or lead maternity care midwife.

Another aspect of the service is that we provide information and discussions about keeping healthy in pregnancy. This can include referrals to smoking cessation, social work support and dietary support, among other things.

All information gathered from assessments, as well as the women’s wishes and records of the keeping healthy discussions are accessible, via the Maternity Clinical Information System, to the women’s ongoing midwife.

Accessing and engaging with early midwifery care is a complex process, shaped by the life influences of women and the support they are offered to find a lead maternity carer. The early pregnancy midwifery care service focuses on the needs of the women, and helps them find and enlist a midwife who suits their desires and needs. This is a womancentred service that starts each woman on a midwiferyfocused childbirth journey, as close as possible to the confirmation of her pregnancy.