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NZ maternity system 'needs improvement'

NZ Newswire logoNZ Newswire 27/09/2016

Babies born to mothers with medical-led care have substantially lower adverse health outcomes than those with midwife-led care, according to an Otago University study.

The outcomes included 55 per cent lower odds of oxygen deprivation during the delivery, 39 per cent lower odds of neonatal encephalopathy and 48 per cent odds of a low Apgar score.

Encephalopathy is a condition that can result in brain injury, while the Apgar score is a measure of infant well-being immediately after delivery.

Senior author Professor Diana Sarfati says the findings demonstrate a need for further research to investigate the reasons for the apparent excess of adverse outcomes in midwife-led care.

"Our primary aim with this work is to improve the quality of the maternity system, which already works well," she said.

Prof Sarfati said the Ministry of Health was taking the research seriously and had set up an evaluation to address some of the issues raised in the paper.

New Zealand adopted an autonomous midwife-led model of maternity care in 1990.

The authors say the research, publish in PLOS Mecidine, is the first detailed study examining what effect, if any, that midwife-led care has on specific health measures for newly born infants.

They say the findings need to be interpreted in the context of New Zealand's good overall internationally-comparable birth outcomes.

They also had to be seen in the context of previous research supporting the many benefits of midwife-led care, such as greater patient satisfaction and lower intervention rates.

Co-author Ellie Wernham, a former midwife, says she saw first-hand the many advantages of New Zealand's midwife-led continuity of care model.

"However our study has identified that there may be aspects of our maternity system where improvements can be made that provide for better outcomes for babies," Ms Wernham, a Master of Public Health graduate from Otago, said.

Researchers examined major adverse perinatal outcomes between babies whose mothers had midwife-led care and those who had medical-led (such as by an obstetrician or a GP) care.

Their study covered more than 240,000 births in New Zealand over a five-year period to 2012.

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