Having a baby — your right to quality maternity care
Depending on the circumstances of your pregnancy, labour and delivery, you may have more than one provider involved in your care when you have a baby. Under the Code of Health and Disability Services Consumers’ Rights, you have the right to co-operation amongst these providers to ensure you receive a quality service.
Lead Maternity Carer (LMC)
In New Zealand you are able to choose who you want to organise your care and to look after you when you have your baby. This person is called your Lead Maternity Carer (LMC) and will provide a comprehensive maternity service during your pregnancy, delivery and up until four weeks following the birth. This person will be responsible for organising the care you require, ordering and acting on any tests, and arranging any referrals or input from other health professionals. Your LMC may be a midwife, general practitioner or specialist obstetrician. The LMC discusses and plans your care in partnership with you.
A midwife is a qualified health care professional who has successfully completed a midwifery degree and is registered with the New Zealand Midwifery Council. Some midwives are self-employed, others are employed by a District Health Board (sometimes referred to as hospital midwives) or private maternity services. All midwives must provide care to a specified standard agreed by their professional body (the New Zealand College of Midwives), the Midwifery Council, and the Ministry of Health (via funding arrangements). The same standards apply to medical professionals.
The majority of women in New Zealand choose a midwife as their LMC. Some women choose a general practitioner or an obstetric specialist obstetrician. When the LMC is a doctor, you will also require the support of a midwife during labour, delivery and after the baby is born. Midwifery support is included when you register with your LMC.
The objective of the LMC approach is to have one person responsible for organising and coordinating your care and to provide the majority of your care as far as possible. All LMCs will be involved in your care during pregnancy and plan to attend your birth. You can get information and guidance about choosing your LMC, including any charges that may apply, from the Health Education section of the Ministry of Health (www.healthed.govt.nz/resources), the Maternity Services Consumer Council (www.maternity.org.nz ) or the NZ College of Midwives (www.midwife.org.nz).
Backup arrangements
You can expect your LMC to tell you about the arrangements for your care if your LMC is not available. For instance, during pregnancy, a midwife may not be available for a scheduled visit and may recommend a colleague to take responsibility for your care temporarily. If an LMC is unable to attend the birth, they are responsible for organising a backup practitioner and ensuring you are well aware of this arrangement. If you are having your baby in a hospital, it may be necessary for your care to be covered by a backup midwife — either another independent midwife or a hospital midwife.
Transfer of care
A midwife LMC has primary responsibility for your care unless and until she transfers that responsibility in circumstances where you or your baby require ongoing medical care. Decisions about a transfer of care are made following discussions that involve you. Transfer of care may happen for a variety of reasons. In the case of complications or complex maternity needs, your LMC may recommend a consultation with a specialist such as an obstetrician, obstetric physician or other physician, or an anaesthetist. This may be for a single consultation or a series of visits. In some cases the LMC may be recommended to transfer your care to a specialist. The transfer may be for part or all of your antenatal maternity care, depending on your condition and the condition of the baby — for example, transfer of care to a specialist obstetrician in hospital for a Caesarean delivery.
Maintaining quality and consistency of care
In any transfer of care, you have the right to ‘seamless’ services so that you receive a consistent appropriate standard of care. Under the Code of Rights, all providers have a responsibility to cooperate with each other to provide quality and continuity of service. Where a transfer occurs, there needs to be agreement and mutual understanding of when and to whom responsibility for your care has been transferred.
In conclusion
You can expect to receive quality services from all maternity practitioners, including when care is transferred from one practitioner to another. It must be clearly understood by all parties involved who has overall responsibility for your care at any given time, and the point at which responsibility for your care is transferred back to your LMC. This information must be communicated clearly to everyone, and must be recorded in your clinical notes.
There must never be any doubt or confusion as to who has responsibility for any aspect of your care at any time, or who to contact when you require information, care or assistance.