Primary maternity options in the Morrinsville/Te Aroha area

4 February 2014

Introduction

This presentation follows on from the presentation to the community in December about the feasibility study carried out by reviewers late last year. It will take about 20 minutes to complete.

The presentation is a summary of: – What the reviewers found– What the issues are– What we’ve been told– Some options for consideration– What happens next?

Discussion in groups after the presentation (30 minutes)

Feedback and next steps (20 minutes)

Summary of review findings

As they are currently configured, primary maternity services in these facilities are:

– Underutilised – The building is no longer fit for purpose e.g., risks

associated with room size and access– Maternity is not connected to other local maternal and

child health services– Poor use of the maternity workforce– Not sustainable over the long-term– Costly

Summary of review recommendations

1. That Waikato DHB consolidates current service provision (birthing) from Rhoda Read and Matariki into the two urban primary units in Hamilton.

THIS DOES NOT MEAN ALL MATERNITY SERVICES SHOULD MOVE TO HAMILTON.

Whilst the recommendation is to cease provision of local maternity hospital services for childbearing women, this does not mean that all maternity services should be removed from these localities.

Engage the two affected communities in consultation to explore what community-based maternity priorities / initiatives are needed.

Feasibility study – Rhoda Read birth numbers

Rhoda Read has 24/7 staffing on-site with 24/7 on-call LMC cover.Births in the facility are declining and that trend is expected to continue.

In the 6 months to July 2013, each month on average:

– 4.2 women admitted – 2.5 women were transferred to Waikato Hospital intrapartally– 5.3 babies were born– 6.3 mothers and babies transferred into the facility postnatally

Women are bypassing local facilities to have their babies in Hamilton

Morrinsville/Te Aroha area Facility used

Birth year Pohlen Rhoda Read Thames Waihi

Waikato Hospital

Hamilton Birthing

Grand Total

2011/12 1 65 1 209 29 305 2012/13 4 58 1 1 234 33 331 Grand Total 5 123 2 1 443 62 636

- The above figures are updated from the feasibility study (pages 21 and 25)- Only women from the local area have been included in these slides- There were 12 out-of-area mothers who gave birth at Rhoda Read in 2012/13

Why are women choosing not to have their babies in their local facility?

EN = enrolled nurse LMC = lead maternity carer

Theme Morrinsville Te Awamutu Factors Impacting on Utilisation

The environment is small Facility is old Local midwifery rooms are a

distance from the unit No visibility of the unit The food is unsuitable for

maternity patients EN being the 2nd at births

prevents usage by some LMCs Distance perceived to be unsafe

by some providers

The model of care prohibits LMC utilisation

The environment is small Facility is old Population unaware of

the unit Lack of community

involvement No local antenatal

classes Distance perceived to be

unsafe

Other issues raised

Theme Morrinsville Te Awamutu Issues related to physical environment

Small size of postnatal rooms

No room for partners sleeping over

Last refurbishment many years ago

Poor maintenance No ensuites Not soundproof Needs better

birthing pool

Small size of postnatal rooms

Last refurbishment many years ago

Poor maintenance Partners sleeping

‘under the sink’ on a mattress if they stay

No ensuites Not soundproof Needs better

birthing pool

Financial viability

• At present, it costs Waikato DHB a total of $1,281,459 to operate these facilities ($665,802 for Rhoda Read, and $615,657 for Matariki).

• This is $856,468 more than the DHB pays for the same number of births in Hamilton.

• Improving community-based maternity services is likely to be a better use of taxpayers’ money than keeping underused, out-of-date maternity facilities open

Where there are no risk factors, women are best served by using primary birthing facilities:

•Hamilton has two primary birthing units; River Ridge East and Waterford•Thames, Te Kuiti, Taumarunui, Tokoroa and Pohlen hospitals have primary birthing units•There are also primary birthing facilities in Huntly and Waihi

Waikato Hospital is best kept for women who have complications.

Where would women birth if Matariki and Rhoda Read closed?

Travel time with and without Matariki

Has the decision to close these facilities already been made?

No.Waikato DHB is consulting with the communities affected. We want your ideas on:

• The advisability of retaining or closing the local birthing facilities• What primary maternity services would be needed in your area if all women

were to have their babies in Hamilton. These could include:

• Improvements to existing community-based services• Grouping some providers into a family / resource centre• Other ideas from the community

This is outlined in more detail in the consultation document andin the submission form.

At the Morrinsville meeting in December, we were told . . .

• Women do not want to have their babies at Waikato Hospital• The DHB should give Rhoda Read a ‘facelift’ and then

women would go there• It’s too hard for families to travel to Hamilton to visit the

mother (cost, distance)• Would the DHB consider a proposal from a private provider?• The DHB team needs to hold a meeting in Te Aroha• Meetings should be held at 7.15pm so they’re after children

are in bed

We looked at what is currently available in MorrinsvilleCurrently in Morrinsville Would no

longer be available in Morrinsville

Will remain in Morrinsville

Could be enhanced locally

Lead Maternity Carers (LMCs)            Midwife group practice with shared rooms   √ √

10 LMCs live in the area   √ √26 LMCs service the area (but not all will use Rhoda Read)

  √ 

√

Total of 96 LMCs with access agreements to Rhoda Read (but not all will use the facility)

  √ 

√ 

       Maternity Services at Rhoda Read       Waikato DHB midwife Antenatal clinics Birth/postnatal stays CTG Lactation service

√ √ 

 √  √ 

 √ √√ 

       Other related services      Postnatal checks in the woman’s home   √

  

Pregnancy and parenting classes   √ 

√ 

Well child providers (GPs, Plunket)   √ 

 

Maternal Mental Health Service 

  Currently provided as needed

 

A family / resource centre: an option?

• A centrally located site could offer screening and immunisation

• Room for classes such as pregnancy and parenting classes

(particularly for women with high needs

• Midwives to work together to maximise cover / relief for each other and ensure back-up for home births

• Resource centres currently exist in Levin, Otaki, Pahiatua and Palmerston North: http://mamaternity.org.nz/maternity-resource-centres/ 

Family / Resource Centre possibilities:

• Resources:

Information / advice, monitoring, smoking cessation, pepi pods• Lactation services:

Outreach service for women with higher needs• Nutrition advice:

Nutrition support / advice for those mothers with BMI over 35. Can lead to complications in pregnancy and birth

• Promoting connections:

Space for coffee mornings, toy library, playgroups

Summary

• The birthing facilities are under-utilised and not sustainable in the long-term

• There has been a recommendation to close these facilities• We need to know if keeping them open is the best use of the

funding, which could be used to provide other services for our communities

• Waikato DHB wants your views on this and if facilities are closed, what maternity services your community needs and how they should be provided

• Submissions close 21 February• A decision is planned for late March 2014

What happens next?

The final decision on the proposed closure is planned in lateMarch 2014.

This decision will take account of the reviewers’ recommendations and the reasons behind them and the consultation feedback.

Submissions can be made in various ways: email, post, 0800 number. Details are in your submission document and at the end of this presentation.

There will be a further meeting in Morrinsville on 11 February from 6.30-8pm in the Events Centre, Ron Ladd Place 

Submissions close on 21 Feb 2014.

Submission options

Post to: Planning & Funding, Waikato DHB, PO Box 934, Hamilton 3240

Email your submission to: support@waikatodhb.health.nz

Attend meetings in December, January and February

 

Complete your survey online at: www.waikatodhb.health.nz/birthing

Ring 0800 100 178 and leave your name and phone number. A member of staff will call you back within two working days and will guide you through the submission form.

The rest of this meeting time

• Discussion in groups – 30 minutes

• Questions:– Views on closure of Rhoda Read and how the issues

could be addressed?– What is most needed in the Morrinsville/Te Aroha area if

Rhoda Read maternity facility closed and all women have their babies in Hamilton?

– What other ideas do you have for enhancements of community maternity services?

• Feedback and next steps – 20 minutes