Transcript Morrinsville and Te Aroha presentation

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:
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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
2011/12
2012/13
Grand Total
Pohlen
1
4
5
Rhoda
Read
65
58
123
Thames
1
1
2
Waihi
1
1
Waikato Hamilton
Hospital Birthing
209
29
234
33
443
62
Grand
Total
305
331
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?
Theme
Factors
Impacting on
Utilisation
Morrinsville
Te Awamutu
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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
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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
EN = enrolled nurse LMC = lead maternity carer
Other issues raised
Theme
Issues related
to physical
environment
Morrinsville
 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
Te Awamutu
 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 would women birth if Matariki and Rhoda Read closed?
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.
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 and
in 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 Morrinsville
Currently in Morrinsville
Would no
longer be
available in
Morrinsville
Will remain in
Morrinsville
Could be
enhanced
locally
Midwife group practice with shared rooms
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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)
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Lead Maternity Carers (LMCs)
Maternity Services at Rhoda Read

Waikato DHB midwife

Antenatal clinics
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Birth/postnatal stays
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CTG

Lactation service
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Other related services
Postnatal checks in the woman’s home
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Pregnancy and parenting classes
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Well child providers (GPs, Plunket)
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Maternal Mental Health Service
Currently
provided as
needed
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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/maternityresource-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 late
March 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: [email protected]
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