Jacoby Poulain: Maternity care needs changes

Jacoby Poulain is a Hastings District Council Flaxmere Ward councillor and a Hawke's Bay District Health Board member.

It's not the easiest being Maori sometimes. Whether it's a board meeting, committee meeting or forum meeting - no matter where I am it's much the same - negative Maori statistics. The unspoken vibe is "why don't Maori get off their behinds and help themselves". The good news is that, contrary to popular opinion, often we do and here's an example.

A new study dispels the myth and common portrayal that young pregnant Maori women delay access to antenatal care in their first trimester. Rather, they are engaging early with health services to confirm their pregnancy and initiate maternity care, but system barriers are delaying timely access to screening and enrolling with a lead maternity carer (LMC).

The Otago University study of 44 pregnant or recently pregnant Maori women aged under 20 showed that, despite their youth and possible implications of finding out they were pregnant, most participants were proactive in taking steps to confirm their pregnancy, with primary care services such as the GP or a school or community-based youth specific health service.

However, this positive health-seeking behaviour was often met with inadequate information and support for young pregnant women navigating the next steps in their maternity care journey.

Many participants felt inadequately supported to be able to identify, confirm and enrol with an LMC. By contrast, those who received proactive support at the first interaction with health services had an appropriate maternity care pathway towards obtaining early and seamless maternity care.

Lead author Charissa Makowharemahihi says that "despite a publicly-funded maternity system, the fragmentation between primary non-lead maternity care (such as a GP) and separate community-based lead maternity care services (such as midwives) had a negative impact on the pregnancy journey for many of these young women, disrupting access to early antenatal care".

The repercussions of this disruption are sobering with babies of Maori women almost twice as likely to have a potentially avoidable death in the weeks immediately before and after birth than babies of New Zealand European mothers.

Study co-author Dr Bev Lawton says these differences can only be partially explained by socioeconomic status. Rather, they are part of a larger picture of health disparities that suggests there are system and health service factors contributing to different health outcomes.

The system has a weak point right from the start - and having been through our maternity system recently I can attest to this. Generally once you front at a GP clinic to confirm your pregnancy, it is then your responsibility to engage a LMC from the community. Sounds simple enough until you need to find information on each midwife with only some available publicly.

You then also need to find your own information on what you should expect from midwifery services and the process in order to assess the differences between the services and methodology offered by each LMC.

By the time you've done this, assuming you have the necessary time and effort between your morning sickness, finding out you're pregnant and all the other matters one must deal with at this life-changing time, your care is delayed and preferred midwife taken at times.

Contrast this with an integrated model of maternity care where our GPs, or the first point of patient contact in the health system, worked closer and more seamlessly with the LMC. In this scenario the GP could take responsibility for first trimester care, education and/or navigation to an LMC. This way the patient enters care quickly and seamlessly from the start and is assisted with their transition.

This is just one issue in the maternity care scheme I believe would benefit from being addressed, not just for Maori but for all in care, and as a board member of the Hawkes Bay District Health Board I will continue to look into.