Maternity clinical indicators Atlas | Updated using 2018 data (October 2020)

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Introduction

The New Zealand maternity clinical indicators are the result of collaboration between the Ministry of Health and maternity stakeholders representing consumer, midwifery, obstetric, general practice, paediatric and anaesthetic perspectives. 

In 2011 an expert working group established a set of 12 maternity clinical indicators that could be measured using the available data collections at that time.

In 2013 the National Maternity Monitoring Group reviewed the original indicator set and recommended some changes to improve the quality, completeness and scope of the New Zealand maternity clinical indicators.

For this report, as with previous reports in this series, the ‘standard primipara’ definition has been used to identify a group of women considered to be ‘low risk’, for whom interventions and outcomes should be similar between regions. Of the 16 indicators covered in the Atlas domain, seven apply to standard primiparae, four apply to all women giving birth, one applies to women who registered with a lead maternity carer (LMC) and four apply to all babies born.

Data sources and method

The New Zealand maternity clinical indicators draw on existing national data collections such as the National Maternity Collection, the National Minimum Dataset and LMC claims.

Download the methodology for this Atlas domain (181KB, pdf).

Where available, count data is provided in the tables and confidence intervals are calculated.

Key findings (2018 data)

A complete summary of the indicators is available at: www.health.govt.nz/publication/new-zealand-maternity-clinical-indicators-2018.

There was wide variation in the rates by district health board (DHB) in the following indicators:

  • Registration with an LMC in the first trimester (by DHB of domicile, range 55.7–81.0 percent). From 2009 to 2018, there has been a significant increase in the proportion of women registered, from 57.6 percent in 2009 to 72.7 percent in 2018.
  • Since 2009, there has been an increase in the proportion of standard primiparae having either an instrumental birth or a caesarean section.
  • The rate of standard primiparae women with an intact genital tract significantly decreased between 2009 and 2018, from 35 percent to 27 percent. Rates varied widely by DHB (range 14.5–46.1 percent). 
  • Maternal tobacco use in the postnatal period (two weeks after birth) decreased between 2009 and 2018 from 13.7 percent to 9.4 percent; the highest DHB rate reduced from 37 percent in 2009 to 20 percent in 2018. 
  • The percent of babies who are small for their gestational age born at 40-42 weeks’ gestation significantly decreased between 2009 and 2018 from 45 percent to 30 percent.

Differences by ethnicity, from 2018: 

  • Those identifying as Māori (60 percent) and Pacific peoples (47 percent) had significantly lower rates of registration with an LMC in the first trimester of pregnancy compared with those identifying as European/Other (83 percent), Asian excluding Indian) (76 percent) and Indian (74 percent).
  • Seventy-seven percent of Māori and 69 percent of Pacific standard primiparae women had a spontaneous (non-instrumental) vaginal birth compared with 66 percent of European/Other, 57 percent of Asian excluding Indian and 48 percent of Indian women.
  • Māori and European/Other women had higher rates of intact lower genital tract (40 and 28 percent respectively) compared with Pacific (21 percent) and Asian excluding Indian (12 percent) women.
  • On average, 41 percent of Indian and 39 percent of Asian excluding Indian standard primiparae women had an episiotomy without a third- or fourth-degree perineal tear compared with 24 percent of European/Other, 20 percent of Pacific and 13 percent of Māori women.

The variation may suggest the outliers had problems with data quality or it may be true variation. We recommend providers do local analysis to explore the reasons for any variation; in addition to the Atlas, the tables provided here may be helpful: www.health.govt.nz/system/files/documents/publications/ci2015trends-final-13jan2017.xlsx.

Notes: 

Due to the low number of cases reported (fewer than 10 in most DHBs in 2018), the following indicators are not presented in this Atlas domain:

  • Indicator 9: Standard primiparae undergoing episiotomy and sustaining a third- or fourth-degree perineal tear
  • Indicator 13: Diagnosis of eclampsia during birth admission
  • Indicator 14: Women having a peripartum hysterectomy
  • Indicator 15: Women admitted to ICU [intensive care units] and requiring ventilation during the pregnancy or postnatal period.
  • Indicator 17: Women with BMI over 35 was not included because it did not meet the description of a clinical indicator. As a result, the indicators previously numbered 18–21 have been renumbered as indicators 17–20.

More information

New Zealand Maternity Clinical Indicators - series (Ministry of Health website)

Last updated 10/12/2020