Maternity clinical indicators Atlas | Updated with 2015 data (May 2017)
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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 a range of 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 is used to identify a group of women who are considered to be ‘low risk’, for whom interventions and outcomes should be similar between regions. Of the 15 indicators covered in the Atlas, seven apply to standard primiparae, five apply to all women giving birth, one applies to women who registered with a Lead Maternity Carer and four apply to all babies born.
Data sources and method
These quality indicators draw on existing national data collections such as the National Maternity Collection (MAT), the National Minimum Dataset (NMDS) and Lead Maternity Carer (LMC) claims.
Where available, count data are provided on the tables, and confidence intervals are calculated.
Wide variation in the rates by DHB was observed for the following indicators:
- Registration with an LMC in the first trimester (by DHB of domicile, range 52.9– 80.9 percent). From 2009 to 2015, there has been a significant increase in the proportion of women registered from 56.5 up to 70 percent in 2015.
- Standard primiparae who have an instrumental vaginal birth (range 5.4–20.5 percent).
- Standard primiparae who have a caesarean section (range 8.6–29.3 percent). Since 2009, the proportion of standard primiparae having either an instrumental birth or a caesarean section has increased.
- Intact lower genital tract after vaginal birth among standard primiparae (range 14.8– 52.6 percent). The rate of standard primiparae women with an intact genital tract has significantly decreased from 2009 to 2015, from 35 percent to 28 percent.
- Episiotomy without third- or fourth-degree tear (range 6.3–31.1 percent).
- Maternal tobacco use in the postnatal period (two weeks after birth) (range 2.8–30.6 percent).
- The percent of babies who are small for their gestational age born at 40-42 weeks’ gestation has significantly decreased from 45 percent to 38 percent. Overall, in 2015, 3.1 percent of babies were born small for their gestational age, a decrease from 3.5 percent in 2009.
Differences by ethnicity, from 2011-2015
- Those identifying as Pacific (40 percent) and Māori (51 percent) had significantly lower rates of registration with a Lead Maternity Carer (LMC) in the first trimester of pregnancy compared with Asian (67 percent) and European/Other (77 percent).
- 77 percent of Māori and 75 percent of Pacific standard primiparae women had a spontaneous (non-instrumental) vaginal birth compared with 63 percent of Asian and 67 percent of European/ other women.
- Māori and European/ other women had higher rates of intact lower genital tract (44 and 32 percent respectively) compared with Pacific (22 percent) and Asian women (12 percent).
- On average, a third of Asian standard primiparae had an episiotomy without a third- or fourth-degree perineal tear compared with 11 percent of Māori, 18 percent of Pacific and 21 percent European/ other women.
- The variation may indicate that the outliers have issues with data quality or it may be true variation. We recommend local analysis to explore the reasons for the variation and, in addition to the Atlas, the tables provided here may be helpful www.health.govt.nz/system/files/documents/publications/ci2015trends-final-13jan2017.xlsx
Note : Indicator 9: Standard primiparae undergoing episiotomy and sustaining a 3rd- or 4th- degree perineal tear, Indicator 13: Diagnosis of eclampsia during birth admission, Indicator 14: Women having a peripartum hysterectomy and Indicator 15: Women admitted to ICU and requiring ventilation during the pregnancy or postnatal period are not presented in this Atlas due to the low number of cases reported (<10 in most DHBs in 2015).