This section outlines the background information for creating the Maternity National Clinical Guidance.
In 2009, the Government agreed to the development of the Maternity Quality Initiative, which included the establishment of a Maternity Quality and Safety Programme. During the programme’s planning it was agreed by the multidisciplinary expert working group developing the New Zealand Maternity Standards that there was a need to have nationally consistent clinical guidance for the maternity sector. This was also in response to recommendations from the Perinatal and Maternal Mortality Review Committee, the Health and Disability Commissioner and the Minister of Health.
This guidance would enable and encourage consistency of clinical maternity practice for particular topics identified as areas of variability within the sector.
The Ministry of Health and members of the National Maternity Guidelines Working Group reviewed existing DHB guidelines, selected international guidelines and recent international literature on the use of clinical guidelines. The working group includes representatives from the New Zealand College of Midwives (NZCOM); Royal New Zealand College of General Practitioners (RNZCGP); Royal Australasian College of Physicians – Paediatric and Child Health Division; Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) – New Zealand Committee; the Society of Anaesthetists and a consumer representative.
Three clinical areas were identified as the first priority for this work:
- observation of the mother and baby in the immediate postnatal period
- management of postpartum haemorrhage
- management of hyperglycaemia in pregnancy
National consensus guidance for Observation of Mother and Baby in the Immediate Postnatal Period: Consensus Statements Guiding Practice, Consensus Guidance on the Management of Postpartum Haemorrhage and Screening, Diagnosis and Management of Gestational Diabetes in New Zealand have been completed.
The service specifications for district health boards providing maternity services require the service to adopt any applicable national clinical guidelines that are endorsed by the professional colleges.
The National Maternity Monitoring Group (instituted in 2012 as part of the Maternity Quality Initiative) has advised the Ministry that the next clinical area for guideline development is hypertensive disorders in pregnancy. This work is currently underway.
Ratification process for External Maternity Clinical Guidance
It has come to the attention of both the Ministry of Health and the National Maternity Monitoring Group (NMMG) that the maternity sector is circulating several maternity guidelines that have not been through a ratification process to become a national guideline. Some of these guidelines might be valuable resources for the maternity sector. Conversely, some might not be evidence-based or robust; in this case, they could have a negative influence.
The NMMG and the Ministry have developed a formal process by which they can appraise and ratify externally developed guidelines. The following page outlines this process: