Implementing the Blueprint to improve maternity care in NSW

​​​​​​Implementation priorities

The NSW Health Maternity Expert Advisory Group and the NSW Health Maternity Consumer Reference Group are providing advice and making recommendations on the following implementation priorities of Connecting Listening and Responding: A Blueprint for Action - Maternity Care in NSW​ (the Blueprint) and the Inquiry into Birth Trauma:

Increasing access to maternity continuity of care models, including midwifery continuity of care

What we heard

Continuity of care is essential to women.

What we are doing

We are committed to increasing access to maternity continuity of care models. We have commenced two pieces of key foundational work:

• We are improving the way we record and classify the model of care each woman has. This work will give us a clear understanding of the models of care being provided across NSW and the numbers of women cared for under various maternity continuity of care models. It will enable us to monitor improvements to access to maternity continuity of care models.
• We started consultation with each local health district to understand what is impacting on providing and increasing maternity continuity of care models. It is crucial we understand the barriers and enablers so we can start to work through these and find and implement solutions.

Embedding trauma-informed care into all aspects of maternity care

What we heard

Many women have a positive experience of maternity care; however,​ we heard that some women experience birth trauma, this may be physical and/or psychological. Other women may enter maternity care with trauma and this trauma is not understood, recognised and responded to.

What we are doing

We are committed to addressing this.

• NSW Health published the Integrated Trauma-Informed Care Framework: My story, my health, my future in February 2023. An implementation plan is being developed and we are committed to ensuring that maternity care providers embed this framework in their everyday work.
• We are developing an ‘at a glance’ resource for clinicians to accelerate adoption of trauma informed care principles into routine maternity care. The resource will co-designed by consumers for all maternity staff (both clinical and non-clinical) to provide real-world, practical considerations that will lead to improved experiences for women.

Improving the way information is provided to women

What we heard

Women need access to information to ensure that they can make informed decisions about their care. This includes provision of information about the risks and benefits for any intervention in maternity care, such as an induction of labour.

What we are doing

• We are reviewing the induction of labour policy with clinicians and consumers. The updated policy will include specific guidance about the provision of consumer information, methods to promote and ensure informed decision-making, and clearly outline the requirements for valid consent.
• We are conducting a pilot of an induction of labour decision aid in three local health districts. This decision aid, co-designed by consumers in Northern NSW, supports the discussion between maternity clinicians and consumers, enabling women to express what matters to them and will support their informed decision-making. It is designed to be able to be modified for other maternity care interventions that require informed decision-making.
• We are reviewing and updating local health district maternity web pages to improve the consistency of information provided. This includes:
  • how to book in
  • local maternity models of care available
  • service capability and networked maternity care
  • video tours of birthing rooms, maternity unit and special care nursery/neonatal intensive care unit
  • local options for birth and parenting education
  • how to make contact
  • how to share feedback, including asking questions, raising concerns and making complaints.

Improving the consent process in maternity care

What we heard

Women said they had not given their consent for some maternity interventions and procedures. We also heard from women who felt coerced into making decisions and accepting treatment and procedures they did not want. In NSW Health we take consent seriously.

What we are doing

• We are collaborating with maternity clinicians and consumers to inform an agreed process for obtaining genuine and valid consent for maternity interventions, underpinned by the NSW Consent to Medical and Healthcare Treatment Manual. This will include a review of the education available for our clinicians.
• We are developing guidance to support women, and their treating clinicians, when women make choices outside of clinical recommendations. We are involving consumers, clinicians and professional peak bodies in developing this guidance to ensure the resources are fit for purpose and meet the needs of both consumers and clinicians.

Supporting women who experience pregnancy complications

What we heard

Some women are not supported well enough when they experience pregnancy complications. This includes women who experience the loss of their pregnancy or newborn and women who are given diagnoses of fetal anomalies and genetic disorders. We heard that women and their families need individualised, compassionate and supportive care, and access to clear information.

What we are doing

• We are finalising the Perinatal Loss guideline which will provide specific advice for clinicians on how to provide respectful care, including bereavement support, to women who experience pregnancy or newborn loss. This includes pregnancy loss at any gestation or location (inclusive of maternity units, emergency departments and operating theatres).
• We are developing a web page that features information for women and families so that they can easily access information and support when they experience an unexpected fetal diagnosis in pregnancy. This is a crucial step forward to supporting parents.
  

Related links

• Maternity care in NSW​
  
• Connecting, Listening and Responding: A Blueprint for Action – Maternity Care in NSW
• Developing the Blueprint​​ to improve maternity care in NSW