This essay discusses the determinants of health in New Zealand with a focus on maternity care in rural areas, mainly the rural Tai Rawhiti area and how two objectives of the New Zealand Health Strategy can have a positive impact. The two objectives described are …
1Discuss health inequalities in nz.
Dew and Matheson (2008) state that the disciplines of epidemiology and social epidemiology have progressively given more descriptions of health inequalities. Epidemiology mainly focuses on how and from where infectious diseases spread, whereas social epidemiology looks at the patterning of health outcomes involved with social characteristics such as gender, ethnicity and income in order to find the causes of differences between these groups (Dew & Matheson, 2008).
(Kyle & Hendry, 2012)
There are fewer rural facilities employing core midwives because some have chosen to move into self-employment.
In many rural areas, Lead Maternity Carer (LMC) midwives provide on call services for the local facility in addition to their LMC role.
Some of these midwives carry higher caseloads than midwives in urban areas and work alone.
The distribution of the midwifery workforce is identified as a key problem of maternity care.
Some urban localities have too many LMC midwives and have been targeted to recruit into rural localities of need.
Most LMC services in rural areas are provided by midwives who either have to travel from the nearest city or those who live locally.
Postnatal stay in rural facilities places added pressure on staffing these facilities.
It is recommended that a midwife be on duty all day, every day when a woman is an inpatient within the primary facility.(&2013)
(Kyle & Aileone, 2013)
Midwives provide the majority of maternity services in rural localities, working either as Lead Maternity Carers (LMCs), providing primary maternity care to women from early pregnancy until 6 weeks postpartum, or employed by rural maternity hospitals, providing midwifery care when women are in the hospital.
Most LMC midwives in rural localities are self- employed and work in close proximity to primary maternity facilities. However, some midwives are employed to provide case loading midwifery services.
Many core midwives in rural localities chose to move into self- employment. This has now placed pressure on DHBs and facility providers to recruit core midwives and in many instances registered nurses (RNs) are employed in this role.
LMCs are having to move further and further out to gain a full caseload,
local midwives are managing larger caseloads and some women are opting to receive care in an urban centre.
Primary maternity facilities are for low risk women to birth and do not offer women any operative interventions or inductions. For these services, women need to transfer to a ‘base maternity facility’ where obstetric specialist services are available. Many women who birth at the base hospital are then able to transfer back to a primary unit in their locality...