121022 postnatal care guidelines_web

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Postnatal Care Program

Guidelines for Victorian

Health Services


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Postnatal Care Program

Guidelines for Victorian

Health Services


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I you would like to receive this publication in an accessible ormat, please phone 1300 253 942using the National Relay Service 13 36 77 i required, or email: [email protected].

Copyright, State o Victoria, Department o Health, 2012

Published by the Perormance, Acute Programs and Rural Health branch, Victorian Government,

Department o Health, Melbourne, Victoria. This publication is copyright, no part may be reproduced

by any process except in accordance with the provisions o the Copyright Act 1968.

This document is also available in PDF ormat on the internet at: www.health.vic.gov.au/maternitycare

Authorised by the State Government o Victoria, 50 Lonsdale Street, Melbourne.

October 2012 (1210022)

Print managed by Finsbury Green. Printed on sustainable paper.


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1. Introduction 1

2. Purpose 3

3. Scope 5

4. Principles 7

5. Key priorities 9

i. Woman-centred care 9

ii. Culturally appropriate care 13

iii. Collaborative and coordinated care 15

iv. Access to home-based postnatal care 21

v. Sae and high-quality care 25

Appendix. Policy context 29

Reerences 33

Contents


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1

The postnatal period is dened as the period ater the delivery o the baby, usually the rst six weeks

ater birth (Commonwealth o Australia, 2011). Postnatal care may be provided in the acute and

community healthcare sectors or in the womans home.

Care may include routine clinical examination and observation o the woman and her baby, routine

baby screening to detect potential disorders, support or inant eeding, and ongoing provision o

inormation and support (Demott et al., 2006). Postnatal care may be provided by a number o health

proessionals, including registered midwives, registered and enrolled nurses, obstetricians, general

practitioners (GPs) and Aboriginal health workers.

Postnatal care begins immediately ater birth and the primary aims are to provide:

recuperationfromthebirthingprocess

breastfeedingeducationandsupport

parentingeducationandsupport

clinicalcaretopromotethephysicalandpsychologicalhealthandwellbeing

o the woman and her baby.

The Postnatal care program guidelines or Victorian health services (the guidelines) ocuses on the

immediate postnatal period o care in hospital and in the womans home. This period o time is

dependent on the individual needs o the woman, the womans geographical location and the health

service conguration.

The time that women spend in hospital ollowing childbirth has steadily declined. In 200910, theaverage length o stay or a public hospital birth episode was two days or an uncomplicated vaginal

birth and our days or a caesarean section without major complications (Department o Health,

2012). This refects improvements in acute care and the development o alternative and appropriate

care settings, including the womans home.

Whether the setting or care is the hospital or a womans home, the ocus should be on the most

appropriate care setting or each woman. As a result, the average length o hospital stay ollowing

childbirth may continue to decrease. Whether postnatal care is provided in hospital or in the

womans home, it is imperative that the care provided is o the highest standard and meets the

needs o the individual.

These guidelines outline the Victorian Governments expectations o public health services, including

Koori Maternity Services, in the delivery o postnatal care to ensure best quality care is provided to all

women and their babies.

1. Introduction


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The guidelines urther the aims outlined in the Victorian Health Priorities Framework 20122022,

in particular:

developingasystemthatisresponsivetopeoplesneeds

improvingeveryVictorianshealthstatusandexperiences

implementingcontinuousimprovementsandinnovation

increasingaccountabilityandtransparency.

The Department o Health has developed the guidelines in consultation with

the ollowing stakeholders:

MaternityandNewbornClinicalNetwork DepartmentofEducationandEarlyChildhoodDevelopment

associatedprofessionalgroups

representativesfrommetropolitan,ruralandregionalhealthservices.


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The guidelines provide direction to support continued reform of

all Victorian public health services responsible for the delivery of

maternity and newborn care, to ensure the needs of the community

are met now and into the future.

It is widely recognised that demand or maternity and newborn care is growing. The guidelines are

intended to assist health services to deliver improved health outcomes or the Victorian community.

Current service delivery and coordination are discussed to inorm health services and the health

service system o the actors that may impact on the delivery o postnatal care.The guidelines identiy key priority areas or improving maternity and newborn care and access

inVictoriaspublichospitals.Eachoftheprioritiesoutlineinitiativesalreadyunderwayandfurther

actions required into the uture.

The key objectives o the guidelines are to:

promotegoodpracticeinthedeliveryofpostnatalcaretowomenandtheirfamilies

identifytheresponsibilitiesofhealthservices,community-basedprovidersandwomen

improvecommunicationbetweenwomen,healthservicesandcommunity-basedproviders

improvecontinuityofcareforwomenacrossthefullrangeofmaternityservices

providescope,directionandauthorityforlocalpolicyandproceduredevelopment.

Public health services are responsible or ensuring compliance with the guidelines.

This includes putting processes in place to:

implementtheguidelines

identifyandprovideappropriateeducationandtrainingopportunitiestohealthservicestaff

who ull the roles and carry out the tasks required by the guidelines

regularlyreviewindividualhealthserviceperformance

validatetheaccuracyandintegrityofreporteddata.

Eachsectionoftheguidelinesincludesinformationtosupportimplementation.Healthservices

should view the sections collectively and, where appropriate, develop their own local policies and

procedures that comply with the guidelines.

2. Purpose


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The guidelines provide direction or all Victorian public health services that are responsible or the

delivery o maternity and newborn services. For the purpose o this document, public health service

reers to all public hospitals and denominational hospitals, public health services and multi-purpose

services established under the Health Services Act 1988.

The guidelines outline the Victorian Governments expectations o public health services in the

delivery o the immediate postnatal period o care in hospital and in the womans home. This period

o time is dependent on the individual needs o the woman, the womans geographical location and

the health service conguration. As the average length o hospital stay ollowing childbirth decreases,

health services should ensure appropriate services are provided to women in their home.

While the care provided by GPs, maternal and child health (MCH) services and other community-

based providers during the postnatal period is not included in the scope o the guidelines, the links

between these and public health services are important and are included in this document.

3. Scope


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The ollowing principles underpin the guidelines and are designed to enable delivery o best available,

evidence-based interventions to optimise the health o the woman and her baby

Postnatalcarewillbewoman-centredtoenablewomentoparticipateininformeddecision

making regarding their own care and the care o their baby.

Postnatalcarewillbeprovidedbyanappropriatelyqualiedmidwife,GPorMCHnurse,

supported by a multidisciplinary team.

Healthserviceswillfacilitatetimelyandequitableaccesstopostnatalcarewithwomenableto

access services as close to home as possible.

Postnatalcarewillbeculturallyappropriateandculturallysafe.

Postnatalcarewillberesponsivetotheoftencomplex,multifacetedneedsofwomenfrom

culturally and linguistically diverse (CALD) backgrounds.

Healthserviceswillworkinacollaborativeandcoordinatedwaywithotherhealthservicesand

community-based providers o maternity and newborn services to optimise womens experiences

and postnatal care outcomes.

Healthserviceswillensurewomenhavetimelyandconsistentaccesstoservicesacrossthe

continuum o care according to their needs.

Healthserviceswillpromotesafeandhigh-qualityoutcomesforwomenandtheirfamilies.

Healthserviceswillcollectandreportaccuratedataonwomensaccesstopostnatalcare.

4. Principles


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i. Woman-centred care

Many women report lower levels o satisaction with the care and support they receive during

the postnatal period than at any other phase o their maternity care (Forster et al., 2005). Feeling

listened to and well supported, and receiving timely and consistent inormation are important actors

contributing to womens satisaction with their postnatal care.

Providing inormation and education relating to the normal physiological changes associated with

childbirth, breasteeding and parenting is a key component o postnatal care that is aimed at giving

women and their amilies the condence to manage the care o their baby.

For a number o rst-time parents, the reality o caring or a baby can be overwhelming and oten

diers rom their expectations. The provision o timely and eective postnatal care and support can

have a signicant impact on the long-term health and wellbeing o women and their amilies.

Postnatal care should be delivered in the most appropriate setting, whether that is in hospital or in

the womans home. Irrespective o the postnatal care setting, it is imperative that the care provided is

o the highest standard and meets the needs o the individual.

Principles

Postnatal care will be woman-centred to enable women to participate in inormed decision making

regarding their own care and the care o their baby.

Postnatal care will be culturally appropriate and culturally sae.

Program guidelines

1. Health services should provide postnatal care that is woman-centred.

Woman-centred care ocuses on a womans unique needs, expectations and aspirations; recognises

her right to sel-determination in terms o choice, control and continuity o care; and addresses her

social, emotional, physical, psychological, spiritual and cultural needs and expectations (Australian

Nursing and Midwiery Council, 2006).

2. Postnatal care planning should commence as early as possible, preerably during the antenatal

care period.

3. Irrespective o the postnatal care setting, health services must ensure that care is woman-centred,

sae and o the highest quality.

4. Health services should plan or postnatal care in partnership with women and their amilies or

signicant others, as determined by the woman hersel.

5. Health services must provide women with timely, appropriate and consistent written inormation

and education to enable inormed decision making.

6. Health services must ensure that women have an individualised home-based postnatal care plan

prior to discharge rom hospital that provides inormation on the care they will receive.

7. Health services should provide breasteeding advice and support according to the Ten Steps

to Successul Breasteeding as specied in the Baby Friendly Health Initiative (World Health

Organization,UNICEF,2009).

5. Key priorities


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Implementation guidance

Inormation and education

Women should be given appropriate and consistent written and verbal inormation and education

relating to the postnatal period. This enables women to make inormed decisions regarding their

care and the care o their baby, and can increase womens condence and satisaction with the care

provided (Newburn & Bhavnani, 2010).

The inormation provided by health services should be given to women as early as possible,

preerably during the antenatal period. It should be easy to understand and communicated in

the womans primary language. Women should also be given the opportunity to discuss and askquestions about the inormation provided with a midwie and/or doctor.

The ollowing inormation should be provided and discussed with women to support decision making

regarding the provision o postnatal care and beyond:

thebirthexperience

psychologicalandsocialadjustmenttoparenthood(forexample,expectations,mood,self-care,

child saety, relationship with partner, contraception)

careofthebaby(forexample,feeding,bathing,handlingandsleep/settlingbabies)

maternalphysicaladjustments(forexample,fatigue,sleep,breastfeeding,breastandbody

changes, sexual health)

familyadjustments(forexample,careofthebaby,siblingsacceptanceofthebaby)

familyenvironment(forexample,housing,employment,safety)

socialsupportandlocalnetworks.

Where appropriate and determined by the woman, written inormation and education should be

provided to her amily and/or signicant others.

Planning

Planning or the postnatal period and beyond should be undertaken in partnership with women as

early as possible. Planning initiated during the antenatal care period can benet women and lead

to higher levels o satisaction with the care provided (Three Centres Consensus Guidelines on

Antenatal Care, 2001).

A written record o planning should be kept by both the woman (Victorian Maternity Record) and

the health service (patient record). The Victorian Maternity Record prompts health proessionals

to discuss planning or postnatal care, and includes a section to document the womans

preerences ater birth.


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At a minimum, a womans postnatal care plan should include inormation relating to:

thewomanspreferredlocationofcare

timingofcare

thewomansexpectationsofcare

contactdetailsofthehealthservicespostnatalcarecoordinatorormidwife

centralcontactdetailsofaMCHservice,closetothewomanshome,towhich

the birth notice has been sent

rolesandresponsibilitiesofboththewomanandthecareprovider(s).

Health services should ask women who they would like to be involved in planning or and deliveringcare throughout the postnatal care period, and where this care should be provided.

Breasteeding

Providing mothers with accurate inormation about the importance o breasteeding to the health

o their baby can result in changes in inant eeding decisions. Health promotion eorts should

emphasise the importance o breasteeding or normal growth and development, and the risks and

costs associated with premature weaning (Berry & Gribble, 2008).

The World Health Organization (WHO) recommends exclusive breasteeding or babies up to six

months o age, with breasteeding continuing alongside complementary oods or up to or beyond

two years o age, as this contributes to optimal physical growth and mental development (WHO,

UNICEF,2009).

There are a number o reasons why women are less likely to breasteed, including less amily

support or breasteeding, less ability to seek help with breasteeding problems, less fexibility with

working arrangements, and concerns about breasteeding in public. Women with lower measures

o education, income and occupational status; younger women; women who are overweight/obese

and women who are smokers are also less likely to breasteed (Amir & Donath, 2008).

According to the 2010Australian National Inant Feeding Survey(Australian Institute or Health

and Welare (AIHW), 2011), almost all Australian babies commence breasteeding but most do

not continue as long as recommended. Although 96 per cent o babies were initially introduced to

breastmilk, 61 per cent were exclusively breasted or less than one month and this progressively

decreased to 15 per cent at around six months o age (AIHW, 2011).

According to the AIHW survey, the main reasons why mothers gave their baby breastmilk were that it

was healthier or child, convenient or helps with mother-baby bonding. Wanting to share eeding

responsibilities with their partner and previously unsuccessul breasteeding experiences were the

two most common reasons or not breasteeding. Many women also elt that ormula was just as

good as breastmilk (AIHW, 2011).

The Baby Friendly Health Initiative(BFHI)developedbytheWHOandUNICEFsetsoutTenSteps

to Successul Breasteeding, which provide the global accreditation standards or health services

providingmaternityandnewborncare(WHO,UNICEF,2009).In200910,26publichospitalsin

Victoria were BFHI accredited (Victorian Government Department o Health, 2012).

TheAustralian national breasteeding strategy 20102015 recognises the biological, health, social,

cultural, environmental and economic importance o breasteeding and provides strategies to

promote breasteeding and complementary oods to 12 months o age and beyond (Commonwealth

o Australia, 2009a).


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Caesarean section

For women who have undergone a caesarean section, postnatal care is important to prevent and,

where necessary, treat inection and post-birth complications.

The rate o caesarean section is growing both in Victoria and nationally. This can be explained,

in part, by actors such as maternal age and medical conditions such as obesity, diabetes and

hypertension (Commonwealth o Australia, 2009b).

In 200809, the rate o caesarean section was 27.9 per cent o all deliveries in Victorian public

health services compared with 39.4 per cent in private hospitals. This rate increased in public health

services to 28.2 per cent in 200910 and 28.4 per cent in 201011. The WHO recommends a

caesarean section rate o 15 per cent (WHO, 1985).

Caesarean sections perormed ollowing an appropriate medical indication are potentially li e-saving

procedures. At the same time, in many settings, women are increasingly undergoing caesarean

sections without any medical indication (Souza et al., 2010).

The World Health Organization Global Survey on Maternal and Perinatal Health (WHOGS) provides

evidence on the relationship between mode o delivery and maternal and perinatal outcomes.

Findings indicate that an increase in rates o caesarean delivery is associated with increased use

o antibiotics postpartum, greater maternal morbidity and mortality, and higher etal and neonatal

morbidity, even ater adjustment or demographic characteristics, risk actors, general medical

and pregnancy associated complications, type and complexity o institution, and proportion o

reerrals (Villar et al., 2006). The need or evidence-based counselling about the risks and benets o

caesarean section or women and their babies is imperative (Boutsikou et al., 2011).

When compared with vaginal delivery, emergency and elective caesarean deliveries are associated

with a decreased rate o exclusive breasteeding. In general, separation o the mother and baby,

post procedure immobility and wound pain may attribute to some womens inability to breasteed

comortably (and thereore exclusively) ollowing a caesarean section (Bodner et al., 2011).

This emphasises the importance o appropriate breasteeding education and support or these

women in the immediate postpartum period.


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Women and their amilies should always be treated with compassion, respect and dignity. The views,

belies and values o the woman and her amily in relation to her care and that o her baby, should be

sought and respected at all times. The woman should be ully involved in the planning o postnatal

care so that care is fexible and tailored to meet her and her babys needs (Demott et al., 2006).

Cultural awareness is an appreciation o cultural, social and historical dierences. Cultural saety

builds on the concept o cultural awareness and is based on the basic human rights o respect,

dignity, empowerment, saety and autonomy (Phiri et al., 2010). Culturally appropriate and culturally

sae care recognises diversity and the dynamic nature o culture.

A culturally competent healthcare system will support eorts to increase the capacity o the system

to design, implement and evaluate culturally and linguistically competent services to address health

disparities among populations rom CALD backgrounds and to promote health and mental health

equity (Department o Health, 2011).

Principles

Postnatal care will be culturally appropriate and culturally sae.

Postnatal care will be woman-centred to enable women to participate in inormed decision making

regarding their own care and the care o their baby.

Postnatal care will be responsive to the oten complex, multiaceted needs o women rom

CALD backgrounds.

Health services will collect and report accurate data on womens access to postnatal care.

Program guidelines

1. To ensure equitable access, postnatal care must be:

culturallyappropriate;withreadilyobtainabletranslatedhealthinformation(forexample,telephone

interpreters, written material sensitive to diering cultures and levels o literacy)

culturallyresponsive;deliveredbyculturallycompetentstaffwithknowledgeofhealthissues

impacting upon dierent population sub-groups, experience in comprehensive assessment and

awareness o support services available or reerral.

2. Health services should ensure that registered midwives and other health proessionals providing

postnatal care are sensitive to the individual needs o women rom CALD backgrounds.

3. Health services should provide women rom linguistically diverse backgrounds with readily

obtainable, translated health inormation, including appropriate interpreting services (ace-to-ace

or telephone), during each postnatal care appointment including home-based visits.

4. Postnatal care must be appropriately coordinated, with good connection to support services and

streamlined processes or reerral.

5. Postnatal care should be innovative and fexible, to meet the complex, multiaceted needs o

women rom CALD backgrounds.

ii. Culturally appropriate care


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Cultural competence

Cultural competence requires an understanding and respect or a womans culture, and a

commitment to provide care that appropriately responds to her values, practices and belies.

For example, some Aboriginal and Torres Strait Islander women do not want a prolonged stay in

hospital ollowing the birth o their baby. Health services should ensure systems are strengthened

so that women who discharge early are appropriately supported in the postnatal period. In some

instances, this support may be best provided by an Aboriginal Community Controlled Health Service,

which has an established relationship with the woman.

Health services should provide regular and ongoing training to ensure cultural competency o all sta.

Health services should also embed cultural competence within their quality improvement ramework

to build organisational capacity.

Accountability

Health services will ensure comprehensive and consistent monitoring and management o maternal

and neonatal outcomes data to improve health service planning and delivery or women irrespective

o their cultural, linguistic and socioeconomic background.

This will include improved identication o Aboriginal or Torres Strait Islander status in key

administrative data sets by routinely asking and reporting whether either or both parents o the baby

are o Aboriginal or Torres Strait Islander descent.

Interpreting services

Health services should provide women with access to appropriate interpreting services (ace-to-ace

or telephone). It is the responsibility o health services to arrange an interpreter or required postnatal

care appointments, including home-based visits. This is necessary to ensure that inormation

provided is understood and to enable women and their amilies to ask questions and seek

additional advice.

The Department o Human Services language policyoutlines the requirements or providing access to

proessional interpreting and translating services in Victoria (Department o Human Services, 2005).


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The coordination o maternity and newborn services across the care continuum and throughout

the postnatal period is important to ensure that women and their amilies are able to access timely

and appropriate care that optimises their health and wellbeing and supports amily unctioning and

child development.

Public health services

The current system o maternity and newborn services in Victoria includes three hospitals with

tertiary services (plus a ourth tertiary service dedicated to neonatal and paediatric services) and

a range o metropolitan, large regional and local rural hospitals, providing primary and secondary

maternity care services, as outlined in the Capability ramework or Victorian maternity and newbornservices (Department o Health, 2010).

Victorian public health services are responsible or providing postnatal care to women both in

hospital and or the immediate period ollowing the womans discharge. This period o time is

dependent on the individual needs o the woman, the womans geographical location and the health

service conguration.

Maternal and child health services

It is a requirement under the Child Wellbeing and Saety Act 2005 (Oce o the Child Saety

Commissioner, 2005) that a birth notice is sent by health services to the appropriate local

government authority within 48 hours o the birth.

Localgovernment,inpartnershipwiththeDepartmentofEducationandEarlyChildhood

Development, is responsible or providing community-based MCH services. These services oer

support, inormation and advice regarding parenting and child health and development to amilies

with children up to six years o age.

Upon discharge rom hospital, women are reerred to their local MCH service. The MCH service is

required to contact women to oer and arrange a home visit. In most cases, a MCH nurse will visit

a woman within seven to 14 days o their discharge rom hospital.

Principles

Health services will work in a collaborative and coordinated way with other health services and



Health services will acilitate timely and equitable access to postnatal care with women able to


Health services will ensure women have timely and consistent access to services across the

continuum o care according to their needs.

Health services will promote sae and high-quality outcomes or women and their amilies.

iii. Collaborative and coordinated care


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Program guidelines

1. Health services must establish and maintain eective linkages with other health services and

community-based providers o maternity and newborn care to enable women to access

appropriately qualied and skilled health proessionals.

2. Health services must ensure MCH services are appropriately notied o inants and children that

are vulnerable, including those known to Child Protection, Placement and Family Services.

3. Health services must ensure MCH services are appropriately notied o women who are

vulnerable or disadvantaged or who have high needs. Health services must take measures to

ensure continuity o care, a seamless transition between services and that there is no gap incare provision.

4. Health services must clearly document the provision and outcomes o postnatal services in the

womans patient record and Child Health Record to ensure seamless reerral and transer o care.

5. The Child Health Record must provide the woman with suciently detailed inormation to take

with her to her rst MCH appointment.

6. Health services must reer women to other services, where appropriate, that will meet their

individual healthcare needs.

7. Health services must respect womens privacy. Health services must operate within the

parameters o the Health Records Act 2001 with regards to the management, release and

sharing o health inormation between health service providers.

8. Health services should work collaboratively with a womans lead maternity care provider(s) to

ensure early identication and management o physical, emotional, psychological and social

actors that may impact on the health and wellbeing o the woman or her amily during the

postnatal period and beyond.

9. Health services should provide comprehensive assessment and treatment o psychosocial

actors, where indicated, throughout the antenatal and postnatal periods. Health services will

provide support/onward reerral or mothers experiencing postnatal depression and other

health problems.

10. Women should be oered access to postnatal care, irrespective o Medicare or nancialstatus. Health services should notiy women who are ineligible or access to Medicare

subsidised healthcare.


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Collaborative and coordinated care

Health proessionals who may be involved in the provision o care during the postnatal period

include registered midwives, registered and enrolled nurses, obstetricians, paediatricians, GPs,

Aboriginal health workers, allied health proessionals and lactation consultants. Care may be

provided by an appropriately qualied midwie, GP or MCH nurse, and be supported by a number

o individual health proessionals orming part o a multidisciplinary team. Care may also include

team consultations.

Health services should promote continuity o care throughout the maternity care pathway and shouldthereore work collaboratively with a womans lead maternity care provider(s). Continuity o care has

been shown to lead to a woman-centred approach to care and consistency in the inormation and

support provided. As a result, women report higher levels o satisaction with their care and a greater

sense o control and saety during the postnatal period (Fereday et al., 2009).

Collaboration between health proessionals and organisations providing care to women and their

amilies during the postnatal period is necessary to acilitate timely access to care that meets

individual needs and expectations (Homer et al., 2009). Successul collaboration is based on the

ollowing elements:

sharedvisionandvalues

agreementandcommitmenttocommongoals soundgovernanceandleadership

recognitionandvaluingofhealthprofessionalsindividualrolesandresponsibilities

willingnesstosharerisks

effectivecommunication

mechanismstoshareinformation.

Assessment o womens health and wellbeing

There is an increasing awareness o the impact o psychosocial actors on the health and wellbeing

o women and their amilies, including the behaviour and cognitive development o children

(Williamson & McCutcheon, 2004).

Health services should ensure that there is a comprehensive assessment process in place

addressing the physical, emotional, psychological and social actors that may impact on the

health and wellbeing o women and their amilies during the postnatal period and beyond (NSW

Department o Health, 2009). The assessment process, where possible, should be initiated during

the antenatal care period and should be ongoing to ensure that new and emerging needs are

identied and managed in a timely manner. The outcomes o assessment should contribute to

planning or the postnatal care period.

Health services should work collaboratively with a womans lead maternity care provider(s) to ensure

early identication and management o physical, emotional, psychological and social actors that

may impact on her health and wellbeing during the postnatal period and beyond.


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Postnatal depression and anxiety

The incidence o clinically signicant symptoms o depression during the postnatal period is

estimated to range between 10 and 15 per cent (Commonwealth o Australia, 2009b). Postnatal

depression can start within one or several months o giving birth. About 40 per cent o women with

postnatal depression had symptoms that started in pregnancy (Matthey et al., 2004).

Risk actors or postnatal depression include a history o mental illness, recent lie stressors (or

example, bereavement, relationship issues) and past or current physical, sexual or psychological

abuse(NICE,2007).Depressionduringthepostpartumperiodisdistinguishedfrombabyblues

by duration and intensity o mood symptoms. Baby blues occurs in 80 per cent o women, with

symptoms resolving within 710 days o childbirth with minimal or no treatment (Pearlstein, 2008).

Recent studies examining anxiety across the antenatal and postnatal periods suggest that as many

as 30 per cent o women may experience signicant symptoms o anxiety (Britton, 2008).

Women with a previous history o a serious mental illness have an increased risk o developing

a recurrence o symptoms during pregnancy or ollowing childbirth. For example, a woman with

a history or amily history o bipolar aective disorder has an overall risk o recurrence o mood

symptoms during pregnancy o 71 per cent. Those who cease taking mood stabiliser medication

during pregnancy are at double the risk (Viguera et al., 2007).

Support vulnerable and at risk children

Health proessionals may encounter vulnerable children and amilies who are at risk o child abuseor neglect, or may witness abuse or neglect that has already occurred or children who are at risk o

signicant harm.

Under the Children Youth and Families Act 2005, some proessionals, such as medical practitioners,

nurses, police ocers and school teachers, are legally obliged to report suspected child abuse. In

addition, any person who believes on reasonable grounds that a child needs protection can make a

report to the Victorian Child Protection Service.

Health services providing postnatal care have a key role to play in the care and protection o

vulnerable children through early identication o child abuse and neglect. By working with

community services, Child Protection and the justice system, health services can contribute to

the provision o early intervention to help meet the needs o vulnerable babies, children and young

people at risk o harm.

The Department o Health has produced and distributed a best practice ramework, Vulnerable

babies, children and young people at risk o harm: Best practice ramework or acute health services

(Department o Health, 2006), that provides inormation and guidance or health services on issues

relating to children and young people at risk o abuse and neglect.

Health proessionals working together to keep children sae (Victorian Forensic Paediatric Medical

Service) is an online resource designed to assist health proessionals working in Victorian hospitals

and community settings to identiy vulnerable children; respond to situations where abuse or neglect

is suspected; and understand the child protection service system.


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Medicare ineligible patients

Medicare ineligible patients are individuals within Australia who are not eligible or Medicare and are

unable to receive ree public hospital services under the National Healthcare Agreement and the

National Health Reorm Agreement. Medicare ineligible patients are generally temporary entrants to

the country, including tourists, international students and temporary workers.

Medicare ineligible patients seeking treatment or maternity care can access treatment at a public

hospital as a private patient. Women seeking care should be encouraged to discuss the likely ees

with the hospital.

The National Health Reorm Agreement (COAG, 2011) allows states and territories to charge

Medicare ineligible patients or services provided by public hospitals. Current Department o Health

policy advises that ees or ineligible patients be set to achieve ull cost recovery. Health services

may charge Medicare ineligible patients at the ull cost recovery rate and manage debt processes to

ensure appropriate revenue is collected to recover costs.

Under current Department o Health policy, Medicare ineligible asylum seekers are classied as

public patients and hospitals are unable to charge these patients. Medicare ineligible asylum seekers

are provided with the ull medical care they require and health services are paid the relevant public

price by government or their treatment.

Patient consent and confdentiality

Health services should obtain a womans consent* or reerral and ensure that she has been givenadequate inormation regarding the nature o the reerral.

Health services must respect womens privacy and must operate within the parameters o the

Health Records Act 2001 with regards to the management, release and sharing o a patients health

inormation between health service providers.

Reerral guidelines

Women who would benet rom other specialist services (or example, physiotherapy, psychology,

lactation consultants) during the postnatal period and beyond should be reerred to an appropriate

service provider located as close as possible to the womans home.

* Consent may be express or implied. Signing a consent orm is one orm o express consent. Consent is implied rom a

persons actions, such as when rolling up a sleeve to receive a fu vaccine.


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A reerral or transer o a womans care to another health service or community-based service

provider should be written and should contain relevant and sucient inormation to appropriately

prioritise and manage a womans wait or services and her care at the rst appointment

(Department o Health unpub). The ollowing is suggested as the basic content that should

be included in a reerral:

thewomansdemographics(forexample,contactdetails,dateofbirth,andinformationabout

special needs)

referrerdetails

primarymaternitycareprovider(s)(forexample,GP,specialistobstetrician,registeredmidwife)

healthservicedischargesummaryincludingrelevanthistory,currentmedications,postnatalcareplan and reason or reerral

relevantinvestigationresults

priorityforcare,ifrelevant.

The Service Coordination Tool Templates (SCTT) (Department o Health, 2009) were developed

to acilitate and support service coordination. The SCTT support the collection and recording o

initial contact, needs identication, reerral and care planning inormation in a standardised way.

This can improve communication and inormation sharing to support better outcomes or women

and their amilies.

Record keeping

Health services should keep comprehensive written records o postnatal care, including a womans

consent or care. This is important to ensure consistency o inormation provided and timely transer

and ollow-up o care.

Guidance on the collection and storage o patient inormation is available rom the Public Records

Oce o Victoria (http://www.prov.vic.gov.au).


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Postnatal care, irrespective o setting, is ocused on the needs o the mother and supporting her to

care or her baby. Postnatal home-based care should be provided by a registered midwie rom the

birth hospital where possible, and supported by a number o individual health proessionals orming

part o a multidisciplinary team. However, home-based care may be transerred to the service o a

dierent hospital, a Koori Maternity Service, the Royal District Nursing Service or a private nursing

agency to better suit the individual needs o a woman, particularly when located closer to the

womans home.

Home-based models o postnatal care are becoming increasingly important in assisting women to

transition rom hospital to home, and or providing them with care and advice in the most appropriate

care setting or their needs. For many women, home can also be a more relaxed, convenient andprivate environment or recovery rom childbirth and or the establishment o breasteeding.

As a minimum requirement, ollowing discharge, public health services should oer women at least

one postnatal visit in her home. Additional home visits are provided on the basis o individual clinical

and psychosocial needs.

Principles

Health services will acilitate timely and equitable access to postnatal care with women able to


Health services will work in a collaborative and coordinated way with other health services and




Health services will collect and report accurate data on womens access to postnatal care.

Program guidelines

1. Health services providing intrapartum care must oer women home-based postnatal care prior to

their discharge home.

2. Health services will ensure the health and saety o all sta members providing home-based care,

in accordance with relevant legislation.

3. Following discharge home rom hospital, a suitably qualied health proessional, preerably

a registered midwie, should provide at least one postnatal home-based visit tailored to the

individual requirements o the woman. For many women, this visit will be required within

24 hours o discharge.

4. Health services must provide multiple postnatal home-based visits to women with identied

clinical and psychosocial needs during the immediate postnatal period o care. This includes local

health services that are sub-contracted to provide postnatal home-based care. The period o

time and the number o visits required is dependent on the individual needs o the woman, the

womans geographical location and the health service conguration.

iv. Access to home-based postnatal care


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5. Women who should be considered or multiple postnatal home visits include:

rst-timemothers

youngwomen,includingteenagers

womenwithoutasupportnetwork

AboriginalandTorresStraitIslanderwomen

womenwithadisability

womenwithsubstanceabuseissues

womenknowntochildprotection

womenwhoexperiencedbirthorpost-birthcomplications

womenexperiencingbreastfeedingdifculties

womenwhohavenotyetreceivedantenatalcare

womenwithpsychosocialissues.

6. Sub-contracted health services, including Aboriginal Community Controlled Health Organisations

with a Koori Maternity Service, are responsible or arranging appropriate remuneration with the

birthing hospital or any services provided.


Failure to be present at the time o visit

Health services should make reasonable attempts to contact women who are not present on the day

o an agreed postnatal home-based visit. At a minimum, health services should attempt to contact

the woman and her nominated GP to arrange another visit.

Women may choose to decline postnatal home-based care ollowing discharge home rom hospital.

Where care is declined, health services should document this in the womans patient record.

Health services should exercise discretion to avoid disadvantaging women in the case o hardship,

misunderstanding and other extenuating circumstances.

Access in rural and regional areas

Advances in inormation and communication technologies have improved access to healthcare

and advice or geographically dispersed individuals. Where a ace-to-ace home-based visit is not

possible, health services should consider alternative models o service delivery when providing

postnatal care to women in rural and regional areas. For example, providing women with the ability

to access support via telephone in conjunction with home-based visits has been shown to improve

breasteeding duration and exclusivity and decrease symptoms o postnatal depression (Dennis &

Kingston, 2008; Fereday et al., 2009).


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Sub-contracting service delivery

Health services may restrict service delivery to individuals residing within a geographical area. Health

services should, however, demonstrate fexibility to accommodate the exceptional needs o women

residing outside o this area.

Where health services determine that a woman lives outside o their easible geographical area, the

provision o postnatal home-based care should be sub-contracted to a local health service, private

provider or district nursing service. Sub-contracted health services, including Aboriginal Community

Controlled Health Organisations with a Koori Maternity Service, are responsible or arranging

appropriate remuneration with the birthing hospital or any services provided.

In some cases, sub-contracting o postnatal home-based care should be arranged to maintain

continuity o care and/or carer. Continuity o care reers to a consistent organisational structure

around which care is provided (or example, team based model o maternity care). Continuity o carer

reers to care provided by a primary midwie whom the woman has previously met and is amiliar

with (or example, caseload model o maternity care) (Homer et al., 2002).


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Health services should ensure women and their babies have access to sae, high-quality maternity

services. Whether postnatal care is provided in hospital or in the womans home, it is imperative that

the care provided is o the highest standard and meets the needs o the individual.

In addition to ensuring the health and saety o women accessing postnatal care, health services

should also consider the occupational health and saety o all health proessionals responsible or

providing postnatal care.

Principles


Health services will collect and report accurate data* on womens access to postnatal care.

Program guidelines

1. Health services must provide postnatal care within a sound quality and saety ramework.

2. Health services must promote evidence-based practices.

3. Health services must provide sta with access to regular and ongoing education and training that

supports their scope o practice.

4. Health services must collect and report data on womens access to postnatal care including

home-based care.

5. Health services must provide health proessionals delivering postnatal home-based care with

the necessary equipment and training to protect their own health and wellbeing and enable the

delivery o timely and appropriate care.

6. Health services must comply with accepted legislation, including the Occupational Health and

Saety Act 2004.

7. In determining appropriate care or women with co-morbid conditions, health services should

ensure appropriate physical and service delivery capabilities, including appropriate workorce

capability and risk management strategies.

Implementation guidancePolicies and procedures

Health services should have written policies and procedures that address occupational health and

saety considerations that could impact on health proessionals responsible or providing postnatal

care, including home-based visits (or example, driving in hazardous weather conditions, bushre

training and the use o a car as an emergency vehicle).

Health services should also have written protocols relating to the treatment o women and their

amilies during the postnatal care period.

v. Safe and high-quality care

* data elements specied under Perormance reporting


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Education and training

Health services should ensure that health proessionals employed to deliver postnatal care are

appropriately qualied and credentialled. A qualied and skilled workorce is imperative to the

provision o sae and high-quality postnatal care that refects current, evidence-based practices.

Health services should ensure that all health proessionals providing postnatal home-based care

have undertaken adequate training to make decisions regarding the saety o the environment in

which they are to provide care.

Perormance reporting

Health services should report annually against the Department o Healths maternity servicesperormance indicators (Department o Health, 2012). The perormance indicators relevant to

postnatal care are:

MaternityIndicator6Rateofwomenreferredtopostnataldomiciliarycareorhospital-in-the-

home in Victorian public hospitals

MaternityIndicator8NumberofWHOTenStepstoSuccessfulBreastfeedingachievedin

Victorian public hospitals

The ollowing three indicators are in development and will replace the current breasteeding support

indicator (Maternity Indicator 8):

MaternityIndicator8bBreastfeedinginitiationinVictorianpublichospitals

MaternityIndicator8cUseofinfantformulainVictorianpublichospitals

MaternityIndicator8dFinalfeedbeingtakenexclusivelyfromthebreastin

Victorian public hospitals

It is expected that all women will be reerred to postnatal home-based care or hospital in the home

(HITH). Women eligible or HITH must meet the criteria o the Victorian hospital admission policy

(Department o Health, 2011b).

Health services in scope to collect specialist (outpatient) clinic data through the Victorian Integrated

Non-Admitted Health (VINAH) data set should report this to the Department o Health as per

the specications (Victorian Government Health Data Standards and Systems). The VINAH data

collection was rolled out to outpatient clinics on 1 July 2011 or implementation rom 1 July 2012.

Risk actors associated with pregnancy

The most common pregnancy complications are obesity, hypertension, diabetes mellitus,

cardiovascular disease (CVD) and placental abnormalities (Segev et al., 2011). Uncontrolled

conditions such as gestational diabetes and chronic hypertension can increase the risk o maternal

and etal/neonatal complications.

Many women who need assisted reproductive technology because o inertility are older than the

average pregnant woman and the risks or chronic diseases such as obesity, diabetes mellitus,

chronic hypertension, CVD and malignancy greatly increase with maternal age.


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Women who are overweight or obese have increased risks o experiencing pregnancy complications

such as gestational diabetes, pregnancy-induced hypertension and wound inection. Overweight and

obese women are also at greater risk o giving birth to a preterm baby (less than

37 weeks) or low birth weight baby (less than 2500g) compared with women o normal weight range

(McDonald et al, 2010).

In recognition o the additional risks posed by actors such as obesity during the postnatal period,

specic measures o routine care may be required, such as weight management strategies.

Health services should work to strengthen systems or health protection, health promotion and

preventive healthcare, including appropriate assessment and management o women with risk

actors and their baby.

Occupational health and saety

Health services should have written policies and procedures that address occupational health and

saety considerations that could impact on health proessionals responsible or providing postnatal

care, including home-based visits (or example, driving in hazardous weather conditions, bushre

training and the use o a car as an emergency vehicle).

Specically, health services should ensure:

promotionofappropriatestandardsinoccupationalhealthandsafetyandwelfareandinjury

management

useofeffectivepreventionstrategiesandinjurymanagementpractices integrationofoccupationalhealthandsafetyacrossallaspectsofbusinessoperations,systems

o work and procedures (Department o Human Services, 2003).

The Occupational Health and Saety Act 2004 (OHS Act) highlights the principles that all employers

and employees should apply in building and maintaining sae workplaces.

WorkSae Victoria, a statutory authority o the Victorian State Government, works with employers

and employees to ensure the appropriate inormation, guidance and assistance is available to

support compliance with the OHS Act.

Working saely in visiting health services (WorkSae Victoria, 2011a) is a publication developed

or healthcare providers involved in the assessment and treatment o clients in their homes and

other community settings. The publication covers health and saety basics, with a ocus on

occupational violence and manual handling.

Home care occupational health and saety compliance kit(WorkSae Victoria, 2011b) describes

the seven most common hazardous tasks that cause workplace injuries in the home care sector.

It includes seven health and saety solutions to outline ways to control the risks associated with

these tasks.

Inormation includes measures or identiying hazards and risks, and implementing control measures

to eliminate, isolate or substitute the source o the risk. When a clients home is deemed to be

unsae, advice is provided or suspending visits or providing visits in a saer environment such as at a

local hospital outpatient clinic.


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There are a range o state and national policy rameworks that provide guidance to health services

on the principles underpinning maternity and newborn care including postnatal care.

Victorian context

Victorian Health Priorities Framework 20122022

In May 2011, the Victorian Government released the Victorian Health Priorities Framework

20122022, which provides the blueprint or planning and development o priorities or the

Victorian healthcare system or the coming decade.

The ramework is the basis or three supporting plans: the Metropolitan Health Plan, Rural andRegional Health Plan and Health Capital and Resources Plan.

The ramework establishes the key outcomes, attributes and improvement priorities or the Victorian

healthcare system across seven priority areas:

developingasystemthatisresponsivetopeoplesneeds

improvingeveryVictorianshealthstatusandexperiences

expandingservice,workforceandsystemcapacity

increasingthesystemsnancialsustainabilityandproductivity

implementingcontinuousimprovementsandinnovation

increasingaccountabilityandtransparency

utilisinge-healthandcommunicationstechnology.

Metropolitan Health Plan

The Victorian Government published the Metropolitan Health Plan in May 2011. The plan articulates

the long-term planning and development priorities or metropolitan Melbourne and statewide health

services throughout the next decade. It indicates that a Reugee Health and Wellbeing Plan will be

developed and available in 2012, which will increase the capacity o the healthcare system to design,

implement and evaluate culturally and linguistically competent services to address health disparities

among populations rom CALD backgrounds.

Rural and Regional Health Plan

The Victorian Government published the Rural and Regional Health Plan in December 2011.This plan will drive the development o key actions that will deliver services in rural and regional

Victoria that are more responsive to peoples needs and are rigorously inormed and inormative.

Health Capital and Resources Plan

The Health Capital and Resources Plan will be available in 2012 and will apply the overarching

Victorian Health Priorities Framework 20122022 to the specic context and challenges o rural

and regional Victoria.

Victorian Public Health and Wellbeing Plan 20112015

The Victorian Public Health and Wellbeing Plan aims to improve the health and wellbeing o all

Victorians by engaging communities in prevention, and by strengthening systems or health

protection, health promotion and preventive healthcare across all sectors and levels o government.

The plan is a companion document to Victorian Health Priorities Framework 20122022.

Appendix. Policy context


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Future directions or Victorias maternity services

Future directions or Victorias maternity services (2004) provides the policy ramework that sets the

direction or the provision o maternity care in Victoria. The policy refects the belie that birthing is a

normal process and, where possible, should be located close to the mothers home.

The principles underpinning the policy are:

Womenhaveinformedchoice,continuityandsafetyintheirpregnancy,birthingand

postnatal experiences.

Primarymaternitycareisthemostappropriatemodelofcareforthenormallifeevents

o pregnancy and birthing.

Accesstoappropriatespecialisedcarewhenrequiredisintegraltoprovidingsafe,

high-quality maternity care.

Acollaborative,multidisciplinaryteamapproachtotheprovisionofmaternitycarerequires

education, training and development.

Capability ramework or Victorian maternity and newborn services

The Capability ramework or Victorian maternity and newborn services (2011) delineates the role

o maternity and newborn services and denes the minimum standards required to deliver dierent

levels o care. There are six levels o care, which can be broadly grouped as:

Primarymaternitycareservices(levels1,2and3)providecaretowomenwithlow

or normal risk pregnancies and births.

Secondarymaternitycareservices(levels13,4and5)providecaretowomenwith

medium risk pregnancies and births with moderate complications.

Tertiarymaternitycareservices(levels15and6)providecaretowomenwithcomplex

pregnancies and births requiring neonatal intensive care.

Perinatal Emotional Health Program

In2010,theDepartmentofHealthestablishedthePerinatalEmotionalHealthProgramtoimprove

early identication and treatment o women at risk o or experiencing depression during the antenatal

and postnatal periods. The program currently employs 16 mental health nurses or equivalent across

rural and regional Victoria to provide clinical assessment and treatment in maternity services,

MCH services or in womens homes. A pilot o a similar program or metropolitan Melbourne isplanned or 2012.

Continuity o Care: A communication protocol or Victorian Public Maternity

Services and the Maternal and Child Health Service

Continuity o Care: A communication protocol or Victorian Public Maternity Services and the

Maternal and Child Health Service (2004) provides a ramework to support eective communication

between health services, MCH services and other services providing care to women and their

amilies. The ramework was developed through a partnership between the departments o

EducationandEarlyChildhoodDevelopment,HealthandHumanServices,andtheMunicipal

Association o Victoria.


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Programs to support vulnerable and disadvantaged women

In Victoria, a number o programs have been established to support vulnerable and disadvantaged

pregnant women and their amilies during the postnatal period. These include:

Healthy Mothers Healthy Babies program which supports access to appropriate services during

the antenatal and postnatal care period, and provides key health promotion messages to support

healthy behaviours in pregnancy and beyond. The program is available to women up to six weeks

post-childbirth.

KooriMaternityServicesprovideculturallyappropriatematernitycareandsupporttoAboriginal

and Torres Strait Islander women with the principle ocus o increasing access to antenatal

care and postnatal support, and liaising with public maternity services. There are currently 11

Aboriginal community controlled health organisations providing the service.

EnhancedMCHServicerespondstotheneedsofchildrenandfamiliesatriskofpooroutcomes.

The service provides a more intense level o support than the universal MCH service to amilies

with one or more risk actors, including drug and alcohol issues, mental health issues, amily

violence issues, homelessness and low income, socially isolated and single-parent amilies

(DepartmentofEducationandEarlyChildhoodDevelopment,2011).

Care o the obese pregnant woman and weight management in pregnancy

clinical guideline

Care o the obese pregnant woman and weight management in pregnancyclinical guideline aims

to promote and acilitate standardisation and consistency in practice in the care o obese women in

pregnancy. The guidelines recognise the:

potentialcomplicationsassociatedwithobesityinpregnancy

importanceofappropriateweightmanagementinpregnancy

needforconsistencyofpracticeinmanagingobesityinpregnancy

needforappropriateworkforceandworkplacecapabilitytomanageobesityinpregnancy.

National context

National Maternity Services Plan

The National maternity services plan (2010) recognises the importance o maternity serviceswithin the health service system and provides a strategic national ramework to guide policy and

program development across Australia over the next ve years. The plan is underpinned by the

ollowing principles:

Maternitycareplacesthewomanatthecentreofherowncare.Suchcareiscoordinated

according to the womans needs, including her cultural, emotional, psychosocial and clinical

needs close to where they live.

Maternitycareenablesallwomenandtheirfamiliestomakeinformedandtimelychoicesin

accordance with their individual needs. The planning and provision o maternity care is inormed

by women and their amilies.

WomenandfamiliesinruralandremoteAustraliahaveimprovedandsustainableaccessto

high-quality, sae, evidence-based maternity care which incorporates access to appropriate

medical care i complications arise.


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GovernmentsandhealthservicesworktoreducethehealthinequalitiesfacedbyAboriginaland

Torres Strait Islander mothers and babies or other disadvantaged populations.

Maternityservicesoffercontinuityofcareacrossthepregnancyandbirthingcontinuumasakey

element o quality maternity care or all women and their babies.

Maternitycarewillbeprovidedforallwomenandtheirbabieswithinawellnessparadigm,utilising

primary healthcare principles whilst recognising the need to respond to emerging complications in

an appropriate manner.

Thepotentialofmaternityhealthprofessionalsismaximisedtoenablethefullscopeoftheir

specic knowledge, skills and attributes to contribute to womens maternity care.

Maternityservicesprovidehigh-quality,safe,evidence-basedmaternitycarewithinanexpandedrange o sustainable maternity care models.

Maternityservicesarestaffedbyanappropriatelytrainedandqualiedmaternityworkforce

sucient to sustain contemporary evidence-based maternity care.

Maternityservicesoperatewithinanationalsystemformonitoringperformanceandoutcomes

and guiding quality improvement.

Australian National Breasteeding Strategy

TheAustralian national breasteeding strategy 20102015 (2009) recognises the biological, health,

social, cultural, environmental and economic importance o breasteeding and provides a ramework

o priorities or Australian governments at all levels to protect, promote, support and monitor

breasteeding. The objective o the strategy is to increase the percentage o babies who are ullybreasted rom birth to six months o age, with continued breasteeding and complementary oods to

12 months o age and beyond.

National Perinatal Depression Initiative

The National Perinatal Depression Initiative aims to improve prevention, early detection and treatment

o antenatal and postnatal depression. The initiative provides routine and universal screening or

depression or women during the perinatal period; ollow-up treatment and support or women who

are at risk o or experience perinatal depression; training and development o health proessionals

to assist them in screening and identiying women at risk o experiencing perinatal depression;

and research and data collection into prevention activities and the provision o services to meet

womens needs.As part o this initiative, the National Health and Medical Research Council Clinical practice guidelines

or depression and related disorders anxiety, bipolar disorder and puerperal psychosis in the

perinatal period(2011) were developed by beyondblue to assist health proessionals working in

primary and maternity care to identiy and treat mental health problems in the perinatal period.


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Amir LH & Donath SM 2008, Socioeconomic status and rates o breasteeding in Australia:

evidence rom three recent national health surveys, Med J Aust, 189(5) pp. 254-56.

Australian Institute o Health and Welare (AIHW) 2011,2010 Australian national inant eeding

survey: indicator results.Cat.no.PHE156.AIHW,Canberra

Australian Nursing and Midwiery Council 2006, National Competency Standards or the Midwie,

Berry NJ & Gribble KD 2008, Breast is no longer best: promoting normal inant eeding, Maternal

and Child Nutrition, 4, pp. 7479.

Bodner K, Wierrani F, Grnberger W & Bodner-Adler B 2011, Infuence o the mode o delivery onmaternal and neonatal outcomes: a comparison between elective cesarean section and planned

vaginal delivery in a low-risk obstetric population,Arch Gynecol Obstet, 283, pp.11931198.

Boutsikou T & Malamitsi-Puchner A 2011, Caesarean section: impact on mother and child,

Acta Paediatrica, 100(12), pp.151822.

Britton J 2008, Maternal anxiety: Course and antecedents during the early postpartum period

Depression and Anxiety, 25, pp.793-99.

Child Wellbeing and Saety Act year? .

Children, Youth and Families Act 2005, Act No. 96/2005 .

Commonwealth o Australia 2009a, on behal o the Australian Health Ministers Conerence

Australian National Breasteeding Strategy 20102015

Commonwealth o Australia 2009b, Improving maternity services in Australia: The report o

the Maternity Services Review

Commonwealth o Australia 2011, on behal o the Australian Health Ministers Conerence

National Maternity Services Plan,

Council o Australian Governments 2011, National Health Reorm Agreement, .

DemottK,BickD,NormanR,RitchieG,TurnbullN,AdamsC,BarryC,ByromS,EllimanD,

Marchant S, Mccandlish R, Mellows H, Neale C, Parkar M, Tait P & Taylor C 2006, Clinical guidelines

and evidence review or post natal care: routine post natal care o recently delivered women

and their babies, National Collaborating Centre or Primary Care and Royal College o General

Practitioners, London.

Dennis CL & Kingston D 2008 A systematic review o telephone support or women during

pregnancy and the early postpartum period, Journal o Obstetric, Gynaecologic and Neonatal

Nursing, 37(3), pp. 301-314.

DepartmentofEducationandEarlyChildhoodDevelopment2011,Maternal and Child HealthService guidelines, State Government o Victoria, Melbourne. .

References


33/36

34

Department Health (unpublished) Victorian public hospitals specialist clinics:

Access Policy, Melbourne.

Department o Health 2006, Vulnerable babies, children and young people at risk o harm: Best

practice ramework or acute health services, State Government o Victoria, Melbourne. .

Department o Health 2009, Service Coordination Tool Templates & Victorian Statewide Reerral

Form, State Government o Victoria, Melbourne.

Department o Health 2010, Capability ramework or Victorian maternity and newborn services,State Government o Victoria, Melbourne. .

Department o Health 2012, Victorian maternity services perormance indicators: complete set or

200910 , State Government o Victoria, Melbourne.

Department o Health 2011a, Victorian Health Priorities Framework 20122022: Metropolitan Health

Plan, State Government o Victoria, Melbourne. .

Department o Health 2011b, Victorian hospital admission policy, State Government o Victoria,

Melbourne. .

Department o Human Services 2003, Occupational health and saety management ramework

model, Department o Human Services Public Hospital Sector, State Government o Victoria,

Melbourne.

Department o Human Services 2005, Language services policy, State Government o Victoria,

Melbourne, .

Fereday J, Collins C, Turnbull D, Pincombe J & Oster C 2009, An evaluation o midwiery group

practice, Part II: womens satisaction, Women and Birth, 22, pp. 11-16.

Forster D, McLachlan H, Yelland J, Rayner J & Lumley J 2005,A review o in-hospital postnatal care

in Victoria, La Trobe University, Melbourne.

Health Records Act 2001, Act No. 2/2001, .

Health Services Act 1988

Homer CS, Davis GK, Cooke M & Barclay LM 2002, Womens experiences o continuity o midwiery

care in a randomised controlled trial in Australia, Midwiery, 18, pp. 102-112.

Homer CS, Henry K, Schmied V, Kemp L, Leap N & Briggs C. 2009, It looks good on paper:

Transitions o care between midwives and child and amily health nurses in New South Wales,

Women and Birth, 22, pp. 64-72.

Matthey S, Phillips J, White T, Glossop P, Hopper U, Panasetis P, Petridis A, Larkin M & Barnett B

2004, Routine psychosocial assessment o women in the antenatal period: requency o risk actorsand implication or clinical services,Archives o Womens Mental Health 7, pp. 223-229.


34/36

35

McDonald SD, Han Z, Mulla S & Beyene J 2010, Overweight and obesity in mothers and risk o

preterm birth and low birth weight inants: systematic review and meta-analyses, British Medical

Journal; 341: c3428 DOI: 10.1136/bmj.c3428.

Newburn M & Bhavnani V 2010, Let to your own devices: The postnatal care experience o 1260

frst-time mothers, NCT, London.

NICE2007,Antenatal and Postnatal Mental Health: The NICE Guideline on Clinical Management and

Service Guidance, The British Psychological Society & The Royal College o Psychiatrists, Leicester.

NSW Department o Health 2009, Maternal and Child Health Primary Health Care Policy.

NSW Department o Health, Sydney. .

Pearlstein T 2008, Perinatal depression: treatment options and dilemmas,Journal o Psychiatry

Neuroscience 33(4), pp. 302-18.

PhiriJ,DietschE&BonnerA2010,CulturalsafetyanditsimportanceforAustralianmidwifery

practice, Collegian, 17(3), pp. 105111.

Segev Y, Riskin-Mashiah S, Lavie O & Auslender R (2011) Assisted reproductive technologies:

medical saety issues in the older woman, Journal o Womens Health; 20(6), pp. 853-61.

Souza JP, Glmezoglu AM, Lumbiganon P, Laopaiboon M, Carroli G, Fawole B, Ruyan P & the WHO

Global Survey on Maternal and Perinatal Health Research Group 2010, Caesarean section without

medical indications is associated with an increased risk o adverse shortterm maternal outcomes:

the 2004-2008 WHO Global Survey on Maternal and Perinatal Health, BMC Medicine, 8, p. 71.

Three Centres Consensus Guidelines on Antenatal Care 2001, Low risk pregnancy guidelines:

discharge planning during antenatal visits, .

Victorian Forensic Paediatric Medical Service, Health proessionals working together to keep children

sae online module, .

Victorian Government Health Data Standards and Systems .

Victorian Government Public Record Oce .

Viguera AC, Whiteld T, Baldessarini RJ, Newport DJ, Stowe Z, Reminick A, Zurick A & Cohen LS

2007, Risk o recurrence in women with bipolar disorder during pregnancy: prospective study o

mood stabilizer discontinuation, Am J Psychiatry164(12), pp.1817-24.

Villar J et al 2006, Caesarean delivery rates and pregnancy outcomes: the 2005 WHO global survey

on maternal and perinatal health in Latin America, Lancet, 367, pp. 181929.

Williamson V & McCutcheon H 2004, Postnatal depression: A review o current literature, Australian

Midwiery Journal o the Australian College o Midwives, 17(4), pp. 1-16.

WorkSae Victoria (2011a) Working saely in visiting health services, State Government o Victoria,

Melbourne. .


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36

WorkSae Victoria (2011b) Home care occupational health and saety compliance kit, State

Government o Victoria, Melbourne. .

World Health Organization 1985, Appropriate technology or birth, Lancet, 2, pp. 43637.

WorldHealthOrganizationandUNICEF2009,BabyFriendlyHospitalInitiative


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