Maternity

The maternity section of our website is here to provide accurate and evidence based information to support you and your whanau to make the best informed decisions for you, during your pregnancy, birth, and postnatal period. There is an overwhelming amount of information available and advice given to pregnant people and this can be hard to navigate. Our aim is to provide you links to good quality information to help support your decision making.

Maternity care is free for New Zealand Residents and some other visa holders. Check your eligibility for funded maternity care at this website.

 

When you are pregnant

A pregnancy test is the best way to confirm if you are pregnant or not. A pregnancy test can be purchased from a pharmacy or done by a midwife, nurse or GP (doctor), at home or in a clinic, or at family planning.

Finding out you are pregnant can be an emotional experience. You may be joyful, excited, overwhelmed, anxious, nervous, or any other feelings you have.

 

Supplements

The Ministry of Health recommends taking iodine and folic acid supplements to avoid neurodevelopmental problems in babies. It is recommended that women take iodine for the duration of pregnancy and breastfeeding. It is also recommended that folic acid is taken 4 weeks prior to conception through to 12 weeks into pregnancy. Both folic acid and iodine are available on prescription from your midwife or doctor. Taking any supplements during pregnancy is your choice. Currently there is no known adverse effects from taking folic acid or iodine at the recommended quantities. Taking excessive iodine has been linked to thyroid problems and taking excessive folic acid can mask vitamin B12 deficiencies.

 

What if I do not want to be pregnant?

If you have a positive pregnancy test, but do not wish to be pregnant or to parent a child, then you have two choices: a termination of pregnancy (also called an abortion) or to put the baby up for adoption. Click here to find information on adoption, or visit the abortion section of our website to learn more about terminating pregnancy.

 

Miscarriage

Losing your baby prior to 20 weeks of pregnancy is called a miscarriage.

If you experience:

➜ cramping
➜ bleeding
➜ feeling faint
➜ strong period-type pain

Contact your Lead Maternity Caregiver (LMC) straight away or make an appointment to see a GP as soon as possible.

If it is confirmed you are having a miscarriage or you have an ultrasound scan that confirms no foetal heartbeat, then your pregnancy will no longer continue. Support and further information on miscarriage can be found through Miscarriage Support.

 

Finding a lead maternity caregiver

A Lead Maternity Carer (LMC) provides your maternity care, including providing care for you and your baby during pregnancy, attending your birth, and monitoring & supporting you and your baby up to 6 weeks after the birth. An LMC can be a midwife, GP, or obstetrician. In New Zealand it is free for eligible women to have a midwife or doctor (GP) as an LMC. You have to pay if you choose a private obstetrician. If you develop obstetric complications during or after pregnancy, care from an obstetrician is free for eligible women.

Most people in New Zealand choose a midwife as their LMC. Alternatively, some hospitals also provide a community midwifery service. You also have the option of visiting a private obstetrician. 

Many GPs have discontinued maternity care and no new GPs are providing an LMC service. This means it is difficult to find a GP to be your LMC. However, your GP will remain available for you throughout your pregnancy for non-pregnancy related problems.

MAMA Maternity provide a list of questions to ask a potential LMC. Research has shown that the earlier you book with an LMC, the better outcomes you are likely to have during your pregnancy and birth. Ideally you should book prior to being 12 weeks pregnant.

 

Pregnancy and parenting education

Some Childbirth Education classes are free for pregnant people in New Zealand, however some free classes charge an administration fee. There are also private classes which you pay for.

Antenatal and childbirth education: most DHBs (District Health Boards) provide free classes for first time parents. Tapuaki offer classes for Pacific families. Otherwise, Plunket, MAMA Maternity, Birthcare, and the Parents Centre offer classes.

Birth preparation:  try Hypnobirth or Calmbirth

Parenting education: SPACE Trust, Plunket, Oranga Tamariki and the Parents Centre all offer parenting classes.

 

Maternal mental health and wellbeing

The transition into parenthood, including pregnancy, birth, and the early weeks is a huge adjustment to make to your life and for some people it can have an impact on their mental wellbeing. Any anxiety or depression, as well as other mental health conditions that occur from the onset of pregnancy until the baby is one year old come under the umbrella of Maternal Mental Health. The highest rate of maternal death in New Zealand is caused by suicide. It is important you seek the help and support you need if you have any concerns about yourself or someone you know.

The Baby Blues, or overwhelming feelings in the first 1-2 weeks after you have a baby are very common and very normal. Conditions included in the term ‘maternal mental health’ are: Anxiety, Depression, Post Traumatic Stress Disorder, Bipolar, and Psychosis.

 

Where can I get help?

The Ministry of Health have a list of helplines you can call to get further information and support. Alternatively, this website has good information about symptoms and what to look for. It has contact details for support groups and places you can access help in different areas throughout New Zealand. Additionally, the Mothers Matter website has up to date information about a variety of maternal mental health conditions, as well as resources to help you, and contacts of local organisations where you can seek support.

 

 

Pregnancy

 

During your maternity care you are protected by the HDC Code of Rights for consumers of health services in New Zealand. Further information on the code can be found here.  You can expect a high standard of safe, evidence-based care throughout your pregnancy, labour & birth, and postnatal period, by all health professionals involved in your care. You are allowed to ask questions, request more information, have a support person with you, and decline any test, screen, intervention, or procedure you do not wish to have done. You can also request another health practitioner to take over your care at any stage, including changing your midwife, and you can seek a second (or third/fourth/etc) opinion if you are not happy with the information you have been provided.

 

Screening

First trimester screening

You will be offered a variety of screening and blood tests during the first trimester (14 weeks) of pregnancy. Further information about these can be found here.

First Trimester Combined Screening (FTCS) involves two screening tests. A maternal serum screening test (a blood test) is taken between 9 weeks and 13 weeks 6 days of pregnancy which detects chemicals in the mother’s blood, followed by a nuchal translucency (NT) scan between 11 weeks and 13 weeks 6 days of pregnancy. The results of both tests are used in combination to estimate the risk of a congenital abnormality (an abnormality which a baby is born with) such as Down Syndrome, Patau Syndrome, Edwards Syndrome and some other rare abnormalities. Your LMC can give you more information about the conditions which are screened for with first trimester screening and there is further information here.

 

Non-invasive prenatal testing

Non-Invasive Prenatal Testing (NIPT) is a highly specific blood test that screens for Trisomy 21 (Down Syndrome), Trisomy 18 (Edward Syndrome), and Trisomy 13 (Patau Syndrome) in a single maternal blood test performed from the 10th week of pregnancy. The NIPT test has a >99% for Trisomy 21 & Trisomy 18 and >85% for Trisomy 13. Just as with the first trimester combined screening a low risk result does not completely exclude chromosomal abnormalities. NIPT is not funded in New Zealand, women have to pay for the test themselves. There is more information on NIPT here.

 

Second trimester screening

Ultrasound scans between 18 – 20 weeks of pregnancy are most often used to confirm the number of foetuses and the due date, to check the fluid levels around the baby, check for normal foetal growth, to look for foetal malformations such as cleft palate, and to locate the placenta. Second trimester ultrasound scanning may also be used to screen for spina bifida and some heart conditions. The likelihood of detecting abnormalities during second trimester screening depends on many factors. The quality of the scanning machine, the expertise of the person performing the scan, the duration of the scan, the position of the foetus and the woman’s body size can all affect the likelihood of detecting an abnormality. Estimates for detection rates can range from 13-85%

Some of the first trimester tests are still available during the second trimester. This link has more information on second trimester screening.

 

Staying well during pregnancy

Here is some information on keeping you and your baby well during pregnancy, as well as some helpful tips for you & your partner/whanau.

Smokefree: it is important to consider stopping smoking or at least cutting back during pregnancy and when your baby is born. You can call Quitline on 0800 778 778 or visit Quit.org to get help with this. Your LMC can prescribed you smoking cessation products such as patches or lozenges, as well as providing you with emotional support. There is more information on quitting smoking in pregnancy here.

Exercise: before exercising during pregnancy it is important to talk with your midwife or LMC. Exercising during pregnancy is important for your wellbeing and will help keep you fit & healthy. There is information on pregnancy & exercise here.

Eating well: The Ministry of Health produce a comprehensive guide on unsafe foods and healthy eating for pregnancy. Ask your midwife for a copy or view it online here.

 

Danger signs in pregnancy

If you have any concerns during your pregnancy or postnatal period it is important you call your midwife or LMC as soon as possible. Do not use text messages to communicate concerns with your midwife.

It is important to be aware of your baby’s movements, especially after 20 weeks. This clip explains baby movements and here is more information on baby movements.

Things to be concerned about during pregnancy:

➜ any vaginal bleeding
➜ vaginal discharge that is dark coloured or green tinged, thick, smelly, lumpy
➜ if your waters break and a green or brown tinged or coloured
➜  reduction in baby’s movements
➜ sudden swelling or puffiness
➜ severe frontal headache or headache that lasts longer than an hour
➜ changes in your vision such as blurred or double vision or spots or flashing lights
➜ painful or burning urine
➜ if you develop a fever (over 37.5)
➜ you have severe itchy skin all over
➜ you have a fall or injury especially around your abdomen
➜ you feel sick and are throwing up after the first trimester

 

Complications during pregnancy

Pre-eclampsia

Pre-eclampsia is a pregnancy complication that can be very dangerous for you and your baby. It is important to know the signs of pre-eclampsia. Let your midwife or LMC know straight away if you experience any of the following:

➜  headache
➜  blurred vision or seeing flashing lights
➜  feeling unusually unwell
➜  sudden hands or face swelling
➜  upper abdominal pain
➜  baby moving less

More information on pre-eclampsia can be found here.

 

Gestational Diabetes

Diabetes in pregnancy is called Gestational Diabetes Mellitus or GDM. It is diagnosed through urine and blood tests and needs specialist input during your pregnancy. Diabetes screening is offered as part of the first antenatal blood test and again around 24-28 weeks. Each time you visit your midwife you will be invited to do a urine test for sugar in your urine. There is more information on diabetes in pregnancy testing here. It is your choice if you undertake Gestational Diabetes Screening during pregnancy.

For more information on GDM and other forms of diabetes you can follow this link, and this document may help answer some questions if you are diagnosed with GDM.

 

Advanced maternal age

Women who are over 35 years of age during pregnancy are considered to have Advanced Maternal Age (or AMA). AMA has been associated with adverse pregnancy outcomes including an increase rate of stillbirth, and this risk goes up for women over 40 years. However, the rate of stillbirth for New Zealand women over age 40 remains very low at 3.4/1000 births and can be modified by parity (number of previous pregnancies) and general health. Latest guidelines recommend that for women 35-39 years, age alone is not an indication for early induction of labour, but further assessment of the baby’s wellbeing (CTG, ultrasound scan) can be done from 40 weeks if you choose. For women over 40 years of age an induction of labour may be offered from 40 weeks gestation. It is your choice what monitoring of your baby you choose to have and at what stage an induction is considered, this decision should be made in consultation with your LMC.

A link to the Auckland region guidelines can be found here, and a link to the latest research on AMA in NZ can be found here.

 

Stillbirth

A baby born not living after 20 weeks of pregnancy is called a stillbirth and about 1 in every 200 pregnancies in Aotearoa ends in a stillbirth. Losing a baby is a very sad and challenging thing to go through and you may have a variety of emotions. It is important to get the help and support you need if you go through a stillbirth. Information about stillbirth and support can be found here and your LMC should offer you ongoing support. It is important to talk to your midwife or doctor about your feelings and how you are coping with the loss of your baby.

 

Birth

 

Place of birth

It is your choice where you give birth to your baby. In New Zealand you can choose a homebirth, a primary birthing unit, small maternity hospital, or secondary/tertiary hospital. Your LMC may not work in all of these locations, so it is important to discuss your place of birth options with your LMC and find an LMC that will meet your needs and support you to give birth where you would prefer to be. The Ministry of Health provides further information on choosing where to give birth. Research has shown that for low-risk women birthing at home or at a primary birthing unit, with midwives providing care, is the safest option with the lowest intervention rates. You can access further information on homebirth here.

The Ministry of Health publish Maternity Clinical Indicators annually which compare birth & intervention statistics across DHBs and Hospitals throughout New Zealand. You can use this to help with your decision making on where to give birth.

 

Induction

Induction of labour is a medical intervention used to start labour artificially. It is used when there is a risk to the baby or mother by pregnancy continuing. There are significant risks to an induction of labour and these should be discussed with your LMC and any other person involved in your care. There is more information about induction of labour in this document.

Reasons for induction can include: Being overdue (10 days past the due date – close to 42 weeks), gestational diabetes, pre-eclampsia, waters breaking and labour not starting, baby not growing well. Some babies/mothers are less at risk than others and so your individual situation needs to be considered, prior to an induction being started.

NICE although UK based, also has good information for consumers about induction of labour. MSCC produce a resource for consumers with further information on induction of labour.

 

Cesarean birth

A caesarean section (c-section) is when the baby is delivered through a cut (incision) in the abdomen & uterus. It is a surgical procedure and is most commonly used in emergency situations to deliver the baby as quickly as possible. A c-section that occurs after labour has begun and is not planned is called an emergency caesarean. A c-section that is planned in advance and occurs prior to labour beginning is called an elective caesarean. In most cases a caesarean is carried out with an epidural or spinal block, where you are numbed from the waist down, and a support person can attend in theatre with you. In rare but very urgent emergencies a general anaesthetic (where you are put to sleep) is used and only a midwife can remain with you for support.

As a caesarean is abdominal surgery, there can be some complications during and afterwards. It is important to have a thorough discussion with your care providers prior to having a c-section. Complications can include:

➜ heavy bleeding and/or haemorrhage during or after surgery
➜ infection in or around your wound
➜ developing blood clots in your legs (deep vein thrombosis)
➜ bladder and/or bowel injury (very rare)
➜ as well as adhesions, nerve or artery damage, and more minor complications

Caesarean rates around New Zealand vary from around 15-40% and are influenced by hospital policy and culture as well as obstetric complications and decision making as well as women’s choice. The recovery after a c-section can take around six weeks and women often need additional support afterwards. You should avoid driving and heavy lifting in the weeks after a caesarean.

This clip explains some of the ways a c-section can be ‘normalised’ especially in an elective or pre-planned situation.

Vaginal swabbing is a relatively new idea that is yet to be backed up by any large scientific studies. The theory is based on more recent knowledge around the significance of gut bacteria on long term health and the importance of bacteria from the vagina during birth in colonising the babies gut. This clip explains this in more detail.

For some women breastfeeding can be delayed and have a slower start than with a vaginal birth. Skin-to-skin immediately in theatre can help as well as not being separated from your baby. Most babies will be ready for their first breastfeed within one hour after birth. There is more information on breastfeeding after a cesarean here.

 

Vaginal birth after cesarean (VBAC)

A VBAC is when you have a vaginal birth after having a previous caesarean birth. Most women who have had one previous c-section are safely able to have a vaginal birth in subsequent pregnancies. There is a slight increase in the risk of uterine rupture (6.2 per 1000 trial of labour) with a VBAC but they are still considered safe.

VBAC is not considered the safest option when:
➜ previous c-section has a classical incision (vertical on the abdomen rather than horizontal)
➜ previous uterine rupture
➜ three previous c-sections
➜ morbid maternal obesity

If you are planning to have a VBAC it is advised you give birth in hospital, however some midwives will provide labour & birth care at home. All hospitals have a VBAC policy which will include interventions such as continuous fetal monitoring and IV leur insertion. It is your choice where you give birth and what interventions you accept.

 

Third stage

The third stage of labour is the time from the birth of your baby until the birth of the placenta/whenua. The birth of the placenta/whenua can happen in two ways: Physiological: Your body is left to naturally birth the placenta which is assisted through hormones your body makes during labour and birth. This is a safe option for women who have no complications and have a normal birth. Active Management: The birth of the placenta/whenua is managed by the midwife or doctor present at the birth of your baby and involves artificial hormones (syntocinon or syntometerine) being injected into your body to ensure the rapid delivery of the placenta/whenua. This is used for women with risk factors or when there have been birth interventions. The aim with an actively managed third stage is to prevent post-partum haemorrhage. Women’s Health Action produce a decision making guide which can be ordered from our website which has further information about your choices for third stage management.

 

Delayed cord clamping

The World Health Organisation (WHO) recommends that active management with delayed cord-clamping should be standard practice. A 2008 review on the effect of umbilical cord-clamping for both the baby and the birthing woman recommends that “regardless of third stage of labour ‘management type’, the cord should not be clamped and cut until after pulsation has ceased”.

Research has found that delaying clamping of the cord until it stops pulsating (about 2 – 3 minutes) reduces the risk of anemia (iron deficiency) in the newborn. Advantages of delayed cord-clamping include:
➜ the extra blood volume which occurs when clamping is delayed helps your baby’s lungs to expand and supports your baby to make the necessary adaptions to life outside the womb.
➜ reduces the risk of iron deficiency (anemia) in the newborn.
➜ increased red cell volume. Red cells carry oxygen around the body and contain antibodies for a healthy immune system.
➜ a greater supply of stem cells to your baby which end up in your baby’s bone marrow and support new growth and healing.
➜ reduces the chance of your baby being separated from you and your partner which means a higher chance for more skin-to-skin contact. Skin-to-skin contact immediately after birth has been found to reduce the baby’s crying, improve mother-infant interaction, and help successful breastfeeding.

 

Vitamin K

Vitamin K is a vitamin that plays an important role in blood clotting, and babies are born with low vitamin K levels. In a small number of babies this can lead to a rare type of bleeding called Vitamin K Deficiency Bleeding (VKDB). VKDB can have serious complications for babies, including brain haemorrhage and death, and it is not currently possible to know which babies will develop VKDB.

It is your choice if Vitamin K is given to your baby. If you do decide to give Vitamin K, you can choose either an injection (usually given at birth) or three oral (by mouth) doses given within the first 4 weeks after birth. Women’s Health Action produce a decision making guide which can be ordered from our wesbite which has further information about giving Vitamin K to your baby.

 

 

Postnatal

 

Registering your baby

It is a legal requirement to register the birth of a baby born in New Zealand. It is expected that you name and register your baby within 2 months of the birth. It is free to register your baby, but you need to pay if you would like a birth certificate. You can follow this link for more information on registering your baby and to access the online form to complete.

 

Postnatal care

After the birth of your baby, you will receive midwifery care to support your transition to parenting your baby/babies. If you have a normal birth with no complications it is likely you will be discharged within 3-4 hours after giving birth. In some hospitals you will be transferred to a maternity ward within the hospital or you may go to a smaller maternity unit located elsewhere. You can usually stay for 3-5 days after giving birth. You midwife will continue to visit you after the birth for 4-6 weeks, usually at your home or location of your choice. There is more information on postnatal care here

Pregnancy when you’re transgender in
Aotearoa New Zealand

 

The below information has not been written to provide anybody with medical advice. Instead it has been written to collaborate and explain the existing research on transgender pregnancy and lactation in an Aotearoa New Zealand context. If you are considering having a pregnancy and are transgender you should speak with your GP, endocrinologist, sexual health nurse or surgeons to discuss how this process can be made empowering, positive and supportive for you.

The information in this resource has been reviewed by Associate Professor Dr Gareth Treharne from the Department of Psychology, Otago University. It was written by Scout Barbour-Evans from Otago Polytechnic’s Bachelor of Leadership for Change.

Pregnancy can bring up a lot of feelings about your gender, so it is important to make sure you have access to good mental health care before, during, and after your gestation.

It may be helpful to choose a midwife (or doctor) while you are still planning your pregnancy. In Aotearoa New Zealand you do not need to stay with the first Lead Maternity Carer (LMC) you find – it is your choice who cares for you through your pregnancy. It may be helpful to ask questions about their existing knowledge about gender identity and their willingness to learn. Other transgender people in your area, or staff at your local Family Planning clinic might be able to recommend a good LMC for you.

Having a good birth plan can ensure your wishes are followed during your labour, and that you are referred to in ways that affirm your gender and make it a positive experience.

 

Legal issues for transgender parents 

Every district health board (DHB) in Aotearoa New Zealand has different approaches to caring for transgender people, so it can be helpful to contact your hospital’s patient affairs representative to gain an understanding of how your access to pregnancy related services and tests might be affected if you have male/indeterminate gender markers on your records.

At the time of publication of this information, the person who gives birth cannot be recorded as the “father” on a child’s birth certificate, and birth registration forms do not allow you to choose your title. You can contact the Department of Internal Affairs directly on 0800 22 52 52 to discuss this and in some cases they will issue a birth certificate naming you as the “parent” instead.

Fertility for transgender people

Nobody knows how taking hormones might change a person’s fertility, or ability to create a foetus and carry to term. What is known is that testosterone during pregnancy can harm a growing foetus, so it is suggested in limited research from Canada that you stop this medicine before trying to have a baby.

In New Zealand you can access free services to freeze your sperm or eggs before you go through certain medical procedures. If you have testicles, you can freeze sperm before you start any hormone therapy. If you have ovaries, you can freeze eggs before you have any surgeries on your uterus or ovaries. You should ask your GP, endocrinologist, sexual health nurse or surgeon for a referral to these services.

Taking testosterone or estrogen does not stop you from becoming pregnant or making somebody else pregnant.

If you are having any sort of sex while on testosterone or estrogen which could cause a pregnancy you need to use an appropriate barrier such as a condom. You could also speak to a sexual health nurse about other forms of contraceptive medicine.

Breast or chest feeding for transgender people

It is possible to cause your body to produce milk if you have not been pregnant, even if you’re a transgender woman. This is through medicine and breast pumps, a process called the Newman-Goldfarb protocols. Many trans women worldwide have successfully had a feeding relationship with their children, and if you are interested in this you should speak to a doctor or an endocrinologist to learn more.

Having had top surgery, or the removal or reduction of breasts, does not always mean that your body will not make milk after a pregnancy. You will need extra support from a lactation consultant from the start. Every person’s experience of producing milk is different – some people can fully feed their child while others need to supplement with formula, or find they have no milk supply at all. There can still be the same, or higher, risk for conditions like mastitis or clogged milk ducts after top surgery.

According to limited research from Canada, there is no evidence that suggests that testosterone could be present in human milk, and the limited existing research suggests that it is safe to take testosterone and breast or chest feed at the same time. But as there has been very little research done in this area, you should always discuss the risks of this with an endocrinologist to make an informed decision. Your doctor might choose not to prescribe you testosterone if you are feeding your baby your own milk.

Further reading

 

Complaints

 

If you are unhappy with any aspect of your maternity care you can provide feedback or make a complaint.

Midwifery Standard Review » you can provide feedback about any midwife involved in your care. The feedback can be anonymous of you wish and is seen by the New Zealand College of Midwives, the midwife herself, and a consumer representative who will participate in the midwife’s Midwifery Standard Review (each midwife completes an MSR every three years).

Resolutions Committee » if you wish you wish to make a complaint about a midwife and try to resolve the issues you have.

Health and Disability Commission » you can lay a complaint with the Health & Disability Commission regarding care received from any health professional involved in your pregnancy, birth, or you or your baby postnatally. Any complaint laid to HDC is assessed and then addressed in the most appropriate way the assessor sees fit.

Accident Compensation Corporation » you can place a complaint and claim with ACC if your complaint is related to an injury which occurred during your pregnancy, birth, or postnatal period, including injuries caused by poor health care you received. ACC only cover injuries related to accidents and these don’t include complications associated with your pregnancy or birth.