This project explores the issues relating to the care of māmā and pēpī in the first 6 weeks after childbirth in the general practice setting.

It focuses on the traditional 6 week check, seeking to understand what influences access to the check, how the check is best provided, what items need to be included and how this information helps plan care for māmā and pēpī that is coordinated with other early childhood health care providers.

The project aligns with the Whanganui Maternal & Child Integration Group which has mapped the pathway of care for māmā and pēpī in the first 6 weeks after birth and which provides a forum for engagement of these service providers.

The project uses the Best Start Māmā and Pēpī 6 week check designed by the National Hauora Coalition (NHC) as part of the 2040 Equity Generation programme as an assessment tool. This tool provides an opportunity to collate and attend to multiple evidence-based items that require checking by 6 weeks after birth for both māmā and pēpī. Some of these checks may already be provided in the community (by LMC midwives, Plunket, WellChild providers, newborn hearing and hip check providers) prior to the general practice 6 week check. This check then provides an opportunity to collate the currently dispersed information, and to attend to any check items that have not been accessed. The check also provide the opportunity to initiate childhood vaccination programme and plan for ongoing child  maternal health care.

Analysis of data from an Equity Snapshot for Whanganui region in 2001, and a literature review for the Best Start early pregnancy assessment project, identifies that many of these items are not fully addressed for wāhine Māori and their pēpī. There is inequity in services accessed and in the impact of preventable health risk factors resulting in poorer health outcomes for wāhine Māori and pēpī. For this reason, Māori māmā and pēpī will be the priority focus for this project.

These items can be addressed at the 6 week check and provided there is high participation by wāhine Māori and pēpī the health of Māori will benefit and the equity gap will improve.

The proposed research addresses the implementation of the Best Start Māmā and Pēpī 6 week check with the aim of identifying the issues affecting access to post-natal and well baby checks  and developing integrated solutions. These solutions will draw on the currently HRC funded Best Start early pregnancy project including the clinical systems review and Hapū Māmā Village insights from that project, a co-design of service access based on a series of hui with hapū māmā and their whanau.

Specific features of this project include:

1. An updated literature review will report the issues relevant to the project. This literature review will be an extension of the review completed for the Best Start early pregnancy project with additional focus on the 6 week post-partum period. The literature review will take a strength-based approach identifying what is working to improve health for wāhine Māori and pēpī, including the relationships and structures that support better health outcomes; as well as defining what is not working well  that needs to be addressed in the project.
2. The Hapū Māmā Village insights report from the current Best Start early pregnancy project will provide a basis for exploring māmā and whānau needs in relationship to the 6 week post-partum period. This insights report has been developed through the Healthy Families Whanganui  design approach which includes participant engagement; systems mapping;  Māmā and Pēpī Village stories and journey mapping; key themes development; synthesis and feedback loops; design, walk through and fine-tuning. This report will include insights relevant to the  Best Start Māmā and Pēpī 6 week check project and these collated insights will guide the clinician response to improving access for wāhine Māori and pēpī to the range of checks recommended in the post-partum period. .
3. The clinician response includes service re-design. The re-design process has been successfully used for the current Best Start early pregnancy project and involves an iterative process addressing identified issues and changing clinical systems to resolve the issues. As well as from the village insights and the literature review, issues are identified by case notes analysis; clinical staff hui; analysis of participation in each of the checks required during the 6 week post-partum period; and input from providers of checks including midwives and well child providers. Issues are problem solved in clinical staff hui, meetings with other providers,  and through engagement with the region’s Primary Secondary Maternity Interface project.
4. The issues list is checked for saturation in at least four different types of primary care practices and the service design modified in response to each practice’s experience.
5. The outcomes of the project include reporting the identified issues, the proposed solutions and service re-design, the impact of the project on participation in the recommended checks by wāhine Māori and pēpī, and the development of an implementation guidance document for PHOs and other primary care practices advising on training, education, and resources and environmental development.
6. Attention is given to cultural safety throughout the project. There has been  cultural supervision in the project design. The insights from Best Start Hapū Māmā  Village have been developed within a kaupapa Māori hui process independently  by Healthy Families Whanganui. The service re-design meetings are attended and supervised by a practice-based cultural advisor.