This evaluation was designed to understand how the process is experienced by māmā, what works well, and what improvements could enhance care coordination, access, and outcomes across pregnancies.

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Method

The study used a qualitative approach (involving kōrero with hapū māmā) focused on equity and Kaupapa Māori principles. Nine māmā who had completed the Best Start assessment were interviewed about their experiences. These kōrero explored access, engagement, communication, and follow-up support, among other things. Thematic analysis (the process of finding patterns in what people say) identified important enablers and barriers, with a focus on what matters most to māmā.

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Key Findings/What this Study Shows

The Best Start Model of Care has strong foundations and is already improving early pregnancy support in Whanganui. When delivered well, it strengthens connection, confidence, and access to wrap-around care. Overall, māmā valued the holistic design of the Best Start process—especially its focus on mental health, nutrition, and social supports. Many described it as one of the few times in early pregnancy they were asked about their wellbeing in a safe, structured, and non-judgmental way.

However, experiences varied. System inconsistencies mean that not all māmā receive the full benefit of the model—especially newcomers to the region, those struggling to find a midwife, and those needing timely mental health support. In addition, some māmā experienced the process as a “tick-box” approach and wanted more space for open kōrero. Wait times for appointments, limited staff availability, and variable follow-up sometimes created barriers to timely care. Māmā also highlighted challenges in accessing midwives, navigating referrals, and attending appointments—especially when lacking transport, or when recovering from birth or, and parking options.

Despite these barriers, the model was recognised as an important facilitator of connection and prevention—identifying unmet needs early, supporting mental health, and linking māmā to wrap-around services.

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Main Recommendations

The evaluation identified opportunities to strengthen and scale the Best Start model:

1. Strengthen Early Pregnancy Pathways, Coordination, and Follow-Up – Use routine prompts and clear processes so every pregnancy is identified early and consistently. Standardise referrals, document what happens next, and ensure māmā are not left to chase information.
2. Build Communication through Whakawhanaungatanga (Connection) – Ensure all assessments begin with warm, respectful, and clear explanations, including what will happen and where information goes.
3. Prioritise Flexible Locations for Best Start Assessments – Offer options such as Te Whare Piringa (a Māori-led community space for pregnancy support) or home-based visits to reduce stress and increase cultural support and safety.
4. Strengthen Mental Health Support – Respond to disclosures with care, validation, and practical next steps. Strengthen pathways to in-house and external mental health support, including warm handovers to Health Improvement Practitioners (HIPs) and Health Coaches.
5. Support Access to Midwives – Integrate midwife-finding support within Best Start and improve communication between primary care and midwifery services.
6. Reduce Practical Barriers – Improve parking access for hapū and newly-postnatal māmā and offer transport-friendly options or support.
7. Uphold Māmā-Based Strengths – Recognise māmā as experts in their own wellbeing and ensure the process enhances their mana and agency.

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Why This Matters

Early pregnancy is a critical window for ensuring equity. When Best Start is delivered well, it strengthens confidence, connection, safety, and cultural wellbeing from the very beginning of the maternity journey. This project highlights the importance of early pregnancy care and provides clear guidance for how Whanganui can continue to lead innovative, community-grounded early pregnancy care that honours māmā and whānau.

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Next Steps

Findings will be shared with māmā, local primary care practices, iwi partners, and regional stakeholders to inform service improvement and future research.

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