National Maternity Clinical Guidance

In 2009, the Government agreed to the development of the Maternity Quality Initiative, which included the establishment of a Maternity Quality and Safety Programme.

During the programme’s planning it was agreed by the multidisciplinary expert working group developing the New Zealand Maternity Standards that there was a need to have nationally consistent clinical guidance for the maternity sector.

This was also in response to recommendations from the Perinatal and Maternal Mortality Review Committee, the Health and Disability Commissioner and the Minister of Health.

This guidance would enable and encourage consistency of clinical maternity practice for particular topics identified as areas of variability within the sector.

The Ministry of Health and members of the National Maternity Guidelines Working Group reviewed existing DHB guidelines, selected international guidelines and recent international literature on the use of clinical guidelines.

The working group includes representatives from the New Zealand College of Midwives (NZCOM); Royal New Zealand College of General Practitioners (RNZCGP); Royal Australasian College of Physicians – Paediatric and Child Health Division; Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) – New Zealand Committee; the Society of Anaesthetists and a consumer representative.

Three clinical areas were identified as the first priority for this work: 

• observation of the mother and baby in the immediate postnatal period
• management of postpartum haemorrhage
• management of hyperglycaemia in pregnancy

 The following national consensus guidance has been completed.

• Observation of Mother and Baby in the Immediate Postnatal Period: Consensus Statements Guiding Practice
• National Consensus Guideline for Treatment of Postpartum Haemorrhage
• Consensus Guidance on the Management of Postpartum Haemorrhage
• Screening, Diagnosis and Management of Gestational Diabetes in New Zealand
• Diagnosis and Treatment of Hypertension and Pre-eclampsia in Pregnancy in Aotearoa New Zealand – published by Health NZ

The service specifications for district health boards providing maternity services require the service to adopt any applicable national clinical guidelines that are endorsed by the professional colleges.

The National Maternity Monitoring Group (instituted in 2012 as part of the Maternity Quality Initiative) has advised the Ministry that the next clinical area for guideline development is hypertensive disorders in pregnancy. This work is currently underway.

It has come to the attention of both the Ministry of Health and the National Maternity Monitoring Group (NMMG) that the maternity sector is circulating several maternity guidelines that have not been through a ratification process to become a national guideline.

Some of these guidelines might be valuable resources for the maternity sector.

Conversely, some might not be evidence-based or robust; in this case, they could have a negative influence.

The NMMG and the Ministry have developed a formal process by which they can appraise and ratify externally developed guidelines. The following page outlines this process:

• External Maternity Clinical Guidance

• National Consensus Guideline for Treatment of Postpartum Haemorrhage
• Treatment of Postpartum Haemorrhage - Poster

Published 31 March 2022

This consensus guideline has been updated to include the latest evidence-based research to guide clinical practice for treatment of postpartum haemorrhage.

• Pulse oximetry screening guidelines for newborn babies

National guidance on newborn pulse oximetry screening including guidelines for health practitioners, screening algorithm, and information for parents.

Published July 2024

• Companion Statement on Vitamin D and Sun Exposure in Pregnancy and Infancy in New Zealand

Published 10 December 2020

This document provides advice for health practitioners on vitamin D and sun exposure in pregnancy and infancy. It identifies those at high risk of vitamin D deficiency and provides recommendations for vitamin D supplementation.

• National Guidance for the Assessment, Diagnosis and Surgical Treatment of Tongue-Tie in Breastfeeding Neonates

Published 25 November 2020

This publication provides clinical guidance for health professionals on the assessment, diagnosis and surgical treatment of tongue-tie in breastfeeding babies up to six weeks of age.

•  New Zealand Obstetric Ultrasound Guidelines

Published 13 December 2019

This publication provides new national guidance to support radiology professionals and lead maternity carers to deliver nationally consistent, clinically appropriate and high-quality maternity ultrasound services.

•  Diabetes in Pregnancy

Published 17 December 2014

This guide gives recommendations for screening and diagnosis of probable undiagnosed type 2 diabetes and gestational diabetes in pregnancy. It also includes recommendations for treating and managing gestational diabetes.

• Screening, Diagnosis and Management of Gestational Diabetes in New Zealand: A clinical practice guideline

Published 17 December 2014

This clinical guideline gives detailed recommendations for screening and diagnosis of probable undiagnosed type 2 diabetes and gestational diabetes in pregnancy. Recommendations on treating and managing gestational diabetes are also outlined.

• Observation of Mother and Baby in the Immediate Postnatal Period: Consensus statements guiding practice

Published 01 July 2012

Guidance for health practitioners supporting mothers and babies in the immediate postnatal period.