Dr Amy Jones

Background

Pregnant Māori women are more at risk of a number of adverse birth outcomes when compared to non-Māori, including low birth weight babies, small for gestational age, and preterm labour. Māori mothers are also at increased risk of adverse mental health outcomes. Those with health issues, such as a diagnosed illness before pregnancy, elevated body mass index, greater pregnancy weight gain, and less pregnancy exercise, are more likely to have a caesarean section (increasing poorer health outcomes for mum and baby) and women with multiple health risks were even more at risk of adverse birth outcomes. The inequities in maternal care for Māori are pervasive, thus identifying and addressing these issues for women is vital.

Abstract

The parent study Collaboration Grant aims to develop a health needs assessment to identify unmet needs for wāhine hapū and is focused on improving antenatal supports outside of the health sector. However, wāhine hapū are also likely to have unmet clinical needs. But a means of identifying and meeting unmet clinical needs for wāhine hapū was not built into the parent project. This is because the Harti model that the parent study is based on was initially a non-clinical model. Harti was used in a randomised trial in paediatrics and then became the highly effective WHIRI model after it was expanded to include a clinical arm as part of the COVID response.

There are clear gaps in clinical care for pregnant Māori women, with health needs impacting on their ability to access effective antenatal supports and achieve health equity. This study offers the opportunity to enhance equity and health outcomes by embedding clinical support into the wāhine hapū project to fill this gap and help to address the unmet clinical needs, and better link wāhine with midwives and primary care as well as secondary care services.

This study assesses the feasibility of providing a Māori nurse led service, and the potential Māori health gains, for wāhine completing a hauora assessment as part of the parent study Collaboration Grant.

Method

In the Collaboration Grant, 400 pregnant Māori women will go through a co-designed hauora assessment. The proposal of this WMRF arm of the study is to add a referral pathway through the hauora assessment and a screening question to identify if the participant may have any health concerns. Any women responding ‘yes’ will then be offered a referral to a Māori CNS with Māori GP leadership to support any unmet clinical needs. Examples of this might include the CNS engaging with primary or secondary care to support wāhine or organising any assessments or specialist referrals.

Outcomes measures of feasibility include: time taken, number/type of assessments, type and number of unmet clinical needs, number of women needing support. Further, it will determine any barriers to implementation roll out of the future hauora assessment with addition of the clinical arm. Access to clinical support for identified needs in this project will ensure safety for hapū māmā and identify areas requiring service development.

Media summary of research

Achieving antenatal care outcomes for Māori in our community will make immediate and longterm impacts, for both babies and mothers. This requires increased understanding of hauora/health, and support for clinical needs. This project will determine how feasible it is to add a clinical component to a health and wellbeing needs assessment for pregnant Māori women. This is a nurse led kaupapa Māori approach. This targeted intervention will help address a gap in care for vulnerable pregnant Māori, where there are well known barriers for them in accessing primary care (i.e. cost, institutionalised racism/system failures). This comes at a particular time when primary care services are already stretched with reduced ability to provide standard preventative health care due to the COVID-19 pandemic.

Outcome statement

The present study will help provide evidence of the feasibility and potential health gains of offering clinical support for wāhine hapū who complete a wellbeing needs assessment as part of the HRC funded Collaboration Study at Waikato DHB.