Current Programs / Initiatives

Having a baby in Victoria website

This website is a resource for women having a baby or women who are thinking about becoming pregnant. It provides information about the many questions that arise during pregnancy and in preparing for birth and life after the birth. The site is designed to help women make their care decisions and promotes the concept of partnership between women and health professionals who provide maternity care services. Visit the Having a baby in Victoria website.

Maternity Services Performance Indicators

Since 2003 all Victorian public hospitals providing maternity care hare been reporting annually against a suite of 10 performance indicators addressing both process and outcome measures across the maternity services episode from pregnancy through to the early postnatal period. These indicators are evidence based and were developed in consultation with maternity care managers, clinicians and consumers.

Current report:

Victorian Maternity Services Performance Indicators - Complete set for 2007-08 - released February 2009 (pdf, 2.84mb) - Re-printed March 2009; MAT-6: Figure 9 amended

About the indicators:

The original maternity services performance indicator development report "

Measuring Maternity Care A Set of Performance Indicators (PDF File 1.55MB) " was published in 2001.

These indicators were trialed and a final set of indicators "

Measuring Maternity Care - The Final Set of Performance Indicators - 2002 (PDF File 559KB) " that cover the following domains were selected:

1. Outcomes for first time mothers with uncomplicated pregnancies (inductions, caesarean sections and severe perineal tears).
2. Term infants transferred or admitted to special care nursery (SCN) or neonatal intensive care unit (NICU).
3. Antenatal corticosteroids for births before 34 weeks gestation.
4. Vaginal birth for women after a previous caesarean section.
5. Standardised perinatal mortality ratio.
6. Women referred to postnatal domiciliary care.
7. Women offered appropriate interventions in relation to smoking.
8. Appropriate breastfeeding support and advice.
9. Women who receive timely hospital antenatal clinical services.
10. Women from a non-english speaking background (NESB) without proficiency in English who receive appropriate interpreter services

Previous reports:

Victorian Maternity Services Performance Indicators - Complete set for 2006-07 - released February 2008 (pdf, 3.12mb)
Victorian Maternity Services Performance Indicators - Complete set for 2005-06 - released March 2007 (pdf, 2.69mb)
Victorian Maternity Services Performance Indicators - Complete set for 2004-05 - released January 2006 (pdf, 577kb)
Victorian Maternity Services Performance Indicators - Complete set for 2003-2004 - released March 2005 (pdf, 330kb)
Victorian Maternity Services Performance Indicators - Public hospitals indicators MAT1, MAT4 & MAT5 using combined data from 2001 and 2002 - released November 2003 (pdf, 427kb)

Hospital use:

MSPI Business Rules & Reporting Template 2008-09 (Word File 1.73MB)
Maternity Services Performance Indicators Business Rules for 2007-08 (PDF File 201KB)
Maternity Services Performance Indicators Proforma 2007-08 (Word File 547KB)

Please note the changes to population sample size for both small and large services for MAT 7 (Women being offered appropriate interventions in relation to smoking)

Victorian Maternity Record (VMR)

The Victorian Maternity Record (VMR) is a government initiative to provide pregnant women with a uniform hand held maternity record.  This reflects the government’s vision and the principles outlined in Future directions for Victoria maternity services, particularly that all pregnant women accessing public maternity services in Victoria will carry the VMR by December 2009. 

The VMR was introduced to engage women in decisions regarding their own care and to improve communication between service providers.

Key Functions of the VMR

• Risk minimisation by access to a complete pregnancy record
• Improve provision of information given to women
• Improve consistency of information give to women
• Enhance continuity of care
• Improve communication between service providers
• Provide continuity of documentation between clinicians and sites

In February 2009, feedback was sought from health services around VMR design and user-friendliness.  The feedback was consistent and constructive.  Two key recommendations were agreed 1) one standard state-wide handheld maternity record and 2) Redesign the current core VMR.  The revised VMR is expected August 2009.

A guide to tests and investigations for uncomplicated pregnancies (PDF 3.43MB)

Victorian Maternity Record (PDF 4.12MB)

Order copies of the Victorian Maternity Record here.

For further information contact Karen Irving on (03) 9096 0109

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The Rural Maternity Initiative (RMI)

The Rural Maternity Initiative commenced in 2003 to support rural maternity hospitals in the establishment of continuity of midwifery models of care. The RMI was broadened in 2007/08 to include projects and service redesign that supported rural maternity services more broadly. This strategy has contributed to sustainability of local maternity services and has given rural women choice in childbirth options, a principle that underpins the Government’s maternity framework - Future directions for Victoria’s maternity services - May 2004 (PDF file 1.23MB). A total of thirty nine health services have been funded up until the 2007/08 year through the RMI. Some health services have examined their maternity services with a view to ensuring sustainability into the future; a large proportion of these have resulted in the introduction of midwifery care models. Collaborative maternity care between hospital midwives and local general practitioners has also been a feature of many of the funded models/projects.

In some rural communities where birthing services are not available, the development of collaborative projects and alliances has enabled the provision of antenatal care, often by midwives, in a woman’s own community. This local care has resulted in women being able to access local care with travel only required for their birth. These alliances have also enabled a sharing of resources and an increase in capacity of all hospitals to meet consumer needs and the growth in birth numbers that have occurred in recent times. Area based integration of health service provision between sub-regional and local health services is a feature of some of these alliances and collaborative projects. This feature has formed a key platform of the Rural Directions for a better state of health policy document.

Further funding of $5.6 million for 2007–2011 has been allocated to continue to enhance maternity care and sustainability of services in rural areas.  Future allocation of funds will continue to target programs that support sustainability of maternity services in rural Victoria as well as midwifery models of care where they contribute to viability of the maternity service.

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Industrial Framework For Continuity Models

The industrial framework for continuity models has been developed to assist health services to achieve equitable work practices and conditions for all midwives. There are many variations of work practices in continuity of midwifery care models as some of these models require midwives to work outside the traditional ward roster which provided some challenges in relation to industrial conditions. The Agreement outlines the proposed conditions of employment of midwives within these models and provides security for those midwives who remain within the traditional or acute system when a continuity model has been introduced – thus ensuring maintenance of skills and conditions. A guideline has also been developed to assist health services in the process of implementing the industrial framework.

Industrial Framework for Continuity Models of Midwifery Care (March 2005) (PDF File 49KB)

Guide for health services to Framework Agreement (PDF File 42KB)

The Pregnancy Care and Maternity Emergency Education Program (PCMEEP)

The Pregnancy Care and Maternity Emergency Education Program provides evidence-informed multidisciplinary education in pregnancy care and maternity emergencies.

The program consist of two separate components (Pregnancy Care and Maternity Emergency Education) which build on the existing knowledge of maternity clinicians to further develop their confidence and competence to meet the specific needs of each pregnant woman in Victoria. Piloted in 2005, the on-going program consists of workshops conducted onsite in primary, secondary and tertiary maternity services in each geographical region across Victoria. Both education programs are provided using a collaborative framework and explore the scope of practice of maternity clinicians.

PCMEEP components:

Pregnancy care program

The pregnancy care program is conducted as a one day workshop using learning modules that are aligned to the 3Centres Consensus Guidelines on Antenatal Care. Individual programs are developed to support professional practice, knowledge and skill enhancement The modules include:

• Victorian maternity services: challenges and opportunities
• Organisation of pregnancy care
• Lifestyle considerations – cessation of smoking
• Screening for haematological conditions
• Screening for fetal abnormalities
• Screening for infections
• Screening for clinical conditions
• Clinical skills
• Management of specific clinical conditions – pregnancy after 41 weeks
• Management of common symptoms of pregnancy

Maternity emergency education program

The maternity emergency education program is conducted over one and a half days on site in the maternity care setting. Each workshop focuses on three of the following emergencies; antepartum haemorrhage/postpartum haemorrhage, shoulder dystocia, hypertensive crisis, eclampsia, breech, uterine hyperstimulation, cord prolapse or maternal collapse. The program focuses on crisis resource management and clinical risk management and involves use of simulation.

Both programs use interactive learning environments and are facilitated by a team of consisting of clinical midwife consultants, obstetricians and simulated patients.

For further information contact maternityservices@dhs.vic.gov.au

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Koori Maternity Services Program

Culturally appropriate maternity care is provided to Aboriginal and Torres Strait Islander women throughout pregnancy, working with hospitals for birth and during the postnatal period through Aboriginal Community Controlled Cooperatives (VACCHO) in ten sites throughout Victoria. There are two key ways in which care is provided. The first involves an Aboriginal maternity health worker and a midwife, who are both employed by the Aboriginal health service. They combine their skills to offer a comprehensive service to women in the local community, including a clinical component. The second employs an Aboriginal Health worker who supports women during pregnancy and after birth and is responsible for linking Aboriginal women with appropriate clinical service providers. Further details about programs at specific sites is provided on the Having a Baby in Victoria website

Perinatal Emergency Referral Service (PERS)

The Victorian Government will be funding over $800,000 each year to provide a 24-hour hotline for immediate access to expert specialists in the event of an unforseen birthing emergency. For the first time in Australia, expert obstetric and neonatal advice, emergency transport, if required, plus access to the necessary beds will all be co-ordinated and managed in ‘one’.

The Victorian Perinatal Emergency Referral Service (PERS) was launched by the Victorian Minister for health in later November 2005. The mission of this state-wide service is to provide maternity care providers in Victoria with a coordinated, timely and safe approach to:

• Accessing expert clinical advice about perinatal emergency situations.
• Arranging perinatal emergency transfers to appropriate facilities when required.
• Accessing key obstetric and neonatal resource information.

For further information about PERS

PERS is a key element of the Victorian Government’s ‘Future directions for Victoria’s maternity services’

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Fetal Surveillance Education Program

The Intrapartum Fetal Surveillance Education & Credentialing Project established an education program in intrapartum fetal surveillance which is now being rolled out to all interested Victorian Public maternity hospitals. This project was a collaboration between the Three tertiary centres (Royal Women’s Hospital, Southern Health and Mercy Hospital for Women), the Royal Australian College of Obstetricians and Gynaecologists and the Australian College of Midwives and jointly funded by the Department of Human Services (DHS) and the Victorian Managed Insurance Authority (VMIA). Further details regarding this project can be found at the RANZCOG Fetal Surveillance Education Program web site

3Centres Collaboration

Visit the 3centres collaboration web site

The 3centres collaboration refers to collective decisions undertaken by a joint steering committee of leaders in obstetric and midwifery services at the three tertiary maternity hospitals. The collaboration receives funding from the Department of Human Services (the department).

Two work programs (2003-5 and 2006-9) have been completed.

Major achievements of the collaboration to date include:

• Development of 17 evidence based clinical practice guidelines on routine antenatal care for women assessed as having a low risk of pregnancy complication at their first antenatal visit. The purpose of these guidelines is to improve health outcomes and encourage the appropriate use of resources by improving the practice of health professionals and providing people with better information about their treatment options. These guidelines were reviewed in 2005.  Members of the steering group who developed the guidelines are currently participating in development of the National Pregnancy Guidelines.
  
  
• Development of high quality consumer information on A guide to tests and investigations for uncomplicated pregnancies (PDF File 3.43MB), with 20,000 copies of this booklet distributed annually throughout Victoria and nationally.
  
  
• An extensive education program was carried out from 2003-5 to assist with implementation of the guidelines throughout Victoria
  
  
• The guidelines and the consumer information provide a foundation for other department initiatives, including the Victorian Maternity Record (VMR) and the Pregnancy Education Program.
  
  
• Facilitation of initiatives to address barriers to implementation, including development of a tailored HIV counselling accreditation program for midwives, and smoking cessation education.

A work program for 2009-11 is being developed, and the collaboration aims to:

1. Provide regular bimonthly forums for multidisciplinary leaders in tertiary maternity care services, which model collaborative behaviour within the group and with other key stakeholders in maternity services, including Maternity and Newborn Clinical Network (MNCN), Perinatal Emergency Referral Service (PERS), and the Programs branch of the department.
   
   
2. Support informal networking which facilitates synergy between other maternity service projects, through the Maternity Project Community of Practice (MPCoP)
   
   
3. Provide advisory role for PERS (as per review outcomes), in collaboration with PERS director
   
   
4. Maintain high quality consumer information on antenatal tests and investigations for uncomplicated pregnancies
   
   
5. Establish and maintain formal collaborative relationships with the MNCN and other stakeholders to represent tertiary issues, clarify the roles for tertiary maternity services, and investigate issues of mutual concern (eg. caesarean section audit).
   
   
6. Improve consistency of evidence based practice and uniformity of guidelines within tertiary services, with initiatives which have benefits across the system.

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