Antenatal care and the Lead Maternity Carer system in New Zealand

The LMC system, and why it has no equivalent anywhere else

New Zealand does something no other English-speaking country does. Rather than being allocated to a hospital clinic, you choose one named practitioner — your Lead Maternity Carer, or LMC — who carries you through the entire pregnancy, the labour and birth, and the first six weeks with your baby. For most New Zealanders that person is a self-employed community midwife, and the care is free.

Health New Zealand describes the LMC as having a legal, professional and practical responsibility to make sure you and your pēpi receive appropriate maternity care. Your LMC is available 24 hours a day, seven days a week.

Who can be your LMC

• A midwife. Most women choose a community-based midwife. They usually work in small practices with a team, so you have a named back-up. They care for you through pregnancy, labour and birth, and at home afterwards, and they work alongside hospital midwives and obstetricians if you need additional medical care. Midwifery care is free to New Zealand residents and other eligible women.
• A GP with a Diploma in Obstetrics. A small number of family doctors act as LMC, usually prioritising patients already enrolled with them. The maternity care they provide is free.
• A private obstetrician. They care for you through pregnancy, labour and birth, working with midwives who see you at home afterwards. A private obstetrician charges a fee.

How to find one

Start looking as soon as you find out you are pregnant. Midwives in popular areas book out months ahead, and the practical consequence of leaving it late is that you take whoever is left rather than whoever suits you. Use Find Your Midwife (findyourmidwife.co.nz), where LMCs advertise their availability and the areas they cover, or search Healthpoint for maternity services near you. Contact the midwife directly to engage them. If you cannot find anyone, Health New Zealand runs a contact form to help.

The antenatal appointment schedule

If you are fit and healthy, Health New Zealand's guidance is that your antenatal checks will usually be every month up to 32 weeks, and more frequent after 32 weeks until your baby is born. If your LMC has any concerns, they will see you more often.

At each visit your LMC checks:

• your blood pressure
• your urine, for infection and for indicators of diabetes and pre-eclampsia
• your weight
• your baby's heartbeat
• your baby's growth and development

RANZCOG, the college covering both New Zealand and Australia, adds the clinical detail behind that: see a practitioner capable of assessing maternal and fetal risk by 10 weeks, have symphysis-fundal height measured and plotted at routine visits, be offered an obstetric ultrasound before 20 weeks, sleep on your side from 28 weeks, and have a labour and birth discussion by 36 weeks.

Screening and scans

Your LMC offers screening tests and ultrasound scans, arranges them if you decide to have them, explains the results, and refers you or your baby for specialist care if needed. They will also prescribe supplements such as folic acid and iodine.

Beyond the clinical

The LMC role is broader than a check-up. Your LMC helps you develop a plan for your care including labour and birth, reviews your general health, discusses any medical or mental health conditions, and helps with social stresses including family violence, unplanned pregnancy, work and income.

After the birth

This is where the New Zealand model diverges most sharply from other countries. Your LMC will visit you, or arrange for you to be visited, in hospital and at home at least seven times after your baby is born. They support you with feeding and caring for your baby, provide health checks for both of you, help you enrol your baby with a general practice, and refer you to your chosen Well Child Tamariki Ora provider — the handover generally happens after about five weeks. LMC care runs until your baby is six weeks old.

Questions worth asking before you commit

Health New Zealand suggests asking any prospective LMC:

• How many people do you care for who are due to give birth each month?
• How long can I expect my antenatal appointments to be?
• How does your backup system work when you are not available?
• What choices do you offer regarding place of birth?
• Do you usually visit people at home during early labour?
• What is your view on pain relief, and on interventions such as induction, episiotomy, forceps or ventouse?
• Are you happy to support me using water during labour and birth?
• How long do you provide care for following the birth?

If you cannot find an LMC, or are unhappy with your care

Shortages are real, particularly outside the main centres. If you cannot secure a community midwife, ask your local hospital about hospital or core midwifery team care — you will see a team rather than one named person, but the care is still free and still comprehensive. Contact Health New Zealand's maternity service in your district directly rather than waiting.

You are allowed to change LMC. If you are unhappy with any of the care you receive during pregnancy, birth or afterwards, Health New Zealand's advice is to talk to your midwife or doctor first, and it publishes a route for escalating if that does not resolve it. Changing carers partway through a pregnancy is normal and does not require a justification.

Free maternity care depends on eligibility for publicly funded health services. If you are on a temporary visa, check your eligibility early, because non-eligible people are charged for maternity care and the amounts are substantial.

Where to get help

Health New Zealand — Te Whatu Ora publishes the LMC guidance at info.health.nz and administers publicly funded primary maternity services. Find Your Midwife lists available LMCs by area. The New Zealand College of Midwives provides information for women on choosing and working with a midwife. Healthline is available 24/7 on 0800 611 116.