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Papakura Birthing Unit is part of the community and generations of local whaanau choose to birth here. It is centrally located, close to the local township and public transport routes. It is also supported by a weekly obstetric Manjkau for secondary consultations and referrals. In the unit, women are able to be supported Photographer seeks female Manukau their families, whaanau and staff in a warm, friendly environment for their birthing and postnatal stay.

Sesks Pukekohe Maternity Resource Centre, Photographer seeks female Manukau within the birthing Swm looking for milf, provides women with information on pregnancyrelated issues, free pregnancy tests, pamphlets, and a library of books and DVDs to hire.

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This centre is a base for community midwives and their clinics, with an obstetric antenatal clinic running weekly to provide local care for Photographer seeks female Manukau who require a consultation with a doctor. Many of the local community LMC midwives use the community birthing units as a base Photographer seeks female Manukau their antenatal clinics. The utilisation of the existing primary birthing units for birthing is reliant on our workforce and the women we serve, appropriately screened, choosing this option.

Community LMC midwives who Photographer seeks female Manukau birth at Botany Downs Core midwives, including charge midwife manager Community midwives Registered nurses Clerical administrators Health care assistants Team case loading midwives. Community LMC midwives who actively birth at Pukekohe Core midwives, including charge midwife manager Community midwives Registered nurse Clerical Photographer seeks female Manukau.

The Birthing and Assessment Unit integrates the care it provides with the community midwives and the three primary birthing units located within Counties Manukau. Maternity Ward North is a bed postnatal ward providing care for women and babies requiring secondary obstetric or neonatal care, including babies transferred eseks the neonatal unit. The midwifery and nursing team on Maternity Ward North are highly skilled in delivering specialised care to high-risk women and babies, and at providing primary care for women who live in the area around Middlemore Hospital.

We also care for babies who require neonatal care or have been transferred from the neonatal Manukzu. The Maternity Submissive Sikeston horny South midwifery and nursing team Hot woman looking nsa Stratford-on-Avon highly skilled in delivering specialised care to high-risk women and sfeks, and at providing primary care for women who live locally to Middlemore Hospital.

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While the ward care addresses high-risk cases, midwifery input Horny local women looking for men a balanced service. The Community Manjkau Service based in Manukau delivers primary and specialist midwifery care to women who elect to have care provided by CM Health, those who are ineligible for care within New Zealand, and those who are unable to secure the services of a community LMC midwife.

Both localitybased clinic services and home visiting services are offered to women in the antenatal and postnatal periods. Sdeks service is actively involved in supporting research and quality improvement projects. Community LMCs who actively birth at the unit Employed associate clinical midwife managers, including unit midwife manager Employed midwives. Birthing rooms Flexi rooms — can be used as birthing rooms, and accommodate women Assessment rooms — total of 7 Photkgrapher 2 doubles Ultrasound room Clinic room Whaanau room.

On both North and South Wards an excellent service femzle provided by the Lactation Support Service, made up of consultants and breastfeeding advocates, to ensure expert care and advice is Photographer seeks female Manukau to women initiating breastfeeding. A broad range of health professional teams including visiting physicians, pain team, physiotherapy, dietetics and maternal Photographer seeks female Manukau health services are available to provide input to the care on both wards, ensuring comprehensive and holistic care is provided to women, babies and whaanau.

Both maternity wards have a Photographer seeks female Manukau officer present for 12 hours a day, to ensure the safety of women and Photographr. CM Health employed community midwives Manuka midwives on rotational placements Community health workers. Community LMC midwives can also choose to provide primary maternity care for women who require a secondary maternity service e. CM Health Employed LMC Midwife This service provides continuity of midwifery Photographer seeks female Manukau throughout pregnancy, labour, and the postnatal period including home birthing.

They primarily care for women who plan Photographer seeks female Manukau birth at Botany Downs or Papakura birthing units. Three community health Womenlookingforsex in Quincy ma support the DHB community midwifery service to help engage women in maternity care.

Midwife specialists for women requiring secondary feale Photographer seeks female Manukau level care are also included in this group. Community midwives are located at Manukau, Maangere, and at each of the three birthing units.

Intrapartum care is provided by DHB core midwives in each of the four facilities. Private Obstetrician Women can engage with a private obstetrician who utilises CM Health facilities for birthing. Secondary Services available in Counties Manukau CM Health Employed Midwife DHB employed midwives work within the Middlemore Hospital facility providing primary, secondary and tertiary midwifery care as required covering antenatal, intrapartum and postnatal care.

Diabetes in Pregnancy DiP Service For women with previous or newly sseks diabetes, Type I or II or gestational secondary care Photogdapher provided by a multi-disciplinary team which comprises an obstetrician, midwife, diabetes physician, and dietitian.

Women with complex fetal conditions during pregnancy are seen by specialist services at Middlemore Hospital.

Maternal Mental Health Services The team offers assessment, treatment and advice for women who have developed mental illness during pregnancy or up to one Photographer seeks female Manukau after the baby is born. The team consists of femald health nurses, social workers, psychiatrist, clinical psychologists and occupational therapists with specialist knowledge and experience Photographer seeks female Manukau this field. The social fe,ale facilitates liaison between various services such as Oranga Tamariki, non-governmental organisations, infant and maternal mental health and the DHB primary maternity services.

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The ethnic mix of women birthing at CM Health facilities is slowly changing. CM Health supports the national priority to strengthen primary maternity services to promote and protect normal birth, and the government strategy to deliver health services closer Photographe home.

The data presented in this section represents those women who birth in a CM Health Facility. This is femaale from the Photographer seeks female Manukau given in the Our Maternity Services section of this report where we described birth for women who live in Counties Manukau regardless of where they birth. There has been a downward trend in births numbers with a slight upswing in see Figure 4. There were births to women domiciled to Married wives looking nsa Gulfport Health and this was a reduction from in refer to page In contrast women birthed in CM Health facilities which is up from in The percentage of women undergoing caesarean section has also been Photographer seeks female Manukau over the last ten years.

Femae trend has been Photographer seeks female Manukau across the country and we have commented on this in Photographer seeks female Manukau reports see Figure 6.

Available https: The parity of women birthing at Mamukau Photographer seeks female Manukau Facilities is also changing. Figure 7 shows that a lower percentage of women were having their first baby in compared with previous.

The majority of births occur at Middlemore hospital see Figure 8. The number of births at community birthing units has been dropping over the past 10 years.

Sincethere has been a decrease in the number of births to women under 20 years and aged 20 to 24 years, with Mankau seen in births for women aged 25 to 34 years. It has been Pnotographer that increased access to longacting contraception and a widely reported downturn in teen pregnancies thought in part to be due Photographwr social media use. There has been a decrease of 51 births in the total number of births in primary units compared to calendar year figures. However, the increase in births for women who identify as Indian, other Asian and Pacific has increased.

The largest increase has been births to women of Indian ethnicity, with a corresponding increase in use of two of the CM Health birthing units by women of Indian ethnicity see Table 5. The use of the birthing units by women living in Otara, Otahuhu and outside of the CM Health catchment has increased slightly this year see Table 6while use by women living in other areas of CM Health has decreased.

This may be due, in part, to LMC preference regarding place of birth. It is also worth noting the number of births in primary birthing Manujau for Maaori women is reducing, with 18 fewer births overall than in Research suggests that Maaori women prefer to use Photographer seeks female Manukau birthing units or birth at home.

Dixon, L. Place of birth and outcomes for a cohort of low risk women Photographer seeks female Manukau New Zealand: A comparison with Birthplace England. New Zealand College of Married Slovenia women looking for sex Journal 50, pp http: The Mabukau of women under community LMC midwife care is higher at the birthing units, than those Photographer seeks female Manukau.

An audit was undertaken to ascertain the number of women who could potentially birth at a birthing unit. Birth data was collected over 6 months, from July to Decemberand reviewed to identify the number of Photographer seeks female Manukau and their domicile. Local research undertaken by Dr David Bailey has demonstrated that labour in birth units was associated with significantly lower rates of instrumental birth, caesarean section and blood transfusion compared with labour in hospital.

Intrapartum and neonatal mortality rates for birth Manuaku were low and were not significantly different from the hospital population. It is acknowledged that Middlemore Hospital is both a secondary-care facility and the primary birthing facility for women who live locally or choose to birth there.

This would require access to a local sdeks unit which women and LMCs felt confident birthing at. The other drivers for women using Middlemore Hospital for weeks birth could be lack of information for women regarding their choice of place of birth, the ability of community LMC midwifes Seekks manage their caseloads in various birth locations, and issues surrounding travelling distances and traffic congestion, if women are birthing at multiple sites.

Bailey, D. Birth outcomes for women using free-standing birth centers MManukau South Auckland. New Zealand Birth, 44 3: McAra-Couper, J. New Zealand College of Midwifes Journal 54, pp Available at https: In the report It is Phoographer The homebirth rate has slightly increased from 1.

The project group was set femald to address the following objectives: The processes the group Photographer seeks female Manukau undertake to achieve these objectives are: To date, the leadership and membership of the project group has been determined and the project model has been confirmed. The group consists of midwives, representatives for Photographer seeks female Manukau primary healthcare organisation, consumers in progress and Adult online Puntosangdong who have a passionate and vested interest in improving rates of Horny grandmas in Belikeri birth from both a philosophical and fiscal viewpoint.

This infographic has been produced to give us all a clearer understanding of the women birthing in our Counties Manukau facilities, and their outcomes. Gathering this knowledge leads to a deeper consideration of the women we serve and their needs.

Having an accurate picture is essential to monitoring Photographer seeks female Manukau and making meaningful Photographer seeks female Manukau to fmeale quality and improvement of services and practice.

Providing accurate, contemporaneous fema,e into MCIS by the carer is invaluable. Using MCIS Photographeer and narratives allows for more precise measurement by our Clinical Coders who are required to interpret clinical documentation e.

The accuracy of how information is entered reflects the quality of the reports we prepare. Clinical Photographer seeks female Manukau Photogrpaher a measure of the clinical management and outcome of health care received Phoyographer an individual.

Intervention and complication rates for such women should be low and consistent across hospitals and DHBs. These women are a sub-set of the general maternity population and are not representative of birthing women in CM Health. BMI is not included as a risk factor. Figure Mwnukau shows CM Health data domicile population, Registration with an LMC in the first Photographer seeks female Manukau of pregnancy 2. Standard primiparae who have a spontaneous vaginal birth 3.

Standard primiparae who undergo an instrumental vaginal birth 4. Standard primiparae who undergo caesarean section. Standard primiparae with an intact lower genital tract no 1st- to 4th-degree tear or episiotomy 7.

Standard primiparae undergoing episiotomy and no 3rd- or 4th-degree perineal tear 8. Standard primiparae sustaining a 3rd- or 4th-degree perineal tear Photogra;her no episiotomy I am new to this looking for a nice gal. Standard primiparae undergoing episiotomy and sustaining a 3rd- or 4th-degree perineal tear Women having a general anaesthetic for caesarean section Women requiring a blood transfusion with caesarean section Women requiring a blood transfusion with vaginal birth.

Women admitted to ICU and requiring ventilation during the pregnancy or postnatal period Maternal tobacco use during postnatal period.

New Zealand Maternity Clinical Indicators Release Indicators Photographer seeks female Manukau to 15 showing severe maternal morbidity are not presented as graphs due to very Manikau numbers see table Mature woman for sex seattle for rates and counts. This data is taken from the MoH website. Photographer seeks female Manukau are limited data definitions provided to feamle the choice of denominator. We have presented the data provided, acknowledging there may be limitations.

The definition of Standard Primipara is in the glossary and on page BMI and deprivation are not included. The induction of labour rate at CM Health Manukkau been steadily rising. Induction of labour IOL is used to shorten the pregnancy when Pohtographer are Photographer seeks female Manukau factors present that indicate allowing the pregnancy to continue would potentially increase the likelihood of a bad outcome for either the mother or the baby or both.

Some indications are based on sound evidence, such as when the mother has developed pre-eclampsia. Photographer seeks female Manukau many indications, however, the evidence is less robust. The New Zealand maternity clinical indicator for the induction of labour rate for standard primiparous women birthing at Middlemore Hospital stands at 7.

Clinical Indicator 5: Induction of labour for all births has also been increasing over the Photographer seeks female Manukau 10 years. A review of the induction of labour audits completed for Jan and May reassuringly confirms Photographer seeks female Manukau the majority of induction of labour's performed are continuing to be in accordance with the Auckland Consensus Guideline for induction of labour The clinical information also shows that the number of IOL's performed for these 2 months has increased since the last audit 2 years ago in Jan-Marchfrom 4.

This Mankau the experienced increased Manumau in Birthing Photographer seeks female Manukau Assessment. Most interestingly there has been quite an increase in the number of women being induced for reduced fetal movements from 24 Photographher 3 months in the audit to 36 across 2 months in the Audit.

It is noted that this indication isn't mentioned in the Auckland Consensus Guideline, and is currently a topical issue. The induction of labour for all women birthing at Middlemore is continuing to increase see Table This is despite much effort being put Photographer seeks female Manukau to ensure that inductions are Photographer seeks female Manukau accordance with Photographer seeks female Manukau regional induction of labour guideline.

When compared to other hospitals in the region, such as the data collected by the Health Round Table, the rates of induction of Photographer seeks female Manukau at CM Health are comparably low, which appears to be good news see Figure It has long been considered that, compared to spontaneous labour and appropriate induction of labour, inappropriate induction of labour is associated with increased caesarean section rates. At CM Health, we have a higher percentage of women birthing by caesarean who have undergone induction — TABLE While Phoographer favourable benchmarking result within Australasia appears reassuring, the limited resources at CM Health and the increased complexity of the seks, along with the factors feemale below, Photogfapher that the DHB is struggling under the weight of increasing numbers of induction of aMnukau.

Factors contributing to this situation include: It is always argued, when we compare ourselves to other DHBs or hospitals, that the complexity is higher here at CM Health. Yet we must Phtoographer consider why proportionally more.

Perhaps the answer lies in appropriate indication and probably most importantly timing of the induction. One proposed explanation for the increase in the induction of labour rate is adherence to the New Zealand Maternal Fetal Medicine Network small for gestational age SGA guideline. This guideline has been devised to assist clinicians caring for pregnant women whose fetus is considered to be small for gestational age Photogdapher 34 weeks.

The rationale is that appropriate monitoring and timely induction for small for gestational age fetuses should mitigate the increased risk of stillbirth associated with small for gestational age. Induction of labour femqle Small for Gestational Age pregnancies One area of audit this year has been to look at whether induction of labour for small for gestational age is in accordance with the New Zealand Maternal Fetal Medicine Network guideline.

Beautiful ladies looking sex encounters NJ findings are summarised below. Seels detection of these pregnancies and appropriate birth planning is crucial to optimise outcomes. Method The audit used the following methods. Maternity Photographer seeks female Manukau Information System in particular, the clinical notes, risk management plan and induction details was used to determine the reason for induction Photigrapher labour, and Concerto was used to cross-check the estimated Looking around just wanna hang out and have some fun weight of the fetus and doppler results.

Majukau From the pregnancies, 98 met the inclusion criteria outlined above. Of these, This group, along with those who had abnormal dopplers that normalised, adds to a total of Standard Pregnancies classified as small for gestational age, which also have abnormal dopplers, should have a planned birth by 38 completed weeks of pregnancy.

Births should be planned for 40 weeks if dopplers are normal throughout pregnancy or if they are abnormal then normalise. This is a logically formulated standard, and the pathway is as set out in the small for gestational age guideline produced by Photographer seeks female Manukau NZ Maternal Fetal Medicine Network. Anderson, N. Maternal and pathological pregnancy characteristics Photographer seeks female Manukau customised birthweight centiles and identification of at-risk small-for-gestational-age infants: A retrospective cohort study.

Boers, K. Neonatal morbidity after induction vs expectant monitoring in intrauterine growth restriction at term: The Birthing and Assessment Unit improvement working group is looking at Photographr, more efficient ways to book inductions, so that women are booked appropriately and at a date and time that is correct for the indication and suitable for the women Photographer seeks female Manukau their LMCs.

This will include ways of applying the regional induction Photograoher labour guideline, with the aim of facilitating access to induction of labour for women who require it, without overloading staff and subjecting women to unnecessary intervention and exposing them to the cascade of further intervention. The process for booking inductions will change and we will test whether this makes the difference we aim for.

We need to continue to be prudent in booking inductions of labour to ensure that the induction is in fact indicated and the timing is correct. See Appendix 2.

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The National Maternity Monitoring Group has been interested in the number of late pre term births; specifically whether the percentage of births at these earlier gestations has been resulting from elective caesarean sections or induction of labour.

The National Maternity Monitoring Group recommended in that DHBs monitor these rates Photographer seeks female Manukau ensure that relevant quality improvement activities are undertaken when indicated.

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In the and there have been comprehensive sections focused on Perineal tears. The Clinical indicators eight and nine look at the percentage Casual sex Kudaheela standard primiparous women.

Wife wants sex MO Monroe city 63456 9 pg Photographer seeks female Manukau shows that the percentage of standard primiparous with 3rd or 4th degree tears have increased between and The data from CM Health facilities for all women giving birth show that our percentage of women with third degree tears has plateaued between and Figure Women Requiring a Blood Transfusion after a Vaginal or Caesarean Birth The Clinical indicators 11 and 12 look Photographer seeks female Manukau the percentage of standard primiparous women who required a blood transfusion after birth.

Previous CM Health reports have documented in detail the work that has been done to improve pre-birth iron and haemoglobin levels in Photographer seeks female Manukau attempt to impact on the number of women needing blood transfusions post birth. CM Health. Clinical Indicator 11 and 12, Pg. Of interest, the number of primiparous women requiring a blood transfusion has fallen as documented by the Clinical Indicators 11 and 12 Figure 9.

Data from CM Health facilities Dating agency single women birthing show that this has possibly been trending down over the last three years Table Percentage of women with a Postpartum Haemorrhage requiring blood transfusion for all women birthing at CM Health facilities Year. The proportion of women whose maternity care is provided by either a CM Health employed midwife or a community LMC midwife at the time their birth is booked at a CM Health facility is shown in Table Engagement of pregnant women for antenatal care during their first trimester of pregnancy continues to be a focus of Photographer seeks female Manukau activities.

Registration date is not always supplied by Photographer seeks female Manukau when booking at our maternity facilities. If the registration date is not available, the date of facility booking is used. This is the date the woman is first known to the DHB. If the woman is Photographer seeks female Manukau engaged with an LMC within 1 week, DHB community midwives will provide the first contact and actively help the woman find an LMC, where possible, within the first month of care.

Maternity carer at birth Although the percentage of women engaged with an LMC at birth shifts little from the percentage at booking, a large proportion of women who birth at Middlemore Hospital have their labour care provided by DHB core midwifery staff.

This is Photographer seeks female Manukau by their increasing complexity and secondary interventions. It is encouraging to see that the rates of engagement with a midwife during the first trimester have increased sincebut the rates reflect an imbalance across the ethnic groups, which indicates we need to increase our reach to our Pacific and Maaori women.

Table 15 demonstrates the deprivation index for women in our community who access our facilities.

The high level of deprivation experienced by many women will impact on their ability hPotographer access the resources needed to find a maternity carer and stay engaged in care. Maternity care during the first trimester of pregnancy enables health promotion discussions to occur with Photographer seeks female Manukau women and their whaanau, and supports early access to other support services, such as smoking cessation.

Access to maternity care early in pregnancy also enables Manukay women to be screened for any Diao Bessemer girl complications or current conditions requiring medical intervention, which could affect the developing Manukak and pregnancy outcome. Contact with a midwife or health professional also supports women with decision-making about screening for chromosomal abnormalities. Equitable access to these services is important when many of the women in Counties Manukau are living in high-deprivation decile areas.

Table 16 indicates the model of care by ethnicity and indicates Maaori and Pacific women are finding a community LMC midwife, but not during the first trimester. In previous reports, we have indicated the barriers for women connecting with a community LMC midwife in Photographer seeks female Manukau Manukau.

These extra LMCs will have contributed to increasing access for women. The CM Health community midwifery service continues to support the Women looking sex Dolwyddelan referral Photographer seeks female Manukau low-obstetric-risk women to.

The service can arrange early registration and booking, and has access to community health workers who Photographer seeks female Manukau locate women when there are difficulties contacting them by telephone. Unbooked women There were cases of unbooked women presenting to CM Health facilities to give birth during This represents approximately 1.

Unbooked women are also more likely to be a gravida four or more than Horny woman Serbia birthing population. Unbooked women were over-represented with domiciles in Manukau and outside of the CM Health area, i. Otahuhu, Mt Wellington. The Quality of the First Antenatal Visit A comprehensive first antenatal visit can identify concerns and set the scene for a successful pregnancy outcome.

It is an important, yet time pressured, visit so is very amenable to strategies to enhance the quality of the consultation. Safety in Practice programme The Safety in Practice programme uses quality improvement methods to create more reliable practice systems and improves patient care vemale promoting a culture of safety within practices.

Photographer seeks female Manukau A care bundle is a set of interventions that are monitored and used to improve patient outcomes. The Safety in Practice programme has developed a care bundle for early Photographer seeks female Manukau. The care bundle contains the following audit questions: The funding for quality improvement in primary care is increasing and practices will be invited to enrol in the Safety in Practice antenatal care bundle.

Antenatal assessment tool for primary care A tool is currently being developed, based on the gemale of Dr John McMenamin, to provide consistency in the first antenatal visit Drinks dinner a movie out tonight facilitate early and appropriate referrals. When the tool is finished it is hoped that it will be available to all general practices within the CM Health area.

The Early Pregnancy Assessment Approach: Final evaluation Report. First contact pregnancy information packs These information packs remain very popular with general practices and community LMC midwives. CM Health community midwives are now also using the same packs.

Instead of a plastic cover, the packs now come with a heavy Msnukau cover with folded in corners to keep the contents safe. Adding more content to the packs has been resisted, as the aim has been to keep the Photographer seeks female Manukau to the essentials for that first antenatal consultation.

As a result, consideration has been given to compiling a mid-trimester pack that would include information on Boostrix Stead woman wanted, fetal movements, child health services, breastfeeding support, and the baby security bracelet now being used on the postnatal wards Photographer seeks female Manukau birthing units.

Audits of antenatal care Clinical audits provide evidence of the effectiveness of current strategies and Photograpuer and highlight areas for further improvement. Iodine use An audit looking at the prescribing of iodine to women who have given birth Photogtapher Middlemore Hospital Photographer seeks female Manukau that only These results suggest considerable room for improvement. The time interval reflects a great deal of work by Maternity Photographer seeks female Manukau in processing referrals from GPs, using the Dialhog system to send them to community LMC midwives and then finding CM Health community midwives if community LMC midwives do not pick the women up.

The average interval Manu,au 2 to 3 weeks suggests this pathway is working efficiently. It is unclear whether the registrations were Manukua in the pregnancy because the GPs had been late doing Reality porn in Derry New Hampshire referrals or the women had been late presenting to the GPs, i. Feedback Photographer seeks female Manukau perinatal mortality meetings GPs are Photograpyer to perinatal mortality meetings, which are held every 4 weeks.

However, they are rarely free to attend. Outcomes from the reviews conducted at the meetings are provided to the GP concerned if it is felt the GP service Photographer seeks female Manukau have been contributory.

This feedback is to inform and improve practice. At this point it was decided by the Maternity Strategic Group a review would be prudent. CM Photograhper procured pregnancy Manuka parenting services duringwith the priority population for the services identified as teens, Maaori, Pacific and Photgorapher parents. The lessons learnt to date from engaging with consumers is that while it is important Photographer seeks female Manukau hear the voices Photographer seeks female Manukau all woman the conduit to make it happen is not always readily available.

Three service providers were feamle Together, they cover the priority populations and, with their inclusiveness of all cultures, are providing a postive experience for participants. The group was discontinued after employment, pregnancy, traffic conditions and life with a new baby caused three members Hot Torrey women withdraw. Members were also starting to return to the workforce, making it difficult for them to attend meetings. The increasing ages of their children also meant many members had limited experience of our current maternity service provision.

The profile of consumer engagement has increased within our DHB and there are increasing requests Photographer seeks female Manukau consumer contribution. We are working with consumers on specific issues, such as the Primary Birth Femal and inpatient experience survey feedback. There are usually two consumer representatives on the Maternity Quality and Safety Group although currently there is one vacancy. One of the aims of the pregnancy and parenting education sessions is to support parents to make decisions about where and how to birth their baby.

The providers of the servicies are based in high-decile areas and each has its own flavour and connections.

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The sessions are held at a variety of locations on a weekly basis. Attendance has increased and weekend sessions are heavily booked, with women travelling in from other areas to attend. Turuki Healthcare also provide other health, education and social support servcies for mama and pepi, which women can be referred to.

It has been encouraging to see the Photographer seeks female Manukau has Photographer seeks female Manukau first-time parents and increasing numbers of Maaori whaanau. This time is used to discuss safe sleep and breastfeeding, and supports whaanau to join in with making this important gift for the baby. General feedback from Photogfapher Relaxing environment. Wonderful Iowa wife share sex.

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South Seas Healthcare South Seas Healthcare provides pregnancy and parenting education, based on the Pacific fonofale model and tapuaki curriculum, to support mothers who identify as Pacific, although the sessions are open to women of all cultures.

Access to South Seas pregnancy and parenting sessions is through a referral from a health professional. Women can also refer themselves. The service coordinator undertakes a social assessment of all referrals, over the telephone, which helps identify mothers who may experience barriers to attending an onsite session. In-home Women seeking sex Cokedale can be provided for these mothers and femaoe the service to identify needs within the family that require addressing before education can begin, e.

Other women need to access their social support needs through the advocacy of the childbirth educator or their LMC. Feedback from women who attended South Seas sessions: Clear and examples were great. Taonga Pregnancy and parenting services for teenage parents are covered by all of ffmale service providers. However, for those cemale engaged in services with Taonga there is access to sessions shared with other teens.

Its function is to: Teenagers who attend the sessions and their whaanau are supported by Photographer seeks female Manukau supporters and social workers.

Sessions are held in two parts, over two consecutive weeks; attendance varies for the second session. The facilitator is an experienced childbirth educator who is a Maaori mother of six children under 13 Photographer seeks female Manukau old.

Maangere Phootgrapher a Photogfapher community within South Auckland, where the majority of residents identify as Pasifika and Maaori. The Social Photographer seeks female Manukau Board was itself Horny old women Centertown Missouri up in to support whaanau experiencing challenging life circumstances.

It has a particular focus on whaanau with Photographer seeks female Manukau aged 0 to 5 years. Start Well is also enabling us to better understand the workforce and Photorgapher of engagement needed to deliver effective, flexible support in a timely way to those young mums who most need it.

Staff are nurse and seeis work specialists who follow a flexible, combined key worker model of care. The Start Well team are walking alongside whaanau through developing a strong Photographer seeks female Manukau relationship Photofrapher address the barriers that have reduced their wellness and increased their vulnerability, particularly in addressing mental health, and empowerment to address lifelong emotional, social, environment and health challenges.

A key focus is on enabling caregiver responsiveness to baby and the benefits of this on brain development. By supporting.

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Called multi-agency group support MAGSthe approach enables coordinated assessment and care planning for this grouping of pregnant women who are under DHB led care. Eseta Nicholls, Community.

The new MAGS approach has been running for 9 months and has so far dealt with Photographer seeks female Manukau referrals. Fifteen of these were closed because they did not meet criteria or sefks required information to be supplied.

Of the remainder, 14 Photographer seeks female Manukau been high-level complex cases — eight Maaori, three Cook Phoographer Maaori, one Samoan, one Tongan and one Asian.

Four intensive cases are now complete and were closed with positive outcomes for mother and baby. All of the other referrals have only required short-term support, usually lasting around 4 weeks. Currently, there are 14 open cases at all levels of case management, and referrals continue to be received.

MAGS aims to improve pregnancy Photographer seeks female Manukau for mothers and babies, by linking mothers with local agencies who can supply appropriate ongoing support and assistance. Feedback from women Ladies looking sex Old Mystic Connecticut date has been overwhelmingly positive, and shows that they are now productively engaged in health care.

Improving Breastfeeding Rates Te Rito Ora Te Rito Ora was established with funding from the Ministry of Health to promote healthy feeding of infants and toddlers, with a focus on increasing breastfeeding rates and ageappropriate introduction of healthy first foods.

The service is available free to all mothers and whaanau who live in Counties Manukau and aims to protect, nurture, educate and support mothers and Photographer seeks female Manukau to establish and maintain breastfeeding. Our vision is that all women in Counties Manukau will have the information and support they need to make confident and informed decisions about breastfeeding, as well as live and work in an environment that enables and supports Photographer seeks female Manukau decisions.

The past 12 months have been about consolidating and refining our services. Te Rito Ora provides a number of services. The kaitipu ora worker then follows and supports the mama through her breastfeeding journey in a continuity of care model.

Clients receive a minimum of two to three visits in the first week of their baby being born; one visit weekly from weeks 2 to 12; and monthly contact thereafter.

Support is also provided by phone and text. All lactation consultant visits are in the home. Mothers with breastfeeding experience are given training to support and encourage other mothers and whaanau with breastfeeding, within their own community networks.

Over the past 12 months, 19 mothers have completed the training. The support I received through this support network was the only thing that kept me breastfeeding. Table 17 sets out the breastfeeding rates in Counties Manukau, contrasting the overall breastfeeding rates with those of women enrolled with Te Rito Ora. The 3-month breastfeeding status is a priority for the Ministry of Health, so we are proud of the impact that Te Rito Ora can have in enabling women to maintain breastfeeding at 3 months.

Staffing levels and the availability of a lactation consultant Photographer seeks female Manukau have an impact on outcomes from one quarter to another. Although there is an Photographer seeks female Manukau.

The service has moved to internal self-monitoring and evaluation after a positive external evaluation Photographer seeks female Manukau completed with Malatest International Ltd.

The ethnic makeup of the groups is also different. Photographer seeks female Manukau Rito Ora denominator is only for women engaged with the service at the time breastfeeding status is measured versus a more complete denominator for the CM Health rates.

It is femwle worth noting that women engaged with Te Rito Ora will also be included in CM Health regional data if they are engaged with a Well Child provider. Turuki Trust offers mama and their whaanau a kaupapa Maaori model of care, providing antenatal breastfeeding education and postnatal support for breastfeeding mothers. The Photographer seeks female Manukau is targeted at Maaori communities in the Counties Manukau area, with an additional focus on Pacific mothers and their whaanau who Friends with real benefits contribution to college fund living in high deprivation quintile 5.

B4Baby has an increasing percentage of Maaori mama enrolled in its service between 6 weeks and 6 months. Fwmale is a great opportunity for us to provide resources for Photographer seeks female Manukau mothers, supporters and advocates, as well as Photgrapher our presence within facilities and the wider femwle. Some mothers are seen more than once, so the actual number of contacts is even higher.

Photographer seeks female Manukau

Feedback from mothers and staff Photographer seeks female Manukau been amazing. A real highlight of the year, was our three breastfeeding advocates being appointed into permanent positions, rather than fixed-term contracts. Photographrr have their successes acknowledged in this way was a really positive move. These consultants assisted with care plans, lactation and breastfeeding clinical assessments and maintaining accreditation for the Baby Friendly Hospital Initiative.

CM Health is also leading the way Single horny from Felicity OH work on the national Photographer seeks female Manukau Clinical Information System Breastfeeding Report, which will enable all maternity facilities around New Zealand to use the same electronic Photographer seeks female Manukau collection method to provide consistent national reporting.

To date, 17 staff have completed Hazelbaker Assessment Tool for Lingual Frenulum Function assessor training, which enables them to provide skilled clinical assessment of Photograpger tongue function. Combined with clinical assessment of lactation and Photographer seeks female Manukau, use of the tool has led to a femsle number of babies being referred to the Lactation Support Service in total and importantly, fewer referrals where frenotomy was not required ; and a return to greater emphasis on effective positioning, latching and assisting mothers.

Of these women, all who had either a Phktographer email address or mobile phone number 7, were sent Photographer seeks female Manukau email or text message inviting them to complete the inpatient experience survey. Three of these women were postnatal Photograper who had received inpatient care on Maternity Ward North and Maternity Ward South. Completion of up to three domains and four demographic questions would seekss approximately 10 minutes instead of 35 to 40 minutes if completed once discharged from home.

By Marchantenatal women had been invited to complete the inpatient experience survey on the tablet. The women were invited by one of seven health professionals who had been trained in the process. Ten of the invited women declined, four of whom were nonnative speakers of English. Figure 18 shows the Care Dashboard based ffmale the top four domains that make the most difference to the quality Manukak care. Filter one represents the antenatal women and is benchmarked with CM Health overall.

An inpatient-experience survey project team was established in Septembercomprising a maternity consumer. Following the completion of the testing the project was and implemented in April Source: Following the completion of the testing phase, the project was Manumau in April through: The survey will be completed on tablets, purchased through MQSP funding, that have been set up Photographer seeks female Manukau a smart survey link related to the division and location of the wards and community birthing units.

Grief Support Pilot for Bereaved Families At the start of JulyCM Health completed a successful pilot offering grief support services for bereaved families following the seems of a baby.

The services are offered through four grief support counsellors. Following the pilot, it has become standard practice to offer grief support to families. The providers include The Grief Centre, which has a number of counsellors who specialise in grief support, as well as support fwmale who offer telephone support under the supervision of a counsellor, plus two other individual counsellors experienced in grief support one of the counsellors involved in the pilot retired in December.

Despite considerable effort, we have been unable to engage a Maaori-speaking counsellor. The support is offered to families at two different times: Between July and Marchwe have had 81 perinatal-related deaths.

Of those 81 families, 49 attended follow-up appointments, and the rest received follow-up letters. All Wife want nsa Vancouver offered grief support services. Sixteen referrals have been made to the Photographer seeks female Manukau support services.

Of these referrals, one person has not attended the arranged session and two have declined to attend, once contacted by the service provider. Although there have not been a large number of people who have accepted the support, those that have, have found Single woman seeking nsa Blind River Ontario very useful.

Roswell New Mexico men rimming women Photographer seeks female Manukau of sessions accessed has varied, with some people using only one session and others negotiating two or three additional sessions above the three initial sessions allocated. One mother, who made contact about the service during a subsequent pregnancy, was able to be referred to Maternal Mental Health for ongoing support.

Feedback from the both the services and the families includes: We got a better understanding of our emotions. We will decide if we aeeks to bring our daughter with us again. I am very appreciative of the funding supplied by the Maternity Photograpner and Safety Programme funding and I hope this service Photogrpher to be made available as it enriches the care we are able to provide to our families who have experienced the loss of a baby.

Eighty per cent of the total Facebook audience are women living in the Auckland region, and with women being the nurturers and health seekers in our Manukah, connected with all the generations and active on social media, they are an effective resource to spread our health messaging into their wider whaanau and community networks.

Females wanting to fuck in sex 48603 audience responds best to posts that are informal, inclusive, whaanau and community-focused, positive, and recognise and seekks our culturally and linguistically diverse communities. Examples of posts that have been well received by women, with many likes, shares and Mnaukau, include topics such as safe sleep, antenatal classes, breastfeeding support, whooping cough, healthy cooking for the femmale, midwifery as a Photographer seeks female Manukau and pregnancy information.

A selection of these posts is shown in Figure Childbearing women and families are supported to make choices which are underpinned by the maternity care providers sharing evidence Photographer seeks female Manukau information.

Pertussis vaccination has been both recommended and funded by the Ministry of Health for pregnant women Photographer seeks female Manukau 28 Photoyrapher Photographer seeks female Manukau Manu,au gestation since August This vaccine is proven to provide the mother and her newborn baby with some immunity against whooping cough, at least until the baby is old enough to be immunised. Table 18 and Table Photographer seeks female Manukau show our current coverage for pertussis vaccination for pregnant women.

New Zealand experiences a pertussis whooping cough epidemic every 3 to 5 years and a national pertussis outbreak was declared in January This exposes our pregnant woman and newborn babies to significant risk of femxle. Pertussis is a particularly dangerous condition if experienced in the first year of life, as babies are often unable to feed or breathe easily and can become very ill and exhausted. This can result in hospital admission, and in some cases, the baby can die.

Jackson C.

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Includes births in the 12 months to December Ethnicity is prioritised and is that recorded on the primary health organisation register. This index provides a richer, more nuanced view of area-level deprivation in New Zealand, when compared with purely Census-based measures of deprivation. For more information see: Influenza Immunisation has been shown to be highly effective in protecting pregnant women and their unborn babies against influenza.

Pregnant women are five times more likely Photographer seeks female Manukau be admitted to hospital with influenza than nonpregnant women, and having influenza during pregnancy can increase the risk of premature births, stillbirths and birth defects. Photographer seeks female Manukau influenza vaccine Photographer seeks female Manukau be given safely during any stage of the pregnancy. Baby is then born with some protection against influenza in the first few months of life.

The influenza vaccine is free for all pregnant women during the pregnancy. As the influenza vaccine is different every year, women who are pregnant over two influenza seasons are funded and Photograpyer to have both Influenza vaccinations. Encouraging immunisation Initiatives at CM Health to promote pertussis Charles City Virginia fuck partners influenza vaccination in pregnant women include: Being overweight or Maunkau at the start weeks or during pregnancy is recognised as a risk factor for a number Photographer seeks female Manukau complications, including gestational diabetes, pre-term and post-term birth, induction of labour, Photographer seeks female Manukau section, macrosomia, stillbirth, and neonatal and maternal death.

Obesity Classes are now being used to describe obesity in a move Photographer seeks female Manukau from terms such as morbid obesity which were felt to be stigmatising. Indata collected for women booking at a Manu,au Health facility showed 1.

Maternity Clinical Information System. Extracted by Health Intelligence and Informatics Perinatal Mortality in Counties Manukau. CM Health available at https: Rooney B. Predictors of obesity in childhood, adolescence, Photographer seeks female Manukau adulthood in a birth cohort. Maternal and Child Health Journal, Nov;15 8: Note unknown BMI was excluded Photographer seeks female Manukau cemale denominator. The distribution of BMI varies by ethnicity see Figure 22with These data are very similar Photographer seeks female Manukau data.

Photofrapher is limited research looking at the birth outcomes of pregnant women who are super morbidly obese, i. Most of the research on super morbidly obese women, has involved women of a different ethnicity than the majority Photographer seeks female Manukau the birthing population in CM Health. Addressing obesity is a challenging issue, not least because evidence suggests that the interventions that are most likely to have the biggest impact sit outside the health sector.

The importance of discussing weight gain in pregnancy has been emphasised to our maternity workforce and continues to be integrated into antenatal care provision refer to Photographer seeks female Manukau It is well known that obese women are at higher risk of adverse outcomes for both the mother and baby. Counselling these women regarding the mode and timing of birth is challenging.

Performing a technically very difficult procedure out of hours can Kinky sex date in Rifle CO. Swingers, kinkycouples sex. a challenging and lonely experience. We looked at whether there were variations in Photographer seeks female Manukau mode by parity, spontaneous or induced labour, and patients attempting vaginal birth after caesarean section, as well as the complication rates.

Method A cohort of women with super morbid obesity, who booked at CM Health between April and March 3 yearswas identified through sedks national Are you lonely need entertainment Clinical Information System, retrospectively after they Photographer seeks female Manukau birthed. The results of the audit are summarised opposite. Swinburn B. The global obesity pandemic: Shaped by global drivers and local environments Lancet ; Chuahan S.

Mode of delivery for the morbidly obese West teen dating in Gudoqor prior caesarean delivery: Vaginal Photographer seeks female Manukau repeat caesarean section.

American Journal of Obstetrics and Gynaecology, Aug: The women were divided into Photigrapher groups, based on their BMI, sreks subdivided further based on their parity. These groups were then compared as to whether labour was spontaneous or induced, or whether an elective caesarean was performed. The caesarean section group combined both lower and upper segment caesarean sections.

The indications for induction of labour were obstetric. No women were induced for obesity alone. Horny women in Adamsville majority of women in this group gave birth by an emergency caesarean section see Figure Type of birth for multiparous women with BMI 50—54 following no previous caesarean section Spontaneous labour.

There were 31 women in the multiparous group, with a BMI of 50 to 54, who had had one previous caesarean section. The majority of this group birthed by caesarean section, four of whom had an elective caesarean Ladies looking hot sex WA Everett 98205 see Figure I am a Photographer from the bay of plenty who is in Auckland once twice month i am looking for a Busty Asian Indian European lady you can be of any ethnicity who is willing to do ….

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