Relevant clause in Section 88 - DA25

Labour and birth exceptional circumstances is a fee that can be claimed by the woman’s LMC under specific conditions in relation to the birth:

Attendance at an elective caesarean section where requested by the woman and where the LMC has provided second and third trimester care (Section 88 p. 1069 part c)

Example of this:

  • A woman registered with her LMC at 25.1 weeks and underwent a planned C section at term. The LMC’s back up was on call during the procedure and was in theatre to support the woman during her C section OR
  • Attendance at the birth if clinical responsibility for the woman is transferred to secondary maternity not more than 48 hours before established labour or birth.

Examples of this:

  • A woman with pre-eclampsia had her care transferred to the secondary services for an induction of labour. She establishes labour within 24 hours of the transfer of care. The baby was born by assisted delivery and the LMC was present.
  • A woman registers with a provider at 33 weeks and she began to labour at 39 weeks. She is progressing beautifully but has not established in labour then the baby goes into distress and the consultant wants to perform a C section. The LMC is present in theatre.

OR

If there is no labour and it was anticipated that clinical responsibility forthe labour and birth would remain with the LMC, but circumstances change, giving no opportunity for a planned transfer.

Examples of this:

  • A woman arrived to clinic in a rural area for a routine visit in her third trimester and it was found the baby was in distress. The midwife sent her urgently to hospital where she underwent an emergency C section shortly after admission. The LMC was unable to get to the hospital in time.
  • A woman is sent by her LMC to hospital for an assessment of APH. While at the hospital, it is decided that a C section needs to be performed but the midwife is not able to be there as she is at the birth of another woman.

Examples where the exceptional circumstances fee cannot be claimed:

  • A woman from a rural area has planned to have a C section however her local midwife cannot attend. She has a colleague who lives closer who can be present at the birth, who registers the woman at 39 weeks. The second midwife attends the C section and the first midwife does not.
  • A woman has high needs and the LMC carries out 20 visits throughout the antenatal period in a remote rural location.
  • A woman had an NVB at 19.2 weeks and the baby weighs 240 grams (non-registerable birth).

The Ministry of Health does have the discretion to pay an exceptional circumstances fee in situations that an LMC deems as “strange” or “unusual” occurrences during antenatal care or during a birth. Any circumstances that are not within the above claiming requirements, the provider must make a written application to the Ministry of Health for consideration and receive approval. (Section 88 p. 1069 part d)