Staff area

Quality and Safety

ISO 9001:2008

Ten Moons is ISO 9001 registered and certified.

Quality Management is important to us to ensure our services meet a certain level of quality;  that is, they are safe, reliable, consistent, meet our clients expectations, continuously improve and comply with the law.

Ten Moons is the first and only private midwifery practice in Australia to have a certified quality management system in place. Our quality management system is meeting the requirements of ISO 9001 for the provision of Private Midwifery Care including antenatal, intrapartum and postnatal care.

We annually evaluate our clinical performance to ensure we have met our clinical key performance indicators. This monitoring process is of upmost importance to us in ensuring that mothers and their babies are receiving safe and high quality care but also allows us to implement necessary changes and improvements to our services.

Quality Policy Statement

Ten Moons is committed to provide high quality midwifery services to women and their families in a safe, skilled, caring and supportive environment and to exceed their expectations by making continual improvements in all we do.

To achieve this goal, we have developed and implemented a Quality Management System that meets the requirements of ISO 9001:2008

We ensure that care is provided by appropriately qualified professionals and, through ongoing training, staff remains aware of the latest developments in their field and have adequate resources to conduct services safely and effectively.

The Quality Management System is reviewed annually to ensure its continued effectiveness and highest standard of client care.

Annual Birthing Statistics

We compare our Ten Moons Statistics to the National Core Maternity Indicators 2009 data and the Cosmos outcomes (‘COmparing Standard Maternity care with One to one midwifery Support’, 2012) for benchmarking comparison to national and local outcomes in the maternity services industry.

2014 Statistics2015 Statistics2016 Statistics

The most important conclusion for our 2014 data is that our midwifery care is safe, in particular homebirth.

National Core Maternity Indicators (Australian Institute of Health and Welfare)

 The ten national core maternity indicators are:

  • Developed by the Australian government to monitor the quality of maternity services in Australia
  • Clinical indicators that monitor the national quality of maternity performance and outcome of care

 

No. Description National Core Maternity Indicators (2009) Ten Moons (2014)
3a Episiotomy for women having their first baby and giving birth vaginally without instruments 15.1% 0%
3b Episiotomy for women having their first baby and giving birth vaginally with instruments 58.5% 0%
4 Apgar Score of less than 7 at 5 minutes for births at or after term 1.1% 0%
5 Induction of labour for selected women giving birth for the first time 32.7% 8.3%
6 Caesarean section for selected women giving birth for the first time 27.1% 8.3%
7 Normal (non-instrumental) vaginal birth for selected women giving birth for the first time 49.6% 83.3%
8 Instrumental vaginal birth for selected women giving birth for the first time 23.3% 8.3%
9 General anaesthetic for women giving birth by caesaraen section 8.4% 0%
10 Small babies among births at or after 40 weeks gestation 1.8% 0%

COSMOS (‘COmparing Standard Maternity care with One to one midwifery Support’, 2012)

  •  First randomised controlled trial comparing caseload midwifery care with standard options of care for women at low risk of medical complications at the Royal Women’s Hospital in Melbourne (in caseload midwifery, women are cared for by a primary midwife throughout pregnancy, birth and the early postnatal period, and care is provided by one or two back-up midwives only when needed)
  • First randomised controlled trial of caseload midwifery in Australia and largest study of its kind in the world
  • Caseload midwifery is a model of maternity care recommended in Victoria and throughout Australia and is often referred to as the ‘gold standard’ in maternity care

 

Description Cosmos (2012) Ten Moons (2014)
Episiotomy 23.1% 0%
Caesarean 19.4% 10.5%
Spontaneous Vaginal Birth 63% 84%
Epidural 30.5% 21%

Other Ten Moons Statistics (2014)

1. Parity (number of times that a woman has given birth)

Parity2014

 

 

 

 

 

2. Planned Place of Birth

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3. Homebirth Transfers

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Out of the 68% of women who planned having a homebirth, 85% gave birth at home. 15% of women got transfered to hospital non-emergently for failure to progress in the first stage of labour.

Emergency Hospital Transfers 0%!

 

 

4a. Type of Birth for all Women 

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Vaginal birth after caesarean (VBAC) were not included into the birthing statistics due to a small VBAC caseload (2). 1- successful VBAC, 2- repeat caesarean after attempted VBA2C

 

 

 

4b. Type of Birth for first time Mothers

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83% of first time mothers had a normal vaginal birth.

 

 

 

 

5. Onset of Labour

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6a. Perineal Injuries for all Women

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67% of 1st and 2nd degree tears did not get sutured and had healed completely by 6 weeks after birth.

 

 

 

6b. Perineal Injuries for first time Mothers

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7. Pharmacological Pain Relief

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N2O= gas in air

 

 

 

8. Birth Positions

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32% of the women having a waterbirth gave birth at home.

 

 

 

 

9. Birth of Placenta

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10. Postpartum Haemorrhage (PPH)

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The PPH >1L occured during a surgical birth in the hospital.

Out of the remainder 21% some occured during homebirths. None of the homebirths were transfered to hospital for PPH management and all of them got safely and appropriately managed at home with no adverse outcomes.

 

 

 

11. Neonatal Outcomes

  • 100% were born at term (>37 weeks gestation)
  • 100% had a birthweight >2500 gr
  • 100% had a 5 minute Apgar of 9
  • 0 SCN admissions in the homebirthing group
  • 2 SCN admissions for phototherapy at 3 days and 7 days of age in the planned hospital birth group (both cases had home visits from hospital midwives only, Ten Moons had limited involvement in the immediate postnatal care)

 

12. Breastfeeding Rates

Description Australian Institute of Family Studies (2008) Ten Moons (2014)
Breastfeeding Initiation Rate 92% 100%
Exclusive Breastfeeding Rate at 6 weeks   79%(11% partial breastfeeding rate, 11% of data incomplete at time of report)
Exclusive Breastfeeding Rate at 6 months 14% 58%(5% partial breastfeeding rate, 37% of data incomplete at time of report)

 

The above published statistics are based on a total caseload of 19.

 

References

The published statistics are based on a total caseload of 36.

1- Clinical Outcomes

1. Planned Place of Birth

2015 Place of Birth

 

  • 63.9% Planned Homebirth with private or public hospital back-up
  • 16.7% Combined Care- Hospital Birth Support in a private Hospital with our collaborating Obstetrician (Dr Ravi Kashyap)
  • 19.4% Hospital Birth Support in a public Hospital

 

 

2. Homebirth Transfers

2015 Transfer

 

  • 82.6% had a successful homebirth
  • 13% non-emergency hospital transfers (failure to progress in first stage, maternal request for epidural analgesia, retained placenta)
  • 4.3% emergency hospital transfer (undiagnosed placenta praevia intrapartum)

 

 

3. Parity (number of times that a woman has give birth)

2015 Parity

 

69% of our women were first time mothers

 

 

 

 

4a. Type of Birth for all Women

2015 Birth type

 

 

  • Caesar 5.6%
  • Vaginal birth 94.4%

 

 

 

4b. Type of Birth for first time Mothers

2015 Birth type - PG only

 

What an amazing result that we are certainly very proud of- 100% vaginal birth rate for all of our first time mothers!!

All of the first time mothers in the home birthing group had a vaginal birth, even if they were transferred to hospital.

 

 

5a. Perineal Injuries for all Women

2015 Perineum all

 

 

  • 72% intact
  • No 3rd or 4th degree tears
  • 3% Episiotomy (the episiotomy was cut in a public hospital for an instrumental birth)

 

 

5b. Perineal Injuries for first time Mothers

2015 Perineum PG

 

 

  • 62%intact
  • No 3rd or 4th degree tears
  • 4% Episiotomy (the episiotomy was cut in a public hospital for an instrumental birth)

 

 

6. Pharmacological Pain Relief

2015 Analgesia

 

 

  • 14% Gas in air
  • 3% Gas in air & Epidural
  • 3% General anaesthetic

 

 

7. Birth of Placenta

2015 Third Stage

 

 

 

 

 

 

8. Postpartum Haemorrhage (PPH)

2015 PPH

 

 

  • All of the postpartum haemorrhages occurred in the hospitals
  • None of the homebirthers had a PPH, despite all of them having a physiological third stage

 

 

9. Neonatal Outcomes

  • 97.2% were born at term (>37 weeks gestation), 2.8% at 34 weeks
  • 100% had a birthweight >2500gr
  • 94.4% had a 5 minute Apgar of 9 (none of the babies have been transferred to hospital or admitted to SCN for low Apgar scores)
  • 0 SCN admissions in the homebirthing group
  • 2 SCN admissions for term babies in the combined care group- phototherapy at 2 days of age, treatment for suspected sepsis

10. Breastfeeding Rates

  • Breastfeeding Initiation Rate 100%
  • Exclusive Breastfeeding Rate at 6 weeks 92%
  • Exclusive Breastfeeding Rate at 6 months 47% (42% of data incomplete at time of report)

2- Consumer satisfaction

client satisfaction

All clients are asked to complete a satisfaction survey at 4 weeks after birth:

  • 72.2% of clients have returned the client satisfaction survey
  • 96% have rated our service as excellent
  • 4% have rated our service as good
  • 0 complaints

3- Discussion

For the second year in a row we have failed to meet some of our clinical key performance indicators due to offering public hospital birth support as part of our services. In our model of care, women that have birthed in the public hospital system were exposed to the highest rate of interventions despite having a private midwife present for advocacy and independent support. As a consequence, this model of care is no longer offered as of 2016.

2015 Birth Type Compare

 

 

 

The published statistics are based on a total caseload of 53.

1- Clinical Outcomes

1. Planned Place of Birth

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  • 90.6% of our mums chose to birth in the comfort of their own home
  • 3.8% chose to birth in a private hospital with our collaborating Obstetrician Dr Ravi Kashyap
  • 5.7% birthed in a public hospital with our support

 

 

2. Homebirth Transfers

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  • 79.2% had a successful homebirth
  • 16.7% non-emergency hospital transfers (failure to progress in first stage, woman requesting pain relief)
  • 4.2% of women got transferred out into the medical model of care due to medical conditions arising during pregnancy

 

 

1 emergency transfer occurred of a newborn baby within minutes of birth. A Mobile Intensive Care Ambulance was called as the baby was not spontaneously breathing after birth despite giving airway assistance by the midwives at home. The baby was intubated at home by the paramedics and transferred to a Neonatal Intensive Care Unit. The baby was observed and treated in hospital for 2 weeks and the discharged home.

3. Parity (number of times that a woman has give birth)

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  • 38% of our mums were first time mums
  • 53% were having subsequent children
  • 9% were mums wanting a vaginal birth after previous cesarean section

 

 

 

4. Type of Birth for all Women

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  • 92.5% vaginal birth
  • 7.5% cesarean section rate
  • 5 women attempted a vaginal birth after cesarean, 3 were successful

 

 

 

 

 

5. Perineal Injuries for all Women

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  • 58% of women did not tear
  • 21% 1st degree tears
  • 13% 2nd degree tears
  • 6% 3rd degree tears
  • 0% 4th degree tears
  • 2% Episiotomy rate

 

None of the women that gave birth at home had a 3rd degree tear or Episiotomy. These all occurred in public hospitals following transfer.

83% of 1st and 2nd degree tears did not get sutured and healed well.

6. Pharmacological Pain Relief

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  • 83% of women used no pharmacological pain relief
  • 6% gas in air
  • 6% gas in air & epidural
  • 2% epidural
  • 2% spinal anaesthetic
  • 2% gas in air & Pethidine

7. Birth of Placenta

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  • 81% gave birth to their placenta spontaneously without administration of medications
  • 11% had the birth of the placenta assisted by traction on the cord

 

 

All women who gave birth at home birthed their placenta spontaneously. The 11% of women who had traction on the umbilical cord had been the ones who transferred into public hospitals.

8. Postpartum Haemorrhage (PPH)

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  • 75% normal blood loss

 

 

 

Some haemorrhages occurred at home but none were transferred to hospital. All of them got safely and appropriately managed at home with no adverse outcomes.

9. Neonatal Outcomes

  • 98% were born at term (>37 weeks gestation), 2% at 34 weeks
  • 100% of term babies had a birthweight >2500gr
  • 96.2% had a 5 minute Apgar of 9
  • 2 babies were admitted to Neonatal Intensive Care for low Apgar scores (1 baby from the home birthing group and 1 baby from the public hospital birthing group with Meconium Aspiration Syndrome)

10. Breastfeeding Rates

Breastfeeding Initiation Rate 100%
Exclusive Breastfeeding Rate at 6 weeks 98%

2- Consumer satisfaction

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  • 95% of clients rated our service as excellent
  • 3% rated us as satisfactory

 

 

 

 

All our clients are asked to complete a satisfaction survey at 6 weeks after birth. 69.8% returned their completed surveys. 1 informal complaint was lodged about value of service for money.

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