Maternal birth injuries

Learn how we are preparing to extend cover to parents injured during labour and birth, and how health providers can deliver these services.

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    Amendment bill in progress

    The Minister for ACC Hon Carmel Sepuloni has introduced an amendment bill which would expand ACC’s cover to include a specific list of maternal birth injuries as accidents. This would also allow for other physical and mental injuries directly related to these to be covered through the existing scheme.

    If passed by Parliament, the maternal birth injury changes in the Accident Compensation (Maternal Birth Injury and Other Matters) Amendment Bill are expected to come into effect from 1 October 2022.

    Keep informed on the progress of this legislation on the Aotearoa New Zealand Parliament website.

    Maternal birth injury amendment bill in Parliament

    How birthing injuries are currently covered

    The ACC scheme and the public health system currently provide help for nearly all injuries relating to pregnancy and childbirth. For example, ACC can cover injuries which are an unexpected result of treatment or lack of appropriate treatment during childbirth.

    The proposed legislative changes do not extend to pēpi (babies) injured during birth, but existing cover for treatment injuries will still be available.

    How we are getting ready

    To prepare for this potential change, we’re building a deep understanding of what is needed so we’re ready to support the needs of birthing parents, māmā and whānau from 1 October 2022.

    This is a significant and complex undertaking for us and will impact many parts of our organisation.

    We’re designing new pathways for birthing parents and practitioners so appropriate care, treatment and support is available for those who need it.

    To meet our responsibilities as a Te Tiriti partner and ensure equitable access to cover, te ao Māori perspectives and practices are being actively woven into how we design the service.

    We’ve been talking with health professionals, sector groups, Māori clinicians, and birthing parents and whānau so our service meets the diverse needs of our hapori and communities.

    As part of this, we’re holding online wānanga with ACC-registered rongoā Māori practitioners to understand how they currently support māmā and whānau during hapūtanga (pregnancy) and after birth.

    An expert advisory group has also been set up to make sure the service is appropriate and meets the needs of ACC clients and the healthcare sector.

    The membership of this group includes representatives from the following organisations:

    • The Royal Australian and New Zealand College of Obstetricians and Gynaecologists
    • New Zealand College of Midwives
    • Nga Maia Māori Midwives Aotearoa
    • Royal New Zealand College of General Practitioners
    • Te Ohu Rata o Aotearoa (Te ORA) – Māori Medical Practitioners Association
    • Nurse Practitioners New Zealand
    • Physiotherapy New Zealand
    • Tae Ora Tinana
    • Pasifika Medical Association Group
    • Victoria University of Wellington
    • AUT
    • Birth Trauma Aotearoa.

    Providing maternal birth injury services

    So providers and suppliers can deliver these services from 1 October, we will be making variations to some existing contracts

    We will also be adding non-contracted codes for some working under Cost of Treatment Regulations. That means for those already working with us, there is currently nothing further to do. Contract variations and updated Cost of Treatment Regulation codes will be sent out shortly.  

    Like other healthcare providers, midwives will have a role to play in the extension of cover to include maternal birth injuries. However, because midwives don’t currently work with ACC, we’re still working through what this will look like.

    We’ll share more information closer to the time about how midwives can prepare to support this new service. In the meantime, there is nothing further for midwives to do.

    Keep up-to-date

    We want to hear from a wide range of practitioners who work across the motu (country) and who provide services to birthing parents and whānau. It doesn’t matter if you’re already registered to provide ACC services or not.

    Please register your details if you would like to receive further updates and opportunities relating to this work.

    Contact form for practitioners wanting to know more about maternal birth injury services

    To help meet our responsibility as a Te Tiriti partner, we encourage those who have experience in te ao Māori and delivering services to whānau Māori to sign up.

    There will be a wide range of healthcare professions which have the skills and expertise in this area, including but not limited to:

    • obstetricians
    • gynaecologists
    • GPs
    • kaupapa Māori health service providers
    • rongoā Māori practitioners
    • midwives
    • pelvic health physiotherapists.

    We know many different professions interact with birthing parents and whānau in different ways and at different times throughout pregnancy, birth, and the early start to life.

    It‘s important we reach as many practitioners as possible across this journey to ensure those who experience a maternal birth injury can receive the appropriate treatment and care at the right time.

    Notifications through GETS

    We will also post information and updates on the Government Electronic Tenders Service (GETS) website.

    GETS website

    Those who are registered with GETS can set up notifications to receive updates. It's not necessary to sign up to GETS if you'd like to apply to deliver these services.

    For practitioners interested in signing up, a registration guide is available.

    How to register as a supplier on GETS

    Feedback and queries

    For any pātai or queries about this work, get in touch. We will collate questions received and update this page with further information regularly.

    If your query is commercially sensitive, note this in the subject line.

    Email maternalbirthinjuries@acc.co.nz

    Answering your questions 

    Which maternal birth injuries will be covered?

    The Amendment Bill proposes ACC extends cover to include seven injuries as accidents.

    These are:

    • Labial, vaginal, vulval, clitoral, cervical, rectal and perineal tears
    • Levator avulsion
    • Obstetric fistula (including vesicovaginal, colovaginal and ureterovaginal)
    • Obstetric haematoma of pelvis
    • Pudendal neuropathy
    • Ruptured uterus during labour
    • Uterine prolapse

    To be eligible for cover, an injury must be on the list and meet the proposed expanded definition of ‘accident’ which would include force or resistance internal to the body from the start of labour to birth.

    However, the legislation is still being considered by Parliament and may change before it is finalised. If passed by Parliament, cover will only apply for injuries from 1 October 2022.

    Updates on the legislative process are available on the Parliament website.

    Why aren’t all maternal birth injuries covered?

    Decisions on which injuries are covered will be made as the legislation goes through the Parliamentary process. The initial list of injuries was developed with obstetric and urogynaecology experts to cover acute injuries understood to result from childbirth. 

    Public submissions made through the Select Committee process are helping to inform and test the appropriateness of the listed injuries in the final Amendment Bill. It’s expected this list will encapsulate all injuries resulting from the forces of childbirth.

    ACC’s focus is on developing treatment pathways for our kiritaki (clients) and their whānau so they can access appropriate care and treatment for their needs. 

    Why aren’t all mental injuries associated with birth included?

    Under the proposed legislation, mental injuries will be covered if they’re caused by a covered physical birthing injury. This is the same as what currently happens with other physical injuries under the AC Scheme. 

    There will be some birthing parents who struggle with mental distress following such a life-changing and traumatic event, which are not associated with the proposed covered physical injuries. 

    These parents should continue to seek appropriate help and support through their Lead Maternity Carer, GP or new parent groups.    

    How are you ensuring te ao Māori is incorporated?

    As a Te Tiriti partner, we’re committed to partnering with Māori to make sure the Maternal Birth Injury service meets tikanga and cultural practices.

    To inform the design of this kaupapa, we’re ensuring we bring insights from hapū māmā and whānau, Māori clinicians, kaupapa Māori health providers and rongoā Māori practitioners to our service design.

    We will also be working with kaupapa Māori health service providers and rongoā Māori practitioners to make sure they are ready to offer these services from 1 October 2022.

    How will the process work for a birthing parent?

    We are developing the specific processes required by the proposed legislation to make sure birthing parents and their whānau can access the support they need from 1 October 2022.

    Because this would be a new service, we’re taking a considered and detailed approach to designing a care and treatment pathway that suits the diverse needs of our hapori and communities.

    We’ve talked with healthcare practitioners, Māori clinicians, sector groups, birthing parents and whānau with lived experience to help us do this.
    We do not expect all birthing injuries will need to have a claim lodged with us.

    For many birthing parents, the injuries suffered during labour and birth will resolve through the normal recovery process and through existing care provided in the public health system and by Lead Maternity Carers.

    If injuries need a level of support beyond what’s provided by normal maternity care in the first six weeks, an ACC claim can be lodged to access appropriate treatment and support.

    Our aim is to make accessing these services as easy as possible for injured birthing parents.

    We expect cover for most physical injuries will be straightforward, and we will be automating parts of the claim lodgement process meaning our clients can begin their recovery faster.

    The normal cover for treatment injuries relating to labour and birth will still be available to the birthing parent and pēpi.

    Who will be able to diagnose and lodge claims?

    The ability to diagnose a specific injury or condition is determined by a health professional’s scope of practice, which is defined by the relevant professional body. ACC has no role in this.

    Lodging an ACC claim is defined by our lodgement framework. This often references specific health professionals and their scope of practice, but we can include additional requirements or restrictions if considered appropriate.

    We’re working on the appropriate lodgement framework for maternal birth injuries. Initially, this may draw on existing frameworks, but we will be consulting with provider groups about this over the next few months.

    What if there’s a delay in diagnosis and claim lodgment?

    The time since an injury happened does not necessarily impact the ability to lodge a claim.

    Maternal birth injuries can often present some time after a birth. For example, a prolapse may happen 18 months later or sexual dysfunction may occur after 12 months. These claims will be considered and processed as consequential injuries.

    In some instances, we may need to ask for more information to establish eligibility for cover.

    What role will specific professions have in lodging claims?

    We know different types of practitioners, such as physiotherapists, rongoā Māori practitioners and acupuncture providers, will already be providing care to kiritaki with birthing injuries and whānau. We’re currently looking at how these will work with the Maternal Birth Injury service to meet the needs of our communities.

    We’re setting up an external Expert Advisory Group to help us as we continue to develop the service. Commercial arrangements may differ depending on the type of practitioner, but we will be working with professional bodies and associations to confirm those details.

    We’ll keep relevant sector groups informed about how to prepare for 1 October.

    In the meantime, practitioners interested in receiving updates can register their details through our survey or set up alerts on the GETS website for future opportunities.

    Contact form for practitioners wanting to know more about maternal birth injury services

    GETS website

    What if I work under Cost of Treatment Regulations?

    Under this proposed legislation, practitioners working under the Cost of Treatment Regulations will be able to provide services to clients who have sustained a Maternal Birthing injury. Treatment provided to these clients will be able to be billed in a  similar way to current injury claims.

    Last published: 2 June 2022