Antenatal Care Guideline (GL956) Approval and Authorisation Approval Group Job Title, Chair of Committee Maternity & Children’s Services Chair Maternity Clinical Clinical Governance Committee Governance Committee

Version 1.0 1.1

Author: Job Title:

Date September 2014 June 2016

Date 10th February 2015 V1.1 approved 1st July 2016

Change History Author Reason Jean Sangha & Trust requirement Emma Matthews E Matthews (Deputy Pg 7 – Sentence added to 3.3 re: Matron for CMW & declining translation Rushey) Pg 12 – 5.4 Social inclusion MW details added Pg 13 - CSE screening tool introduced as part of safeguarding Pg 14 – 6.1.2 para amended Pg 15 – 6.3.1 – Rubella removed Pg 16 – 6.3.2 – 1st para amended Pg 21 – 7.7 bullet point 3 amended Pg 22 – 8.2 Fetal movements criteria changed from 26 to 28wks Pg 24 – 10.0 AN class info added Pg 31 – MRSA flowchart updated Pg 36 – Reduced fetal movement flowchart updated

Policy Lead:

Emma Matthews, Jean Sangha & Nicky Benns Senior Midwife Team Lead, Community Midwifery Matron & Maternity Risk Manager Group Director Urgent Care

Location:

Policy hub/ Clinical/ Maternity /Antenatal/ GL956

Date: Review Date: Version:

July 2016 February 2017 1.1 ratified 1 2016 Page 1 of 35

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This guideline should be read in conjunction with the following policies and guidelines                           

Antenatal Screening Policy (CG474) Antenatal Sickle Cell and Thalassaemia (SCAT) Screening Programme (CG475) Anti D guideline (GL786) Bariatric guideline (GL791) Booking women after 12+6 completed weeks of pregnancy (GL795) Breech third trimester - Antenatal (GL799) Consultant Referral Criteria (GL810) Down’s Syndrome Screening Policy (CG481) Fundal Height measurement guideline (GL847) Gestational Diabetes Screening & Diagnosis (GL823) Guidance on Cultural Issues and Non-English speaking Women (GL814) Protocol for maternity patients requiring an interpreter (CG495) Late Booking >12+6 weeks (GL838) Management of HIV positive women and their baby policy (CG490) Hypertension – management in pregnancy guideline (GL952) Management of Twin & Multiple Pregnancy (GL928) Non attendees at Antenatal clinics/No access Visits protocol (CG499) Planning place of birth (GL887) Poppy team (GL889) Pregnancy Management for Type 1 & Type 2 Diabetes (GL826) Induction of labour and augmentation of PLRoM in prolonged pregnancy guideline (GL861) Record Keeping – Standards for (GL901) Small for Gestational Age (GL916) Protocol in relation to the risk and vulnerability factors for the babies of mothers with problem drug and alcohol use (CG504) Guideline when caring for women who misuse substances - but who are NOT already registered on a Methadone or Buprenorphine (Subutex or Suboxone) regime (GL922) Working with substance misusing parents leaflet for staff Syphilis Policy (CG505)

Author:

Policy Lead:

Emma Matthews, Jean Sangha & Nicky Benns Senior Midwife Team Lead, Community Midwifery Matron & Maternity Risk Manager Group Director Urgent Care

Location:

Policy hub/ Clinical/ Maternity /Antenatal/ GL956

Job Title:

Date:

July 2016

Review Date:

February 2017

Version:

1.1 ratified 1 July 2016

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CONTENTS 1.0 Introduction ........................................................................................................ 5 2.0 Purpose and Principles of Antenatal Care ....................................................... 5 3.0 Standards for Antenatal Care ............................................................................ 5 3.1 Location .......................................................................................................... 5 3.2 Equality and Diversity .................................................................................... 6 3.3 Interpreter Services........................................................................................ 7 4.0 Responsibilities and Accountabilities in the Community Setting .................. 7 4.1 General Practitioner ....................................................................................... 7 4.2 ‘Pre-booking’ Appointment ........................................................................... 8 4.3 Community Midwife ....................................................................................... 8 4.4 Maternity Support Worker in AN Care in the Community ........................... 9 4.5 The Poppy Team............................................................................................. 9 4.6 Documentation ............................................................................................. 10 4.7 Health Visitor ................................................................................................ 11 5.0 Hospital Antenatal Clinics ............................................................................... 12 5.1 Referral process ........................................................................................... 12 5.2 Consultant Antenatal Clinics ...................................................................... 12 5.3 Anaesthetic Care Plan ................................................................................. 12 5.4 Specialist Midwifery Services ..................................................................... 12 6.0 Booking Appointment ...................................................................................... 13 6.1 Screening for important risk factors at the booking appointment: ......... 14 6.1.1 History of congenital/inherited disorders ............................................... 14 6.1.2 New residents to UK ................................................................................. 14 6.2 Mental Health ................................................................................................ 14 6.3 Screening Tests............................................................................................ 15 6.3.1 Booking bloods are taken with consent for: .......................................... 15 6.3.2 Hepatitis C Screening ............................................................................... 15 6.3.3 Urine testing .............................................................................................. 16 6.3.4 Testing for Chlamydia .............................................................................. 16 7.0 Health and wellbeing for all pregnant women ............................................... 17 7.1 Nutritional supplements and dietary advice .................................................. 17 7.2 Folic Acid prophylaxis ..................................................................................... 17 7.3 Vitamin D supplements .................................................................................... 17 7.4 Health Promotion ............................................................................................. 18 7.4.1 Smoking ............................................................................................................ 18 7.4.2 Alcohol .............................................................................................................. 18 7.4.3 Lifestyle Questionnaire .................................................................................... 18 7.5 Observations: ................................................................................................... 19 7.5.1 Height and Weight ............................................................................................ 19 7.5.2 Obesity (Body Mass Index (BMI) >35kgs/m2) ................................................ 19 7.5.2.1 BMI 30-34.9kgs/m2 ...................................................................................... 19 7.5.2.2 BMI >35kgs/m2 ............................................................................................ 19 7.5.2.3 BMI >40kgs/m2 ............................................................................................ 19 7.6 Women at risk of pre-eclampsia ..................................................................... 20 Author:

Policy Lead:

Emma Matthews, Jean Sangha & Nicky Benns Senior Midwife Team Lead, Community Midwifery Matron & Maternity Risk Manager Group Director Urgent Care

Location:

Policy hub/ Clinical/ Maternity /Antenatal/ GL956

Job Title:

Date:

July 2016

Review Date:

February 2017

Version:

1.1 ratified 1 July 2016

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7.6.1 7.6.2 7.7 7.8 8.0 9.0 10.0 11.0 12.0 13.0 14.0 14.1 14.2 14.3 14.4 14.5 14.6 14.7 14.8 14.9

July 2016

Moderate Risk ................................................................................................... 20 High Risk ........................................................................................................... 20 Diabetes screening in pregnancy at approximately 28 weeks: .................... 20 Mothers with established diabetes: ................................................................ 21 Antenatal Appointment Schedule ................................................................... 21 Day Assessment Unit (DAU) ............................................................................ 23 Antenatal parenthood preparation classes .................................................... 24 Late Booking/Missed Appointments............................................................... 24 Standards .......................................................................................................... 25 References ........................................................................................................ 25 Appendices ....................................................................................................... 27 Antenatal booking flow chart .......................................................................... 28 Antenatal management of anaemia ................................................................ 28 Fetal anomaly flow chart.................................................................................. 29 Hepatitis C screening pathway ....................................................................... 30 MRSA pathway ................................................................................................. 31 Maternal Mental Health pathway (pending changes) .................................... 32 Smoking cessation pathway in pregnancy .................................................... 33 Child protection Process for maternity .......................................................... 34 Reduced fetal movement flow chart ............................................................... 35

Author:

Policy Lead:

Emma Matthews, Jean Sangha & Nicky Benns Senior Midwife Team Lead, Community Midwifery Matron & Maternity Risk Manager Group Director Urgent Care

Location:

Policy hub/ Clinical/ Maternity /Antenatal/ GL956

Job Title:

Date:

July 2016

Review Date:

February 2017

Version:

1.1 ratified 1 July 2016

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1.0 Introduction The purpose of this guideline is to assist all professional groups involved in providing antenatal care to pregnant women. It aims to promote a consistent, efficient and evidence based approach to the provision of antenatal care. It also provides a framework and schedule for the delivery of care in the community and hospital setting. It does not however, replace individualised care and management. This guideline does not provide detail on managing medical conditions. This information can be found in the maternity guidelines on the hospital intranet site or from outside the Trust via the internet at http://rberks.nhs.sitekit.net/maternity-guidelines-and-policies.htm 2.0 Purpose and Principles of Antenatal Care The antenatal period is defined from conception to the birth of the baby. The purpose of antenatal care is to maintain and improve the woman’s health and wellbeing by:  Monitor maternal and fetal wellbeing to prevent and manage health problems related to pregnancy  To provide education and advice on health and wellbeing during and after pregnancy  A time for preparation for labour, the birth and preparation for parenthood Pregnancy is a normal physiological process and as such, any interventions offered should have known benefits and be acceptable to the pregnant woman. Each antenatal appointment should be structured and focused with adequate time for discussion to enable the women to make informed choices and to discuss concerns and anxieties. All women should be encouraged to seek antenatal care at the earliest opportunity in order to discuss antenatal screening and to ensure that tests are undertaken in accordance with the UK National Screening Programme and Standards. The woman should be informed who will be providing her care and her options as to where the care will be provided. 3.0 Standards for Antenatal Care The following should be observed when planning and implementing antenatal care: 3.1 Location Antenatal care is provided in a variety of settings such as GP surgeries, children’s centres, hospital, the woman’s home or in other community based settings. Wherever the care is provided it should be welcoming and accessible. The woman’s privacy and dignity should be maintained at all times and Author:

Policy Lead:

Emma Matthews, Jean Sangha & Nicky Benns Senior Midwife Team Lead, Community Midwifery Matron & Maternity Risk Manager Group Director Urgent Care

Location:

Policy hub/ Clinical/ Maternity /Antenatal/ GL956

Job Title:

Date:

July 2016

Review Date:

February 2017

Version:

1.1 ratified 1 July 2016

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discussions around sensitive issues such as domestic and/or sexual abuse, psychiatric illness and illicit drug and alcohol when confidentiality is important. The environment in which antenatal care is provided should be risk assessed to ensure safety for the woman and family. There should be no electrical, sharps or trip hazards. As a minimum there should be access to:          

Hand washing facilities/hand sanitizer A suitable examination couch/bed with appropriate load allowance A sphygmometer to measure blood pressure and urine testing equipment Weighing scales Disposable measuring tapes to measure symphysis fundal height A sonicaid Pathology supplies and request forms A container for safely discarding sharps Transport for blood tests/specimens to the laboratory Access to pathology results where possible

3.2 Equality and Diversity All health care professionals should respect the diversity and individuality of people with disabilities. The disability may be physical, mental, sensory or a learning disability. First and foremost the woman should be seen as an individual with a disability rather than the disability. All care must be compliant with the Disabilities Discrimination Act (1997) which emphasizes the duty of care concerning access, quality of services, communication awareness and makes it unlawful to provide a lower standard of care to a disabled person. Also the Disability Equality Duty (2006) requires that public authorities demonstrate positive attitudes to promote equal opportunities for people living with disabilities. Midwives have a key role in supporting the pregnant women with a disability and should demonstrate disability awareness. They may be required to work in collaboration across service boundaries to provide the best possible care tailored to the individual woman’s needs. Midwives need to find out how the pregnancy will impact on the disability by establishing whether there is a need to refer for specialist advice such as genetic counseling or whether medications, such as anti-depressants are safe to take during pregnancy. The midwife needs to be aware of organisations that can provide information and support and the benefits that can be claimed. Good communication and a clear plan should be developed with the mother in preparation for childbirth and care when home. A visit to the hospital may be arranged to address any care or equipment needs.

Author:

Policy Lead:

Emma Matthews, Jean Sangha & Nicky Benns Senior Midwife Team Lead, Community Midwifery Matron & Maternity Risk Manager Group Director Urgent Care

Location:

Policy hub/ Clinical/ Maternity /Antenatal/ GL956

Job Title:

Date:

July 2016

Review Date:

February 2017

Version:

1.1 ratified 1 July 2016

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3.3 Interpreter Services For women who do not speak or understand English, or who have hearing or speech impairments, the use of a professional, qualified interpreter should be offered. Ideally this needs to be identified prior to the booking appointment so that an interpreter is available for this appointment. Where it has been identified that an interpreter is required this should be noted on the front page of the hand held record so that interpreters can be arranged for all appointments, labour and during the postnatal period as required. The need for an interpreter and the language required should be documented on any referral forms so that an interpreter can be arranged for hospital appointments. For women that decline the use of an interpreter, it must be explained that an interpreter needs to be booked and present as protection for the staff member to ensure that family members/friends are translating correctly. In addition these women should be offered information on how to book Easy English antenatal classes. Women can be directly referred to the social inclusion team or the leaflet can be found in the stationary section on the maternity guidelines website.

4.0

Responsibilities and Accountabilities in the Community Setting 4.1 General Practitioner The role of the GP in antenatal care has declined in recent years since direct access to a midwife was endorsed by Changing Childbirth in 1997. Many women, however, still see their GP as the first point of contact and will continue to see their GP alternately with the midwife. The GP should be adequately trained to care for pregnancy women safely. They have an important role in antenatal care including:    

   

Preconception counselling and advice including prescribing the correct dose of folic acid for those women with risk factors Health promotion in early pregnancy regarding diet, obesity and smoking cessation Early referral to the midwife to ensure booking takes place before 12 weeks The need to be competent in recognising and managing conditions such as hyperemesis, bleeding in early pregnancy, pre-eclampsia, sepsis, headache and breathlessness throughout pregnancy, as well as other pre-existing medical conditions Making urgent referrals Assessing and providing care for women with mental health and/or substance misuse issues They are also required to undertake a cardiovascular examination of all women who have become resident in the UK in the last year Ensuring early communication to the appropriate Children Services department if there are concerns regarding child protection issues

Author:

Policy Lead:

Emma Matthews, Jean Sangha & Nicky Benns Senior Midwife Team Lead, Community Midwifery Matron & Maternity Risk Manager Group Director Urgent Care

Location:

Policy hub/ Clinical/ Maternity /Antenatal/ GL956

Job Title:

Date:

July 2016

Review Date:

February 2017

Version:

1.1 ratified 1 July 2016

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4.2 ‘Pre-booking’ Appointment Women may choose whether they wish to see a GP for a pre-booking appointment. This appointment can provide the woman with information on healthy lifestyle considerations and early antenatal screening options. Otherwise this will be covered at their midwife booking appointment. The following will be addressed: 4.3 Community Midwife Every pregnant woman will need the support of a named midwife whom she knows and trusts throughout her pregnancy. It is important to recognise that pregnancy and birth are normal life events for most women. All midwives are required to have the necessary skills and knowledge which should be evidenced based and to be able to identify when to refer to the most appropriate clinician or specialist team. Good communication between healthcare professionals and the woman is essential to ensure she is able to make informed decisions about her care. The woman should be allocated a named midwife and a consultant obstetrician where appropriate. This should be recorded on the front page of the woman’s hand held record. Where possible the woman should be cared for by her named midwife (NICE, 2012). There should be continuity of care throughout the antenatal period. The named midwife should be identified at the booking appointment. Women should be aware of how to contact their named community midwife or their local community midwifery services. Contact details will be provided in their hand held records. The named midwife may not necessarily provide all the antenatal and postnatal care. They should be responsible for ensuring that the woman has been offered and provided with antenatal care in accordance with the antenatal care schedule. All test results should be recorded in the hand held record and the hospital held record if appropriate. It is the responsibility of either the named midwife or midwife who undertook the test to check the result and action if required. The community midwife, preferably the named midwife, will work in partnership with the women in drawing up a flexible and individualised care plan for her pregnancy and labour. Her choices of where to give birth should be respected. Where possible there should be continuity of care from one or a small number of midwives to gain the women’s trust and confidence. All antenatal hand held notes should be returned to the hospital immediately following delivery, even if the baby is born at home.

Author:

Policy Lead:

Emma Matthews, Jean Sangha & Nicky Benns Senior Midwife Team Lead, Community Midwifery Matron & Maternity Risk Manager Group Director Urgent Care

Location:

Policy hub/ Clinical/ Maternity /Antenatal/ GL956

Job Title:

Date:

July 2016

Review Date:

February 2017

Version:

1.1 ratified 1 July 2016

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4.4 Maternity Support Worker in AN Care in the Community The role of the maternity support worker (MSW) in antenatal care is to undertake work for which midwifery training and registration are not required. Any care provided in the antenatal period should be undertaken under direct supervision of the midwife. They should work within a clear framework which defines their role, responsibilities and arrangements for supervision. The decision to delegate a task should be made solely by the midwife based on his/her professional judgment and he/she retains responsibility and accountability for such delegation. The NHS South Central Maternity Support Worker Governance Framework advises on the monitoring of standards of practice required of Maternity Support Workers (MSWs). It is intended to ensure that MSWs undertake their work in a safe, skilled and competent manner to ensure high quality and safe patient services, in the interest of public protection. The role of the MSW is to carry out a delegated task to the agreed level of competence and to report back to a midwife following completion of a delegated task. The decision to delegate a task should be made by the midwife. The midwife will be accountable for ensuring that any delegation to a MSW is appropriate. The delegating midwife remains accountable to the NMC and her employer for the appropriateness of that delegation. It is important that the appropriate level of supervision has previously been provided to ensure MSW competence in carrying out the delegated task (NMC, 2008). A midwife should also be responsible for reassessing the condition of the woman at appropriate intervals. Clear communication between the midwife and MSW is vital to enable the MSW to report clinical findings to the midwife which should be supported by clear written records. Thus the MSW should be allocated a midwife ‘buddy’ for their working day so that they are able to communicate back their findings to the midwife who will advise accordingly. 4.5 The Poppy Team The Poppy team is a small team of midwives who provide maternity care to women identified with complex social factors with the aim of ensuring these women receive women centred, specialised care that is individually tailored to their needs. Examples of women with complex social needs include, but are not limited to women who: 

Have a history of substance misuse (alcohol and/or drugs)



Have recently arrived as a migrant, asylum seeker or refugee



Have difficulty speaking or understanding English



Are aged under 20



Have a history of mental health problems or a disability

Author:

Policy Lead:

Emma Matthews, Jean Sangha & Nicky Benns Senior Midwife Team Lead, Community Midwifery Matron & Maternity Risk Manager Group Director Urgent Care

Location:

Policy hub/ Clinical/ Maternity /Antenatal/ GL956

Job Title:

Date:

July 2016

Review Date:

February 2017

Version:

1.1 ratified 1 July 2016

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Have experienced domestic abuse



are living in poverty/homeless

July 2016

The Poppy team either work alongside or are complementary to the existing provision of maternity care. They provide antenatal and postnatal for the most vulnerable women. The team aim to work closely with other healthcare professionals and agencies to improve communication and facilitate long term planning and on-going support for these women. The team aim to provide continuity of antenatal and postnatal care from a small number of carers, whilst liaising with other agencies to improve communication and facilitate long term planning and support for these women. This may include intrapartum care for the most vulnerable women. The team also work closely with the substance misuse midwife and the lead midwife with responsibility for child protection. They will also act as a resource for other professionals. For more information on the referral process for substance misuse and child protection see the attached flow charts at the end of this document. It is therefore appropriate that localities give special consideration to these groups of women within the measures to pregnant women with complex social needs and how to encourage women to maintain on going contact with maternity services. The lead professional for women with multiagency/multidisciplinary needs should ensure continuing communication and support with extra or extended appointments as required. For more information and the referral process please see Poppy Team guidelines. 4.6

Documentation It is essential to document all findings and discussions in the woman’s hand held antenatal record (yellow folded sheet) and where applicable the hospital maternity notes. All pathology reports will be reviewed by the person who took the sample and is responsible for following up any action required. The results should be recorded on the investigation and results page in the hand held antenatal record and the hospital maternity record when the woman attends the consultant antenatal clinic if appropriate. This will be done by the attending midwife. The woman should have been informed of the results and if action required this too is documented in the appropriate record. Appropriate action should be taken for abnormal results as soon as possible and the woman informed.

Author:

Policy Lead:

Emma Matthews, Jean Sangha & Nicky Benns Senior Midwife Team Lead, Community Midwifery Matron & Maternity Risk Manager Group Director Urgent Care

Location:

Policy hub/ Clinical/ Maternity /Antenatal/ GL956

Job Title:

Date:

July 2016

Review Date:

February 2017

Version:

1.1 ratified 1 July 2016

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4.7

July 2016

Health Visitor The midwife should obtain verbal consent from the woman for her information to be shared with the Health Visitor. When the woman attends her 16 week appointment, she will have two copies of her electronic booking. The midwife should give the health visitor one copy. If the booking has not been completed electronically, then the pink copy should be photocopied at booking and given to the health visitor. This ensures that the health visitors are notified of the woman’s pregnancy so that effective communication and information sharing is facilitated. The midwife is expected to have regular contact with the woman’s health visiting team, preferably face-to-face meetings. Otherwise contact should be by telephone, practice notes, team email address or telephone. It is considered best practice for the midwife and health visitor to have monthly case discussions. The midwife should notify the health visitor of any relevant information during the pregnancy e.g. miscarriage, change of address or relevant personal circumstances. An additional communication page is to be completed in the handheld notes at 34-36 weeks to update both the health visitor and GP of any change of circumstance or demographic information. Women who are under the age of 19 at booking, who have not had a live born, and are under 28 weeks pregnant, meet the Family Nurse Partnership criteria. The FNP service visit women at home during their pregnancy and until their child are 2 years old. They perform the role of the health visitor during this time. Referrals are made by completing a form which can be telephoned, emailed, faxed or posted. The referral should be made as soon as possible after the initial booking appointment. The FNP nurse will assess if the woman is suitable for the programme and will maintain contact with her up until the child is 2 years old. The generic health visitor will then take over. Other health professionals will still maintain care for the mother for her antenatal and postnatal care.

Author:

Policy Lead:

Emma Matthews, Jean Sangha & Nicky Benns Senior Midwife Team Lead, Community Midwifery Matron & Maternity Risk Manager Group Director Urgent Care

Location:

Policy hub/ Clinical/ Maternity /Antenatal/ GL956

Job Title:

Date:

July 2016

Review Date:

February 2017

Version:

1.1 ratified 1 July 2016

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5.0

July 2016

Hospital Antenatal Clinics 5.1 Referral process Antenatal care provided by consultant obstetricians and their teams is provided at the Royal Berkshire Hospital Tuesday to Friday and at the West Berkshire Community Hospital on a Thursday morning and at Wokingham Community Hospital on a Wednesday afternoon. Both the Royal Berkshire Hospital and West Berkshire Hospital have ultrasound facilities. 5.2

Consultant Antenatal Clinics Women needing particular specialist care due to their medical histories will be allocated an appointment in the relevant clinic through the Consultant Triage system used by the obstetricians.

5.3

Anaesthetic Care Plan Women who have been seen by the obstetric anaesthetist during their pregnancy will have an anaesthetic review sheet filed in their hospital held heath record. See anaesthetic antenatal clinic referral criteria for women who should see an anaesthetist during the pregnancy or labour

5.4

Specialist Midwifery Services In addition to the consultant clinics, specialist midwives are able to offer advice to both professionals and women. 

 

   

Author:

Diabetes Specialist midwife – available for advice Monday to Friday from 08.00- 16.00 or leave an answerphone message on 0118 322 7245 Substance and Alcohol specialist midwife – available Friday mornings or leave answerphone message Antenatal/Neonatal Screening Coordinators – available Monday to Friday 08.00-16.00. Antenatal Screening Coordinator 0118 322 850. Newborn Screening Coordinator 0118 322 7292. A message can be left on the answerphone Specialist HIV midwife can be contacted Tuesdays, Thursdays and Fridays in antenatal clinic Social inclusion midwife can be contacted by leaving a message on Reading Community Midwives’ office 0118 322 8059 Child Protection midwife can be contacted on 07768752529 VBAC midwife – women are identified from consultant referral forms at booking if they are suitable to be assessed antenatally by the VBAC midwife

Policy Lead:

Emma Matthews, Jean Sangha & Nicky Benns Senior Midwife Team Lead, Community Midwifery Matron & Maternity Risk Manager Group Director Urgent Care

Location:

Policy hub/ Clinical/ Maternity /Antenatal/ GL956

Job Title:

Date:

July 2016

Review Date:

February 2017

Version:

1.1 ratified 1 July 2016

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

July 2016

Consultant midwife – referral forms are available on the stationary section under Referral Forms. The consultant midwife can see women who have had previous traumatic births or who are requesting care that is against medical advice

6.0 Booking Appointment The booking appointment is primarily a process of risk assessment, information giving and health promotion. The information above at the pre-booking appointment should also be covered. A full medical, social and family history should be taken as detailed in the first four pages of antenatal hand held record. The woman should participate in its completion and sign that it is an accurate record. Adequate time should be allowed to take an accurate history. The booking history can be entered electronically in the presence of the mother. All women should be directed to the Maternity DVD and Royal Berkshire Hospital Maternity website which provide podcasts of facilities within the maternity unit and useful leaflets for information on pregnancy and labour. They should also be given a Bounty pack containing: -

Maternity DVD ROM Healthy eating information Choosing Where to Have Your Baby Leaflet Maternity Care Schedule Useful Contact Numbers Letter providing information about elective caesarean requests for maternal request only Fetal movements Leaflet

All women should be given the NHS Pregnancy website for advice at http://www.nhs.uk/Conditions/pregnancy-and-baby/ The named midwife is identified at the booking appointment and her name and contact details recorded on the front page of the woman’s hand held maternity record. For all clients who are aged under 19 at booking a Child Sexual Expolitation Screening Tool, Poppy Team referral and FNP referral should be completed and actioned accordingly. The midwife will inform the Maternity Admin department prior to the booking the demographics of the women so that the woman can be registered. At the booking, the midwife can complete the booking electronically and the mother can be advised to book her dating ultrasound the following working day. For those midwives who are unable to complete the booking electronically, they should complete the pink forms in the hand held notes and send pink copies of the booking sheets to the RBH admin office for the Author:

Policy Lead:

Emma Matthews, Jean Sangha & Nicky Benns Senior Midwife Team Lead, Community Midwifery Matron & Maternity Risk Manager Group Director Urgent Care

Location:

Policy hub/ Clinical/ Maternity /Antenatal/ GL956

Job Title:

Date:

July 2016

Review Date:

February 2017

Version:

1.1 ratified 1 July 2016

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woman’s information to be entered on to CMIS patient information system. Additionally, if referral is necessary the booking referral sheet should be completed and sent with the pink sheets to the medical records department who will send and appointment to the woman. 6.1

Screening for important risk factors at the booking appointment: 6.1.1 History of congenital/inherited disorders Women with a personal or close family history of congenital or inherited disorders should be referred as soon as possible for consultant antenatal care in the usual way. These women will usually be seen for counselling by Mark Selinger. 6.1.2 New residents to UK Women who are new residents of the UK (less than one year) such as asylum seekers/immigrants should have a full medical examination performed by their General Practitioner. They should also be given a patient registration form to complete and the midwife should inform the hospital overseas department. Women who are asylum seekers or refugees should be referred to the Poppy Team.

6.2

Mental Health Unidentified or inadequately treated mental illness during pregnancy and following birth can have serious consequences. Joint working arrangements between maternity and mental health services should be provided. All women should be asked about previous psychiatric disorder or a family history of serious mental health issues early in the pregnancy as follows:   

past or present severe mental illness including schizophrenia, bipolar disorder, psychosis in the postnatal period and severe depression previous treatment by a psychiatrist/specialist mental health team including inpatient care a family history of perinatal mental illness.

Additional questions should be asked (Wooley questions):  during the past month, have you often been bothered by feeling down, depressed or hopeless?  during the past month, have you often been bothered by having little interest or pleasure in doing things? A third question should be considered if the woman answers 'yes' to either of the initial questions Author:

Policy Lead:

Emma Matthews, Jean Sangha & Nicky Benns Senior Midwife Team Lead, Community Midwifery Matron & Maternity Risk Manager Group Director Urgent Care

Location:

Policy hub/ Clinical/ Maternity /Antenatal/ GL956

Job Title:

Date:

July 2016

Review Date:

February 2017

Version:

1.1 ratified 1 July 2016

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

July 2016

is this something you feel you need or want help with?

Where the midwife identifies a woman with significant mental health concerns she/he should refer to the GP.

6.3



The woman should be assessed by the psychiatric team and a plan of care recorded in the pathway



A written care plan covering pregnancy, delivery and the postnatal period should be made. This should include increased contact with specialist mental health services (including, if appropriate, specialist perinatal mental health services).



This must be recorded in all versions of the woman's notes (her hand held record, hospital held record and primary care and mental health notes) and communicated to the woman and all relevant healthcare professionals.



Contact numbers for the mental health team should be readily available

Screening Tests 6.3.1 Booking bloods are taken with consent for:  Full blood count  Blood group and antibodies  Serology (Hepatitis B, syphilis and HIV)  Electrophoresis 6.3.2 Hepatitis C Screening If a woman volunteers’ information about risk factors below she may be hepatitis C positive. She should be counselled regarding screening and her wishes documented: 

   Author:

Women with current history of substance misuse or a history of injecting drug use – these women should be referred to the consultant obstetrician responsible for women with addiction. The woman will be counselled regarding screening for hepatitis C following the guidance for care (link to RBFT guideline) Women with HIV can be co-infected with hepatitis C History of blood transfusion or blood products or organ donation prior to 1991, including women transfused in childhood i.e.as part of treatment in Special Care baby Unit for prematurity. History of haemodialysis, particularly if dialysed outside the UK

Policy Lead:

Emma Matthews, Jean Sangha & Nicky Benns Senior Midwife Team Lead, Community Midwifery Matron & Maternity Risk Manager Group Director Urgent Care

Location:

Policy hub/ Clinical/ Maternity /Antenatal/ GL956

Job Title:

Date:

July 2016

Review Date:

February 2017

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 



  



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Exposure to infected blood via sharing toothbrushes, razors or drug smoking paraphernalia i.e., crack pipe Tattoos, body piercing, traditional body marking practices, acupuncture, dental or invasive medical treatment with unsterile equipment or in countries where infection control may be poor. Occupational exposure to blood known to be infected with hepatitis C. The risk from percutaneous exposure is estimated at 3% (9), the risk via mucocutaneous exposure very much lower. Regular sexual partner is hepatitis C virus positive Horizontal spread from a member of the same regular household. Originating from, or resident for a long period of time, countries with high prevalence of hepatitis C i.e. Egypt, South East Asia. In 2007 there was a department of health campaign to raise awareness of hepatitis C among ethnic minority groups (10). Vertical transmission (mother to baby)

6.3.3 Urine testing A MSU should be obtained and sent for microscopy and sensitivity at booking. The woman’s urine should be dip stick tested for protein and sugar at every antenatal appointment. Refer to Management of Hypertension guidelines and management of glycosuria in pregnancy

6.3.4 Testing for Chlamydia Women under 25 years should be routinely offered testing for chlamydia. This can be done by referring to the sexual health clinic or taking a urine or LVS sample. All test results will be reviewed by the midwife who arranged the test. The results will be discussed with the woman and recorded in her hand held notes on the investigation and results page at the next antenatal appointment. Abnormal results will be discussed and acted upon. Where a woman declines any of the routine screening tests this should be clearly documented in the woman’s hand held and/or the hospital maternity record. The screening midwife should be informed of any screening blood tests that are declined. Women who decline booking screening tests should be re-offered again at 16 weeks. This includes Down’s syndrome screening, as this is required by the screening midwives for statistics when the booking has been done electronically.

Author:

Policy Lead:

Emma Matthews, Jean Sangha & Nicky Benns Senior Midwife Team Lead, Community Midwifery Matron & Maternity Risk Manager Group Director Urgent Care

Location:

Policy hub/ Clinical/ Maternity /Antenatal/ GL956

Job Title:

Date:

July 2016

Review Date:

February 2017

Version:

1.1 ratified 1 July 2016

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7.0 Health and wellbeing for all pregnant women The following advice is to be covered in early pregnancy, usually, but not exclusively at the Booking Appointment. 7.1 Nutritional supplements and dietary advice All women should be advised of the importance of a healthy diet during pregnancy and which foods to avoid. All women should be directed to information in the Bounty magazine, the NHS Pregnancy Website and/or the Healthy Eating in Pregnancy Leaflet on the Royal Berkshire Hospital website, which all contain information on foods to avoid and food hygiene, including how to reduce the risk of a food acquired infection.

7.2 Folic Acid prophylaxis All women should be advised to take folic acid (400 mcg daily) prior to conception (for at least 3 months) and up to 12 weeks of pregnancy to reduce the risk of neural tube defects. Women with the following risk factors should be recommended to take 5mg folic acid rather than 400mcg:  BMI >30 kg/m2 

The woman or her partner have a neural tube defect



The woman has had a previous pregnancy affected by a neural tube defect



The woman or her partner have a family history of neural tube defects



The woman has diabetes



The woman is taking anti-epileptic medication

7.3 Vitamin D supplements All women should be advised to take vitamin D supplements (10mcg daily) during pregnancy and after birth if breast feeding. This is available in Healthy Start multivitamins which can be purchased over the counter. This is particularly important for women from the following groups 

Women from South East Asia, Caribbean, Middle Eastern countries



Women who are housebound or remain covered when outside



Women whose diet does not include oily fish, eggs, meat or fortified margarine or breakfast cereal



Women whose BMI is greater than 30 kg/m2

Women should be advised of the risks of taking large doses of Vitamin A in foods such as liver and liver patê. Author:

Policy Lead:

Emma Matthews, Jean Sangha & Nicky Benns Senior Midwife Team Lead, Community Midwifery Matron & Maternity Risk Manager Group Director Urgent Care

Location:

Policy hub/ Clinical/ Maternity /Antenatal/ GL956

Job Title:

Date:

July 2016

Review Date:

February 2017

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Health Promotion 7.4.1 Smoking Pregnant women who are current smokers or have given up smoking in the last 12 months should be referred to the smoking cessation services. They should be advised of the dangers to the fetus of smoke inhalation and should be referred to an evidence-based smoking cessation service. They should also be advised that smoking in the same environment as the baby can be harmful. For further information see smoking pathway in pregnancy flow chart. 7.4.2 Alcohol It is recommended by the Department of Health that pregnant women, or women trying to become pregnant, should avoid alcohol altogether. Additionally women should be advised of the risks of miscarriage in the first three months of pregnancy. Women should be informed that getting drunk or binge drinking can be harmful to the fetus and increases the risk of the baby developing fetal alcohol syndrome. 7.4.3 Lifestyle Questionnaire Within the hand held notes there are questions to ask the mother at booking initially, but these questions can be reviewed at any time during pregnancy if areas of concerns arise. If the mother answers yes to any of the shaded areas on this form, the midwife should gain her consent to share this information with the local authority who will contact her to arrange further support as necessary. The mother should sign the bottom of this form which will give the midwife authority to share this information. No health information should be shared with the local authority. To ensure the lifestyle questionnaire is sent to the appropriate local authority, the midwife should ask the woman which is her local authority, i.e. where she pays her council tax. The midwife should then place a copy of the woman’s front page of the booking form and this lifestyle questionnaire page only in the envelope held either at Reading (call centre office) or Newbury community midwives office. The forms should be placed in the envelope that has a secure DX postal address on the front and also complete the attached tracker with the relevant information. This tracker will be used for audit purposes. This envelope is sent by a dedicated call centre staff each Friday if at RBH and by a dedicated staff member at Newbury daily.

Author:

Policy Lead:

Emma Matthews, Jean Sangha & Nicky Benns Senior Midwife Team Lead, Community Midwifery Matron & Maternity Risk Manager Group Director Urgent Care

Location:

Policy hub/ Clinical/ Maternity /Antenatal/ GL956

Job Title:

Date:

July 2016

Review Date:

February 2017

Version:

1.1 ratified 1 July 2016

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July 2016

Observations: 7.5.1 Height and Weight This should be undertaken at booking and the BMI calculated. It is not acceptable to ask the mother to estimate her height and weight, both should be measured with the appropriate measuring tools. Following the booking appointment antenatal care schedule should be followed. Women identified as high-risk should be booked under consultant care and individual guidelines for the particular condition followed. 7.5.2 Obesity (Body Mass Index (BMI) >35kgs/m2) Obese women have a higher risk of complications during pregnancy and delivery which increases with a rising BMI. The woman should be weighed at booking and the BMI index calculated and recorded on the page 3 of the antenatal hand held record. Women who book with a BMI of 30kgs/m2 or more should receive personalised advice from an appropriately trained professional on healthy eating and physical activity. Weight reduction dieting in pregnancy is not advised. The Healthy Eating in Pregnancy patient information leaflet should be given. 7.5.2.1 BMI 30-34.9kgs/m2 Women with a BMI 30-34kgs/m2 do not need to be referred for consultant led care unless they have other risk factors. This should be documented on the observation page of the yellow fold out sheet in the woman’s hand held records. 7.5.2.2 BMI >35kgs/m2 Women with a BMI > 35kgs/m2 should be referred to the antenatal clinic for consultant led care and should be advised to give birth within the main delivery suite. The bariatric checklist will be completed by the antenatal clinic midwife or doctor and should be filed next to the consultant care plan (green sheet) in the hospital maternal health record. 7.5.2.3 BMI >40kgs/m2 Women with a BMI of 40kgs/m2 or more should be referred to an obstetric anaesthetist by the antenatal clinic midwife. The anaesthetist will assess the anaesthetic risks and agree a management plan which will be filed in the woman’s hospital records next to the green consultant care plan.

Author:

Policy Lead:

Emma Matthews, Jean Sangha & Nicky Benns Senior Midwife Team Lead, Community Midwifery Matron & Maternity Risk Manager Group Director Urgent Care

Location:

Policy hub/ Clinical/ Maternity /Antenatal/ GL956

Job Title:

Date:

July 2016

Review Date:

February 2017

Version:

1.1 ratified 1 July 2016

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A copy of the care plan will be held on the anaesthetic database in the event of the hospital record being mislaid. The referral will be done by the antenatal clinic midwife attending the woman in the antenatal clinic. Women who weigh over 150kgs will require an individual care plan to assess her mobility and safe working load. The AN clinic staff will need to liaise with the Manual Handling team as equipment may need to be borrowed or hired either in advance or at the time for the duration of the woman’s stay in the maternity unit. See Guideline for the Management of the Pregnant Bariatric Woman. 7.6 Women at risk of pre-eclampsia Hypertensive disease predating pregnancy, or occurring for the first time in pregnancy, is common. Proteinuric hypertension (PET) is associated with increased maternal and fetal/neonatal morbidity. Women at higher risk of developing pre-eclampsia should take 75mgs of Aspirin daily, from 12 weeks until delivery. This is thought to reduce the risk of preeclampsia. Women should be assessed by the following risks at their booking appointment: 7.6.1 Moderate Risk  First pregnancy  Age >40  Pregnancy interval >10 years  Family history of pre-eclampsia (mother/sister)  Multiple pregnancy 7.6.2 High Risk  Chronic hypertension requiring treatment  Previous hypertension in pregnancy  Chronic kidney disease  Autoimmune disease e.g. systemic lupus erythematosus or antiphopholipid syndrome  Type 1 or 2 diabetes 7.7 Author:

Diabetes screening in pregnancy at approximately 28 weeks:  Body mass index > 35 kg/m2

Policy Lead:

Emma Matthews, Jean Sangha & Nicky Benns Senior Midwife Team Lead, Community Midwifery Matron & Maternity Risk Manager Group Director Urgent Care

Location:

Policy hub/ Clinical/ Maternity /Antenatal/ GL956

Job Title:

Date:

July 2016

Review Date:

February 2017

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Previous Macrosomic baby weighing 4.5 kg or above Previous gestational diabetes (refer to 'Diabetes in pregnancy' (NICE clinical guideline 63) – PGL should be done as soon as possible after booking and 28 weeks in this case Family history of diabetes (first-degree relative with diabetes) Family origin with a high prevalence of diabetes: o South Asian (specifically women whose country of family origin is India, Pakistan or Bangladesh) o Black African and Caribbean o Middle Eastern (specifically women whose country of family origin is Saudi Arabia, United Arab Emirates, Iraq, Jordan, Syria, Oman, Qatar, Kuwait, Lebanon or Egypt) o History of polycystic ovarian syndrome o Previous unexplained IUD

Women should be identified at booking and given the PGL information at the 16 week appointment and either have this done at the 28 week appointment, or performed with a nurse or phlebotomist at 27 weeks so that the midwife can review the results at the 28 week appointment. 7.8 Mothers with established diabetes: The GP or community midwife should contact the diabetic specialist midwives as soon as the pregnancy is confirmed, even before the booking history is where possible. If this is not possible then this should be done at booking by telephone.

8.0 Antenatal Appointment Schedule At each antenatal appointment the woman should have her blood pressure measured and urinalysis to detect proteinuria and glucose. From 26 weeks gestation the fetal heart should be auscultated and symphysis fundal height measured and plotted.

Author:

Policy Lead:

Emma Matthews, Jean Sangha & Nicky Benns Senior Midwife Team Lead, Community Midwifery Matron & Maternity Risk Manager Group Director Urgent Care

Location:

Policy hub/ Clinical/ Maternity /Antenatal/ GL956

Job Title:

Date:

July 2016

Review Date:

February 2017

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8.1 Fundal Height Measurements From 26 weeks gestation the fundal height should be measured and recorded at all routine antenatal appointments. This will be plotted on the graph on the yellow fold out page in the antenatal hand held notes. Where there is a discrepancy of more than 2cm below gestational age, or if a measurement is static from the last appointment, the woman should be referred to an obstetrician. Where possible the number of professionals attending the woman should be kept to a minimum to reduce errors. See Measuring Fundal Height guideline & Small for gestational age guideline. 8.2 Fetal Movements Women should be advised to observe for fetal movements from 16 weeks onward. Women should be advised to report significantly reduced or sudden alteration in the movements as normal fetal movements are a sign of fetal wellbeing. Women with reduced fetal movements under 28 weeks should attend their GP for auscultation of the fetal heart. Women over 28 weeks should be referred or self-refer to the DAU or Delivery Suite out of hours for a CTG. See Reduced Fetal Movement guideline (GL903) for further information and also flowchart at end of this document. 8.3 Anti D prophylaxis Anti D is recommended for all pregnant non-sensitised rhesus negative women identified following routine antenatal screening blood test results. At the 16 week appointment arrangements should be made for the woman to attend the antenatal clinic at 30 weeks gestation either at the Royal Berkshire Hospital on a Tuesday-Friday morning 08.30-09.00 or West Berkshire Community Hospital on a Friday morning only by telephoning 0118 322 7295. The woman should be given the patient information leaflet ‘Antenatal administration of prophylactic antiD.’ For further details please see Anti D guideline (GL786)

8.4 Membrane Sweeping Membrane sweeping prior to induction of labour has shown to be effective in reducing the need for other induction methods and as such should be offered to all women prior to booking for induction of labour. Primigravida women should be offered this at 40 and 41 weeks, and multigravida women should be offered this at 41 weeks.

Author:

Policy Lead:

Emma Matthews, Jean Sangha & Nicky Benns Senior Midwife Team Lead, Community Midwifery Matron & Maternity Risk Manager Group Director Urgent Care

Location:

Policy hub/ Clinical/ Maternity /Antenatal/ GL956

Job Title:

Date:

July 2016

Review Date:

February 2017

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8.5 Induction of labour Low risk women should be offered an induction of labour at approximately 41+5 gestation and should be given an induction of labour leaflet. Inductions can be booked via antenatal clinic, day assessment unit or out of hour’s delivery suite. High risk women must be booked by a consultant or obstetric trainee. See induction of labour guideline 8.6 Prolonged pregnancy If a woman declines induction she should be given an appointment in an obstetric antenatal clinic as soon as possible to discuss the risks and have further follow up arranged.

9.0 Day Assessment Unit (DAU) The role of the DAU is to provide an assessment and monitoring facility for women who have developed complications after 15 completed weeks of pregnancy. Prior to this gestation women should be referred to Gynaecology services unless the woman is suffering from hyperemesis. The DAU does not replace the Antenatal Clinic and unless the condition is urgent the woman should be made an antenatal clinic appointment. 9.1

Criteria for referral  Women with hyperemesis at any gestation  Women who require monitoring of high risk conditions such as preeclampsia or cholestasis  Women with unexplained abdominal pain >15 completed weeks  Vaginal bleeding >15 completed weeks  Women who are booked for elective caesarean section for preoperative clerking and admission on the day of surgery  Women undergoing induction of labour with Prostaglandins  External cephalic version (Friday mornings only)  Postnatal women with wound infections either abdominal or perineal who having first been assessed by the GP and have not responded to a course of antibiotics

Women who are asymptomatic and whose BP readings are classified as ‘mild to moderate’ DO NOT need same day referral, whether or not there is proteinuria. These women can be referred to the Antenatal Clinic, to be seen within three days. If possible they should be seen in their usual consultant clinic if applicable. If there is concern or an appointment cannot be arranged within 3 days contact the DAU who will decide whether the patient needs interim review. Author:

Policy Lead:

Emma Matthews, Jean Sangha & Nicky Benns Senior Midwife Team Lead, Community Midwifery Matron & Maternity Risk Manager Group Director Urgent Care

Location:

Policy hub/ Clinical/ Maternity /Antenatal/ GL956

Job Title:

Date:

July 2016

Review Date:

February 2017

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Women who are acutely unwell, or whose BP readings fall within the range ‘severe’ should be referred for SAME DAY assessment. Woman whose blood pressure is >160/110 should be transferred to the DAU or Delivery Suite out of hours by ambulance and accompanied by a professional. Heavy proteinuria, in a ‘well woman’ is not necessarily due to PET. This list is not exhaustive and there may be other conditions whereby it would be appropriate to refer the woman to the DAU. Referral can be made by a midwife, GP, Westcall or hospital doctor. The woman may self-refer. For further advice ring the DAU on 0118 322 8741. See Hypertension guideline (GL952). 10.0 Antenatal parenthood preparation classes First time mothers should be encouraged to book a parent education class from 32 weeks. For further information on booking classes in the hospital setting, women should be given the NCT website http://www.nct.org.uk/BerkshireAntenatal for a free class. Feeding classes are drop in for any mothers and dates and times can be accessed online at http://www.royalberkshire.nhs.uk/infant_feeding.htm 11.0 Late Booking/Missed Appointments Women who attend for booking after 12+6 weeks (late bookers) or regularly miss appointments are much more likely to be vulnerable or socially excluded. These women and their babies are also more likely to experience serious health problems and higher death rates, including the mothers being at higher risk of committing suicide. 17% of all maternal deaths in the UK between 2003-2005 were of women who booked after 22 weeks gestation, missed over four routine antenatal appointments, or did not seek care at all (CEMACH, Saving Mothers’ Lives, 2007). Women who miss appointments should be followed up by the community midwifery service or other community-based service with who the woman is in contact, such as a children's Centre, addiction service or GP. All attempts at communication must be clearly documented in the woman’s hospital held record and/or in the midwife’s diary. An antenatal attendance record should be maintained for every antenatal mother in the midwife’s caseload. This caseload file should be accessible to other staff who may need to provide cover and can then update this attendance tool or follow up any non-attenders. The caseload will need to be left either securely at a children’s centre or at the GP surgery. The named midwife will need to have her own personal copy if necessary. Author:

Policy Lead:

Emma Matthews, Jean Sangha & Nicky Benns Senior Midwife Team Lead, Community Midwifery Matron & Maternity Risk Manager Group Director Urgent Care

Location:

Policy hub/ Clinical/ Maternity /Antenatal/ GL956

Job Title:

Date:

July 2016

Review Date:

February 2017

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Follow-up should be via a method of contact that is appropriate to the woman, which may include:  text message  letter  telephone  community or home visit. Where there are concerns about the woman this should be raised with the Community Matron, Supervisor of Midwives or Director of Midwifery. See Late Booking 12+6 week’s guideline (GL795) and Non Attendees at Antenatal Clinics/No access visits protocol (CG499). 12.0 Standards 

Lead professional documented at booking and any changes in pregnancy



Choice of birth recorded



Patient smoking status recorded at booking



Named midwife documented in booking notes



Continuity of care regarding number of midwives in antenatal period



Documentation of late bookers and reason



Documentation of missed appointments, contact with expectant mother and new appointment



DVD ROM given at booking



Antenatal screening leaflet given

13.0 References 1.0

Confidential Enquiries into Maternity and Child Health (2007). Saving Mothers’ Lives: Reviewing Maternal Deaths to Make Motherhood Safer.

2.0

Centre for Maternal and Child Enquiries (CMACE, 2011) Perinatal Mortality. London. Available at www.cmace.org.uk

3.0

Department of Health. (1997). Changing Childbirth. London. Department of Health.

4.0

Department of Health (2004). National Standards for Children, young people and Maternity: Maternity Services. London available at www.dh.gov.uk

Author:

Policy Lead:

Emma Matthews, Jean Sangha & Nicky Benns Senior Midwife Team Lead, Community Midwifery Matron & Maternity Risk Manager Group Director Urgent Care

Location:

Policy hub/ Clinical/ Maternity /Antenatal/ GL956

Job Title:

Date:

July 2016

Review Date:

February 2017

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5.0

Department of Health. (2007). Maternity Matters: Choice, access and continuity of care in a safe service. London. Department of Health. Available at: www.dh.gov.uk

6.0

Kings Fund. (2010). The Role of GPs in maternity Care – What does the future hold.

7.0

National Institute of Clinical Excellence (NICE) 2012. Quality Standards for Antenatal Care. Available at www.nice.org.uk

8.0

National Institute for Health and Clinical Excellence (NICE), (2007). Antenatal and Postnatal Mental Health: Clinical Management and service guidance. London, NICE. Available at www.nice.org.uk

9.0

National Institute of Clinical Excellence (NICE). (2008). Antenatal Care: Routine Care for the Healthy Pregnant Woman, London: NICE. Available at www.nice.org.uk

10.0 National Institute for Health and Clinical Excellence (NICE), (2010). Pregnancy and Complex Social Factors: A Model for Service Provision for Pregnant Women with Complex Social Factors. London. NICE. Available at www.nice.org.uk 11.0 National Institute for Health and Clinical Excellence. (NICE), (2010). Pregnancy and complex social factors: A model for service provision for pregnant women with complex social factors CG110. London, NICE available at www.nice.org.uk 12.0 Nursing and Midwifery Council (2008) The Code; Standards for Performance, Conduct and Ethics. NMC, London 13.0 Royal College of Nursing (2007). Pregnancy and Disability: RCN guidance for nurses and midwives. London. Available at www.rcn.org.uk 14.0 Royal College of Midwives (2013) Maternity Support Workers: Position statement. London. Available at rcom.org.uk 15.0 Royal College of Obstetricians and Gyanaecologists (2008) Standards for Maternity Care – Report for a Working Party. London. Available at www.rcog.org.uk

Author:

Policy Lead:

Emma Matthews, Jean Sangha & Nicky Benns Senior Midwife Team Lead, Community Midwifery Matron & Maternity Risk Manager Group Director Urgent Care

Location:

Policy hub/ Clinical/ Maternity /Antenatal/ GL956

Job Title:

Date:

July 2016

Review Date:

February 2017

Version:

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14.0 Appendices 4.1

Antenatal booking flowchart

4.2

Antenatal management of anaemia

4.3

Fetal anomaly flowchart

4.4

Hepatitis C screening flowchart

4.5

MRS pathway

4.6

Maternal mental health flowchart

4.7

Smoking cessation pathway

4.8

Child protection flowchart

4.9

Reduced fetal movement flowchart

Author:

Policy Lead:

Emma Matthews, Jean Sangha & Nicky Benns Senior Midwife Team Lead, Community Midwifery Matron & Maternity Risk Manager Group Director Urgent Care

Location:

Policy hub/ Clinical/ Maternity /Antenatal/ GL956

Job Title:

Date:

July 2016

Review Date:

February 2017

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14.1 Antenatal booking flow chart

14.2 Antenatal management of anaemia

Author:

Policy Lead:

Emma Matthews, Jean Sangha & Nicky Benns Senior Midwife Team Lead, Community Midwifery Matron & Maternity Risk Manager Group Director Urgent Care

Location:

Policy hub/ Clinical/ Maternity /Antenatal/ GL956

Job Title:

Date:

July 2016

Review Date:

February 2017

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14.3 Fetal anomaly flow chart Abnormality detected on USS

Referred by Sonographer to MS/SA within 48 hrs

No abnormality No further scans

Specialist scan confirms anomaly. Further options discussed and plan of care agreed with couple. SCO notified. Referred To:

Tertiary centre, usually John Radcliffe, Oxford. Fax referral to 01865 221164

To deliver in tertiary centre. Care transferred to Oxford

Clinician and SCO informed by Oxford PND midwives

Author:

Monthly Combined Paediatric/USS Clinic

Paediatric plan written Discussed with patient and partner Copies to  Hospital notes  Delivery Suite  SCBU register

Continue pregnancy

Plan documented on Consultant Care Page Proforma completed CMW/GP Informed

Policy Lead:

Emma Matthews, Jean Sangha & Nicky Benns Senior Midwife Team Lead, Community Midwifery Matron & Maternity Risk Manager Group Director Urgent Care

Location:

Policy hub/ Clinical/ Maternity /Antenatal/ GL956

Job Title:

TOP Only after extensive counselling. CMW/GP informed

Further Testing (CVS/Amnio)

Date:

July 2016

Review Date:

February 2017

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14.4 Hepatitis C screening pathway

Author:

Policy Lead:

Emma Matthews, Jean Sangha & Nicky Benns Senior Midwife Team Lead, Community Midwifery Matron & Maternity Risk Manager Group Director Urgent Care

Location:

Policy hub/ Clinical/ Maternity /Antenatal/ GL956

Job Title:

Date:

July 2016

Review Date:

February 2017

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14.5 MRSA pathway

Author: Job Title: Policy Lead: Location:

Emma Matthews, Jean Sangha & Nicky Benns Senior Midwife Team Lead, Community Midwifery Matron & Maternity Risk Manager Group Director Urgent Care Policy hub/ Clinical/ Maternity /Antenatal/ GL956

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July 2016 February 2017 st 1.1 ratified 1 July 2016 Page 31 of 35

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14.6 Maternal Mental Health pathway (pending changes)

Author: Job Title: Policy Lead: Location:

Emma Matthews, Jean Sangha & Nicky Benns Senior Midwife Team Lead, Community Midwifery Matron & Maternity Risk Manager Group Director Urgent Care Policy hub/ Clinical/ Maternity /Antenatal/ GL956

This document is valid only on date Last printed 13/07/2016 17:23:00

Date: Review Date: Version:

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14.7 Smoking cessation pathway in pregnancy

Author: Job Title: Policy Lead: Location:

Emma Matthews, Jean Sangha & Nicky Benns Senior Midwife Team Lead, Community Midwifery Matron & Maternity Risk Manager Group Director Urgent Care Policy hub/ Clinical/ Maternity /Antenatal/ GL956

Date: Review Date: Version:

July 2016 February 2017 st 1.1 ratified 1 July 2016 Page 33 of 35

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February 2015

14.8 Child protection Process for maternity

Author:

Policy Lead:

Emma Matthews, Jean Sangha & Nicky Benns Senior Midwife Team Lead, Community Midwifery Matron & Maternity Risk Manager Group Director Urgent Care

Location:

Policy hub/ Clinical/ Maternity /Antenatal/ GL956

Job Title:

Date:

July 2016

Review Date:

February 2017

Version:

1.1 ratified 1 2016

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14.9 Reduced fetal movement flow chart

Author:

Policy Lead:

Emma Matthews, Jean Sangha & Nicky Benns Senior Midwife Team Lead, Community Midwifery Matron & Maternity Risk Manager Group Director Urgent Care

Location:

Policy hub/ Clinical/ Maternity /Antenatal/ GL956

Job Title:

Date:

July 2016

Review Date:

February 2017

Version:

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