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In developing this pathway, we aim to provide maternity services commissioners with valuable guidance so that they may safely and effectively meet the demands of their local population. The pathway also describes what women can expect on their maternity journey.
Go to pre-pregnancy
Go to antenatal care
Go to intrapartum care
Go to postnatal care
1 Pre-pregnancy care
1 Pre-pregnancy care
1 Pre-pregnancy
Quick info:
Scope: t his pathway gives an overview of what to expect when planning pregnancy. The pathway is based on UK National Health Service policies and schedules. Associated maternity standards: standard 1: looking forward to pregnancy standard 2: pre-pregnancy care for women with existing medical conditions or significant family or obstetric history standard 3: access to maternity care standard 6: pre-existing medical conditions in pregnancy standard 8: pre-existing and developing mental health conditions in pregnancy standard 7: women with social needs standard 21: choice and appropriate care standard 22: communication standard 23: training and professional competence standard 24: documentation and confidentiality standard 25: clinical governance
5 No
Quick info:
if woman is not planning pregnancy, consider the next two stages
6 Yes
Quick info:
f or women planning pregnancy
7 Access to healthcare
Quick info:
o ffer advice regarding access to healthcare should the woman change her mind
1 Pre-pregnancy care
p rovide advice on choice of and how to access a healthcare professional and pregnancy advice in the future p rovide contraception advice as appropriate and refer to NHS Direct for information o ffer general good health advice on smoking, alcohol, BMI and substance misuse p rovide pre-pregnancy leaflet
1 Pre-pregnancy care
c onsider additional information, care and treatment, and refer according to individual need, ensuring woman continues on maternity pathway if healthcare professional or woman has significant concerns, refer to GP for further assessment a ssess mental health (current, new onset or past incidence) a ssess need or anticipated need for psychological or psychotherapeutic treatment for woman/couple and/or family if severe mental illness (e.g. bipolar disorder or schizophrenia) is suspected, refer to specialist mental health service, including, if appropriate, specialist perinatal mental health service: t his should be discussed with woman and preferably with her GP i nform GP in all cases if a possible current mental disorder or history of significant mental disorder is detected, even if no further assessment or referral is made f or further information refer to the NICE mental health guidance
1 Pre-pregnancy care
16 Once pregnant, refer for antenatal care
Quick info:
advise woman how to access maternity services and inform of choice of booking method (referral/self-referral) once pregnant refer to antenatal provider at earliest opportunity, with all relevant medical information o ffer information on screening. For further information, refer to screening guidance if severe/complex mental illness is identified refer to specialist perinatal mental health team ensure compliance with national guidelines e xplain importance of booking early (within first 10 weeks) and advise how to obtain booking form f or women considering termination of pregnancy, offer advice and refer as appropriate, ensuring woman is returned to maternity pathway when appropriate f or further information, refer to the termination of pregnancy pathway and to NHS London abortion guidance be alert to any factors - clinical, psychological, cultural and/or social - that may affect the health of the woman and baby
1 Pre-pregnancy care
Evidence summary for Pre-pregnancy
This pathway gives an overview of what to expect when planning pregnancy. The pathway is based on UK National Health Service policies and schedules. Search date: Jun-2009
Evidence grades:
Intervention node supported by level 1 guidelines or systematic reviews Intervention node supported by level 2 guidelines Intervention node based on expert clinical opinion Non-intervention node, not graded
Evidence grading:
Graded node titles that appear on this page Is the woman planning pregnancy? Access to healthcare Newly identified medical, mental health and social needs Health and lifestyle advice to woman and partner Once pregnant, refer for antenatal care Eating habits (Body Mass Index) Screening - information and advice Pre-existing medical, surgical and/or psychiatric conditions Pre-existing medical, surgical and/or psychiatric conditions Nutritional advice, vitamins, prescriptions and over-the-counter medicines Evidence grade Reference IDs 9, 8, 7 9 1, 9, 8, 6 9, 8 1, 9, 8 9 9 1, 9, 8, 6, 7 9 9
References
This is a list of all the references that have passed critical appraisal for use in the pathway Maternity best practice ID Reference 1 Department of Health. National Service Framework for Children, Young People and Maternity Services: Maternity services. London: 2004. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/ DH_4089101 2 Department of Health. National service framework for children, young people and maternity services. 2004. http://www.dh.gov.uk/en/Healthcare/Children/DH_4089111 3 Department of Health. Responding to domestic abuse: A handbook for health professionals. London: 2005. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/ DH_4126161 4 National Collaborating Centre for Primary Care. Postnatal care: Routine postnatal care of women and their babies (NICE Clinical Guideline 37). London: 2006. http://www.nice.org.uk/CG37 5 National Collaborating Centre for Women's and Children's Health. Intrapartum care: management and delivery of care to women in labour (NICE Clinical Guideline 55). London: 2007.
1 Pre-pregnancy care
ID Reference http://www.nice.org.uk/CG55 6 National Collaborating Centre for Mental Health. Antenatal and postnatal mental health: clinical management and service guidance (NICE Clinical Guideline 45). London: 2007. http://www.nice.org.uk/guidance/CG45 7 National Collaborating Centre for Women's and Children's Health. Diabetes in pregnancy: management of diabetes and its complications from pre-conception to the postnatal period (NICE Clinical Guideline 63). London: 2008. http://www.nice.org.uk/CG63 8 National Collaborating Centre for Women's and Children's Health. Antenatal care: routine care for the healthy pregnant woman (NICE Clinical Guideline 62). London: 2009. http://www.nice.org.uk/CG62 9 NHS Choices. Health A-Z: Preconception. 2007. http://www.nhs.uk/conditions/Preconception/Pages/Introduction.aspx 10 NHS Choices. The pregnancy care planner. 2009. http://www.nhs.uk/Planners/pregnancycareplanner/Pages/PregnancyHome.aspx 11 NHS Choices. The pregnancy care planner: Bereavement. 2009. http://www.nhs.uk/Planners/pregnancycareplanner/Pages/Bereavement.aspx 12 Royal College of Nursing. Abortion care: RCN guidance for nurses, midwives and specialist community public health nurses. London: 2008. http://www.library.nhs.uk/womenshealth/ViewResource.aspx?resID=297177
16 weeks appointment
18 20 weeks appointment
25 weeks appointment
28 weeks appointment
31 weeks appointment
34 weeks appointment
36 weeks appointment
38 weeks appointment
40 weeks appointment
41 weeks appointment
42 weeks appointment
Go to intrapartum care
10 16 weeks appointment
Quick info:
r eview, discuss and record the results of screening tests: r efer according to individual need, ensuring woman continues on maternity pathway
11 18
20 weeks appointment
Quick info:
if the woman chooses, an ultrasound scan should be performed between 18 weeks 0 days and 20 weeks 6 days to detect structural anomalies o ffer counselling and support as appropriate f or a woman whose placenta extends across the internal cervical os, offer another scan at 32 weeks screen and refer according to individual need, ensuring woman continues on maternity pathway be alert to any factors - clinical, psychological, cultural and/or social - that may affect the health of the woman and baby
12 25 weeks appointment
Quick info:
screen and refer according to individual need, ensuring woman continues on maternity pathway measure fundal height and refer as appropriate, ensuring woman continues on maternity pathway be alert to any factors - clinical, psychological, cultural and/or social - that may affect the health of the woman and baby
13 28 weeks appointment
Quick info:
screen and refer according to individual need, ensuring woman continues on maternity pathway o ffer a second screening for anaemia and atypical red-cell alloantibodies, and hepatitis B obtain maternal consent to give baby vaccinations at birth according to individual need o ffer anti-D prophylaxis to women who are rhesus D-negative 1 c heck for reduced fetal movement depending on normality of episodes r efer for fetal wellbeing assessment according to individual need, ensuring woman continues on maternity pathway screen for eclampsia and refer as appropriate, ensuring woman continues on maternity pathway (refer to Action on Preeclampsia website for further information) be alert to any factors - clinical, psychological, cultural and/or social - that may affect the health of the woman and baby
14 31 weeks appointment
Quick info:
r eview, discuss and record the results of screening tests undertaken at 28 weeks screen and refer according to individual need, ensuring woman continues on maternity pathway be alert to any factors - clinical, psychological, cultural and/or social - that may affect the health of the woman and baby
15 34 weeks appointment
Quick info:
r eview, discuss and record the results of screening tests undertaken at 28 weeks screen and refer according to individual need, ensuring woman continues on maternity pathway o ffer a second dose of anti-D prophylaxis to women who are rhesus D-negative1 g ive specific information on: p reparation for labour and birth, including the birth plan t he postnatal period, including the postnatal plan
16 36 weeks appointment
Quick info:
screen and refer according to individual need, ensuring woman continues on maternity pathway measure fundal height and refer as appropriate, ensuring woman continues on maternity pathway c heck the position of the baby: if breech is suspected, offer external cephalic version r efer as appropriate, ensuring woman continues on maternity pathway g ive specific information (at or before 36 weeks) on: b reastfeeding technique and good management practices, such as detailed in the UNICEF Baby Friendly Initiative c are of the new baby, vitamin K prophylaxis and newborn screening tests postnatal self-care, awareness of baby blues and postnatal depression o ffer support and advice according to need be alert to any factors - clinical, psychological, cultural and/or social - that may affect the health of the woman and baby
17 38 weeks appointment
Quick info:
screen and refer according to individual need, ensuring woman continues on maternity pathway g ive specific information on options for management of prolonged pregnancy be alert to any factors - clinical, psychological, cultural and/or social - that may affect the health of the woman and baby
18 40 weeks appointment
Quick info:
screen and refer according to individual need, ensuring woman continues on maternity pathway d iscuss further management of prolonged pregnancy be alert to any factors - clinical, psychological, cultural and/or social - that may affect the health of the woman and baby
19 41 weeks appointment
Quick info:
f or women who have not given birth by 41 weeks: o ffer a membrane sweep o ffer induction of labour screen as appropriate, ensuring woman continues on maternity pathway be alert to any factors - clinical, psychological, cultural and/or social - that may affect the health of the woman and baby
20 42 weeks appointment
Quick info:
o ffer enhanced surveillance and support according to individual need from 42 weeks, offer increased monitoring to women who decline induction of labour be alert to any factors - clinical, psychological, cultural and/or social - that may affect the health of the woman and baby
Evidence grades:
Intervention node supported by level 1 guidelines or systematic reviews Intervention node supported by level 2 guidelines Intervention node based on expert clinical opinion Non-intervention node, not graded
Evidence grading:
Graded node titles that appear on this page Antenatal (once pregnant) Principles of antenatal care Provide antenatal information Booking appointment (ideally by 10 weeks) 16 weeks appointment 18 # 20 weeks appointment 25 weeks appointment 28 weeks appointment 31 weeks appointment 34 weeks appointment 36 weeks appointment 38 weeks appointment 40 weeks appointment 41 weeks appointment 42 weeks appointment First contact with healthcare professional Pre-existing medical, surgical and/or psychiatric conditions Newly-identified medical, mental health and social needs Evidence grade Reference IDs 1, 8 1, 8 1, 8 1, 8 1, 8 1, 8 1, 8 1, 8 1, 8 1, 8 1, 8 1, 8 1, 8 1, 8 1, 8 1, 8 9 1, 9, 8, 6
References
This is a list of all the references that have passed critical appraisal for use in the pathway Maternity best practice
3 Diagnosis of labour
Quick info:
Diagnosis of start of labour - this setting could be: home obstetric-led unit m idwife-led unit
5 Established labour
Evidence grades:
Intervention node supported by level 1 guidelines or systematic reviews Intervention node supported by level 2 guidelines Intervention node based on expert clinical opinion Non-intervention node, not graded
Evidence grading:
Graded node titles that appear on this page Diagnosis of labour Support of first stage of labour (latent stage) Established labour Care throughout labour Indications for transfer Second stage of labour Third stage of labour Care of the baby and woman immediately after birth Breastfeeding - within first hour after birth Evidence grade Reference IDs 5 5 5 5 5 5 5 5 1, 5, 4
References
This is a list of all the references that have passed critical appraisal for use in the pathway Maternity best practice ID Reference 1 Department of Health. National Service Framework for Children, Young People and Maternity Services: Maternity services. London: 2004. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/ DH_4089101 2 Department of Health. National service framework for children, young people and maternity services. 2004. http://www.dh.gov.uk/en/Healthcare/Children/DH_4089111 3 Department of Health. Responding to domestic abuse: A handbook for health professionals. London: 2005. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/ DH_4126161 4 National Collaborating Centre for Primary Care. Postnatal care: Routine postnatal care of women and their babies (NICE Clinical Guideline 37). London: 2006. http://www.nice.org.uk/CG37 5 National Collaborating Centre for Women's and Children's Health. Intrapartum care: management and delivery of care to women in labour (NICE Clinical Guideline 55). London: 2007. http://www.nice.org.uk/CG55
7 Agree postnatal plan of care (for up to three months according to individual need)
Quick info:
agree community-based postnatal plan of care with woman according to physical, psychological and social need o ffer choice of location of community-based postnatal support a ssess additional needs and respond as appropriate e.g. translation services agree location of first community-based postnatal contact, to take place within 24 hours of discharge from place of birth r eview and re-start specialist pathway as appropriate
13 Eight to 20 weeks
Quick info:
ensure systems are in place to identify high-risk women and babies r efer according to individual need, ensuring women continue on maternity pathway f or information on domestic abuse, refer to the Department of Health Domestic Abuse Handbook
Evidence grades:
Intervention node supported by level 1 guidelines or systematic reviews Intervention node supported by level 2 guidelines Intervention node based on expert clinical opinion Non-intervention node, not graded
Evidence grading:
Graded node titles that appear on this page First hours after birth First days after birth Promote bonding by encouraging and initiating breastfeeding and skin-to-skin contact Assessment and management of physical and mental health Agree postnatal plan of care (for up to three months according to individual need) Agree discharge or transfer plan Provider communications with GP/primary care and Child Health Department Minimum of one postnatal contact at home within first 10 days First community based contact at home or at choice of location Six to eight week check Eight to 20 weeks Evidence grade Reference IDs 1, 4 4 1, 4 4 4 4 4 4 4 4 4
References
This is a list of all the references that have passed critical appraisal for use in the pathway Maternity best practice ID Reference 1 Department of Health. National Service Framework for Children, Young People and Maternity Services: Maternity services. London: 2004. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/ DH_4089101 2 Department of Health. National service framework for children, young people and maternity services. 2004. http://www.dh.gov.uk/en/Healthcare/Children/DH_4089111 3 Department of Health. Responding to domestic abuse: A handbook for health professionals. London: 2005. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/ DH_4126161 4 National Collaborating Centre for Primary Care. Postnatal care: Routine postnatal care of women and their babies (NICE Clinical Guideline 37). London: 2006. http://www.nice.org.uk/CG37
The Map of Medicine is an online clinical knowledge resource implemented throughout the UK and available to patients via NHS Choices. More than 1500 pages, organised into over 350 care pathways spanning care settings, are presented in an easy-to-use visual format, offering evidence-based and up-to-date information across all specialties. The Maternity pathway is available to NHS healthcare professionals at http://london.mapofmedicine.com/ * *Access is via your NHS Athens account