SDMS ID: P2010/0306-001 3.

4/09WACS Title: Replaces: Description: Target Audience: Key Words: Policy Supported: Extended Midwifery Service (EMS) Extended Midwifery Service WACSClinProc3.4/06 Provision of maternity care to low risk women in a home visiting based model Midwives and medical officers, QVMU Low risk, postnatal care, home based, early discharge P2010/0696-001 Lactation Consultant and Referral Guidelines P2010/0299-003 Breastfeeding Protocol P2010/0299-001 Breastfeeding Policy P2010/0382-001 Care of the Well Newborn P2010/0377-001 Examination of the Newborn P2010/0304-001 Care of the Postnatal Woman following an Uncomplicated Pregnancy and Birth Purpose: The extended midwifery service is a midwifery model of care that provides home based postnatal care for low risk women following discharge from the maternity unit within 4 to 48 hours following birth. Although some women may wish to leave hospital as soon as possible following birth they should be encouraged to stay at least 4 hours following birth to monitor the babys adaptation to extra uterine life, babys first feed and maternal post partum blood loss. Access/Geographical Location This service can be provided to the women who reside in Launceston and the greater Launceston area. For women living outside of the greater Launceston area, access to EMS care may be available depending on midwifery staff availability, which needs to be confirmed prior to offering early discharge follow up. Visits outside the greater Launceston area may be made depending on workload, distance and individual circumstances. EMS midwives can arrange visits for most rural areas through midwives based in district hospitals. EMS staff should be contacted and have a plan made with the rural provider of care and the woman prior to discharge from hospital. Criteria for Early discharge Normal labour at term, without complications and risk factors that would require hospital based care for either the mother and or the baby. Evidence of adequate understanding around basic feeding and baby care. Primips or a mother breastfeeding for the first time should have breastfed at least 2 feeds with a 5-6 suck code prior to discharge. A multipara woman who has previously successfully breastfed should complete 1 breastfeed with a suck code of 5-6.
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Women electing to artificially feed must be able satisfactorily make up artificial baby milk and disinfect equipment. The women should have an adequate level of support at home. The women should be contactable by telephone.

Referral to Postnatal Services Written referrals made daily utilising a 16E form. EMS staff visit the Maternity unit at 0815 and at the end of their day. The EMS midwife will aim to visit women prior to discharge and coordinate a visit time and leave contact phone details. Mother and baby will require a midwifery check prior to discharge. The baby will have an initial medical assessment within the first 24 hours as per the Examination of the Newborn and Care of the Well Newborn clinical guidelines If the mother and baby are discharged prior to being seen by the EMS midwife a message should be left on the EMS answer phone ext 8994 informing EMS of the discharge. Clinical Care, Observations and Documentation Care for both mother and baby is provided in accordance within the Department of Womens and Childrens Services clinical guidelines. The clinical pathways are continued and midwifery notes incorporated within the existing medical record documentation. Referral for Medical Review Early discharge can be associated with an increase readmission rate, as some clinical problems may not manifest for several days. It is therefore necessary to facilitate readmission with minimal disruption to the woman and her family. Readmission of the mother and/or baby may be necessary following an assessment on EMS. Clinical review and assessment prior to admission can occur within the maternity unit, in either 4B assessment area or 4O, without the need to present to the Emergency department. Readmission should occur under the consultant of the day in liaison with the obstetric registrar. The obstetric registrar is responsible for contacting the paediatric registrar if required. If the babys condition requires admission to ward 4N the mother may either be admitted to ward 40 if she needs ongoing care or become a boarder mother. Support Services for EMS Lactation clinic and lactation consultant are available Monday to Friday with referral made directly to the lactation consultant. Postnatal clinic appointments can be made through the QVMU OPD.

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Performance Indicators: Evaluation of compliance with guideline to be achieved through medical record audit annually by clinical Quality improvement Midwife WACS Review Date: Annually verified for currency or as changes occur, and reviewed every 3 years. Midwives and medical staff WACS Dr A Dennis Co-Director (Medical) Sue McBeath Co-Director (Nursing & Midwifery) Womens & Childrens Services

Stakeholders: Developed by:

Dr A Dennis Co-Director (Medical) Womens & Childrens Services

Sue McBeath Co-Director (Nursing & Midwifery) Womens & Childrens Services

Date: 06 May 2009

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