An integrated community and hospital midwifery service is provided. Community midwives work in teams affiliated to GP practices with close links to health visitors. Most births are booked for the BGH, although some women choose the Simpson Centre for Reproductive Health at Royal Infirmary of Edinburgh and a small proportion of women book home births. Parent education is available locally and within the BGH.
Maternity services should:
- be woman-centred and family focused
- target services to those who are disadvantaged and most in need
- promote and support normal birth and breastfeeding
- prepare parents for birth and for life with a new baby
Antenatal care is provided by health professionals throughout pregnancy in the form of a series of appointments to check the health of mother and baby and provide access to information about pregnancy, birth and the postnatal period. The record of this care is known as the SWHMR or ‘maternity notes’.
These are held by the pregnant woman who brings them to each antenatal appointment and when labour begins. A national unified maternity record is a priority set by the Scottish Government and should be used by anyone involved in a woman’s care during pregnancy, birth and the postnatal period.
The SWHMR is used to record a plan of care for pregnancy. The midwife will tick the boxes to show when an appointment is due, where it will take place, and whether a blood test or ultrasound scan is planned.
If it is a first baby there will usually be 10 appointments, if the women has had a baby before there will usually be 7 appointments. The first appointment may be sometime between 8 and 12 weeks.
Midwife as First point of contact:
- Information on screening tests and plan ‘booking-in’ appointment for 8-10 weeks with named midwife.
- This contact may be by telephone, and followed by letter and information.
Midwifery Led Scanning
- Early pregnancy onwards
- Invited to Parent Education Classes
- Ususally set of 5 main classes between 28 to 32 weeks
- Additional 1:1 parent education if required.
Shared Care between midwife and Consultant
- Age <16 yrs (prims & parous) Discuss or refer to obstetrician.
- Also, if: <16 yrs: offer Sure Start referral
- Current or past mental illness - Offer Sure Start referral. Consider referral to Consultant
- Late Booker > 20 weeks - Fetal Detailed Scan up to 22 weeks
- Drugs history - Discuss with obstetrician if patient on
- Unusual or complex drug therapy
- Unlicensed medicines or herbal medicine
- Concerns re social or domestic situation - Sure Start Referral, Consider Child protection pathways
- BMI <18 Lifestyle assessment, Growth scan 28 and 34 weeks
- BMI >40 Folic Acid 5mg/day Start care pathway (separate sheet)
Postnatally - Following Delivery;
- All women are supported in their choice of feeding.
- Are supported in caring for their infant
- Are visited by community midwife for 10 days (up to 28days if necessary)
Continuous risk assessment, clear communication and documentation, promoting normality and supporting women’s choice are key to ensuring best midwifery practice. When a woman’s choice differs from the recommended care pathway, her choice should be supported in conjunction with a Supervisor of Midwives and clearly documented in her pregnancy records.
To view more information on the BGH Maternity Unit and its virtual tour click here