CONSULTATION DRAFT Introduction These Guidelines provide evidence-based recommendations to support high quality, safe antenatal care and contribute to improved outcomes for all mothers and babies. The Guidelines have been developed in collaboration with State and Territory governments, funded by the Australian Health Ministers’ Advisory Council (AHMAC) and co-sponsored by the Child Health and Wellbeing Subcommittee (CHWS) of the Australian Population Health Development Principal Committee (APHDPC) and the Maternity Services Inter-Jurisdictional Committee (MSIJC) under the Health Policy Priorities Principal Committee. The lengthy process of reviewing the evidence on the numerous aspects of antenatal care necessitated completion of the project in two modules, which are intended to be used together. Clinical Practice Guidelines on Antenatal Care — Module I was released in March 2013. This document is the consultation draft of Module II, which will be revised after review by a wide range of experts, stakeholders and consumer representatives during the formal consultation period. The development of Module II has followed the key principles and processes outlined in the document Procedures and Requirements for Meeting the 2011 NHMRC Standard for Clinical Practice Guidelines. This involved convening multidisciplinary committees in key areas relevant to antenatal care, with oversight by an Expert Advisory Committee with expertise in provision of, development of, research into and experience of antenatal care. Input was also sought from a Working Group for Aboriginal and Torres Strait Islander Women’s Antenatal Care and a Working Group for Migrant and Refugee Women’s Antenatal Care. More detail on the guideline development process is included in the appendices. Application of the Guidelines Objective of the Guidelines The Guidelines take a woman-centred approach, which includes considering the woman’s context, ensuring cultural safety and enabling the woman to make informed decisions and choices about assessments and tests. They aim to improve the health of women and babies by promoting consistency of care and providing a summary of the currently available evidence on aspects of antenatal care. Scope The two modules of the Guidelines cover the antenatal care of healthy pregnant women (ie those who do not have identified pre-existing conditions or complications, such as multiple pregnancy). They are intended for use in all settings where antenatal care is provided, including primary care, obstetric and midwifery practice and public and private hospitals. Module I of the Guidelines includes principles for providing woman-centred care and discusses optimising antenatal care for a range of groups of women, including Aboriginal and Torres Strait Islander women, migrant and refugee women, adolescent women, women in rural and remote areas and women with serious mental health disorders. Clinical topics included are largely specific to the first trimester, although the timing of a woman’s first antenatal contact and the availability of services may mean that some of the clinical assessments or screening tests discussed are carried out later in pregnancy. As well, some assessments are repeated throughout pregnancy (eg blood pressure measurement) and social and lifestyle advice (eg smoking) is beneficial at all stages of pregnancy. Module II of the Guidelines presents the evidence for specific clinical assessments, screening tests and lifestyle considerations that are discussed during pregnancy. While clinical topics discussed in Module I are generally specific to the first trimester, Module II covers some topics that are relevant to the first trimester (eg anaemia), later stages of pregnancy (eg 18–20 week CONSULTATION DRAFT ultrasound, pre-eclampsia) or throughout pregnancy (eg nutrition, physical activity). Additional advice on optimising care for migrant and refugee women and women with mental health disorders is also included. The Guidelines do not include: information on the additional care that some women will require (eg while they discuss tests to identify clinical signs of pre-eclampsia, they do not give information about its management). Resources providing guidance in these areas are listed where relevant; discussion of diabetes diagnosed during pregnancy, as approaches to screening, diagnosis and treatment are currently being reviewed by a number of relevant organisations including the World Health Organization, Australasian Diabetes in Pregnancy Society, Royal Australian and New Zealand College of Obstetricians and Gynaecologists, the Royal Australian College of Pathologists and the New Zealand Ministry of Health; discussion of models of antenatal care, as the Australian Institute of Health and Welfare is in the process of developing standardised definitions that will enable future evaluation of different models of care; or discussion of specific topics where a practice is established (eg testing of blood group and rhesus D status) or where the topic was not considered a priority for inclusion in these Guidelines and advice is given by other organisations (eg vaginal discharge, backache). Intended audience The Guidelines are intended for all health professionals who contribute to antenatal care, including midwives, general practitioners (GPs), obstetricians, maternal and child health nurses,1 Aboriginal and Torres Strait Islander Health Practitioners; Aboriginal and Torres Strait Islander Health Workers, multicultural health workers, practice nurses, allied health professionals and sonographers. The way in which different professionals use these Guidelines will vary depending on their knowledge, skills and role, as well as the setting in which care is provided. These Guidelines will be of interest and relevance to pregnant women in Australia. In addition, it is expected that policy makers will be able to draw on the Guidelines in the development of policy and health services. Implementation and review It is anticipated that a web-based approach be taken to dissemination, with the Guidelines being published on the Department of Health and Ageing website. Key messages from the Guidelines may also be implemented through a number of existing initiatives. A multidisciplinary team has been convened to contribute to the design and execution of strategies aiming to increase the uptake of the Guidelines through liaison with professional groups and promotion of the recommendations. The team includes representation from midwifery, general practice, obstetrics, rural and remote health, Aboriginal and Torres Strait Islander health, and consumers. A range of implementation strategies will be employed, informed in some cases by an assessment of the likely barriers to uptake of the recommendations. Potential implementation strategies include: education through meetings, conferences and presentations; outreach education; and opinion leaders. Implementation of the Guidelines is discussed in greater detail in Appendix C. 1 Also referred to as child and family health nurses in some jurisdictions.