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.