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MAT/GUI/0410/DISINF
MATERNITY SERVICE GUIDELINE
TITLE:
AUTHORS:
GUIDELINE LEAD:
RATIFIED BY:
ACTIVE DATE:
RATIFICATION DATE:
REVIEW DATE:
APPLIES TO:
EXCLUSIONS:
RELATED POLICIES
THIS DOCUMENT REPLACES
Provision and discussion of
information during the antenatal,
intrapartum and postnatal period.
Lynn Bonsey- Antenatal
Screening Coordinator and
Supervisor of Midwives
Mary Olusile- Practice Facilitator
Lead and Supervisor of Midwives
Guideline Committee
May 2010
April 2010
April 2013
All Maternity Staff
None
New document
1.
INTRODUCTION/PURPOSE OF THE GUIDELINE
1.1
Pregnancy, birth and the time after birth with a new baby are life changing
events, throughout which women and their partners should be offered
evidence based information and support to enable them to make informed
choices and decisions regarding their care. This information will include
where women will be seen and who will undertake their care. (NICE 2008
Antenatal care)
Midwives and other Health Care Professionals are the key to this information
provision and need to respond to the individual needs of each woman and
her partner by providing all the essential and additional information that they
might require throughout pregnancy, birth and the postnatal period.
Community Midwives, General Practitioners (GPs), Midwives, Health Care
Assistants, Maternity Care Assistants, Nursery Nurses and Obstetricians all
have a responsibility to ensure all women have current and up to date
information on which to base decisions regarding their care, regardless of
the care setting.
1.2
1.3
2.
IMPLEMENTATION
o A paper copy will be attached to the guideline and audit notice
boards.
o Emailed copies will be sent to all midwives and obstetricians
o It will be available via the Trust intranet.
o It will be circulated to guidelines folders.
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3.
ROLES AND RESPONSIBILITIES
3.1.
This guideline is the responsibility of all maternity unit staff including
Obstetricians, Anaesthetists, Neonatologists, Midwives and Maternity Care
Assistants to understand the process and their responsibilities to give
approved evidenced based information to women ensuring the provision and
discussion of information during the antenatal, intrapartum and postnatal
period to enable the women and partner to be able to make informed
choices based on the best available evidence.
3.2.
The purpose of this guideline is to highlight the responsibilities of midwives
and relevant staff groups in the discussion and provision of information
leaflets, during the antenatal, intrapartum and postnatal period. In addition,
this guideline will provide the midwives and other health care providers with
a schedule (see appendices 2-4) of the available recommended patient
information leaflets, as approved by the Maternity Women’s Information
Group (for the Maternity Patient Information Pathway, see Appendix 1)
4.
GUIDELINE
Information (in the form of written information and discussion) is ideally given
to the woman in the antenatal period and in line with the antenatal schedule
(see appendix 2) so there is an opportunity to raise any questions before
baby is born and also to be as informed as possible in advance.
Discussion and provision of all information must be clearly documented in
the woman’s hand held Maternity notes, dated and signed; where applicable
use the printed spaces/boxes provided in the Maternity notes.
To facilitate the provision of this information an agreed schedule of
information and leaflet provision has been devised to aid and prompt
Midwives and other Health Care Professionals in their practice (see
appendices 2-4).
Standard booking information (see appendix 2) must be signed and dated as
given in the Maternity notes.
Information given at 28 weeks, 34 weeks and at 41 weeks and all additional
information given when necessary (see appendix 2) must be documented in
maternity notes.
The provision of standard postnatal information must be documented (see
appendices 3 and 4), dated and signed on the designated page in the
postnatal section of the Maternity notes.
Any leaflets/booklets given out must be the current/most up to date edition
and must have date of publication.
Any non-Barts and The London information used must be from a suitable
source e.g. NICE, Royal Colleges, National Screening Committee,
Department of Health and must be approved by the relevant Maternity
Women’s Information Group (WIG). It should not contradict guidelines or
policies and should have a date of publication.
Any advertising in e.g. booklets MUST be approved by WIG and the Trust’s
Patient Information Validation Committee but ideally kept to a minimum.
4.1
4.2
4.3
4.4
4.5
4.6
4.7
4.8
4.9
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MAT/GUI/0410/DISINF
4.10
4.11
4.12
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All pregnant women will be offered opportunities to attend participant-led
antenatal parent education which includes breastfeeding sessions. (NICE
2008)
Communication should be provided in a form that is accessible to pregnant
women who have additional needs, such as those with physical, cognitive or
sensory disabilities. Where possible advocacy will be sourced for those who
do not speak English.
Leaflets used from National sources such as BFI (www.babyfriendly.org.uk)
and DOH (www.dh.gov.uk) have availability to download a variety of
languages, please access the relevant website and download these leaflets.
4.2
PROCESS FOR PROVIDING INFORMATION TO WOMEN WITH WHERE
ENGLISH IS NOT THE WOMAN’S FIRST LANGUAGE OR
COMMUNICATIONS NEEDS.
4.2.1 Information is available from various sources in other languages. A list of all
leaflets available in a choice of language is available from the WIG.
Antenatal leaflets are kept in the community offices and
Intrapartum/Postnatal in the ward areas. There are a team of advocates at
Barts and the London Maternity Hospital and the requirement for an
advocate for all discussions should be requested and written in the hand
held record.
4.2.2 If an interpreter has to be used then the status (e.g. advocate, family
member, language line) and name need to be documented in the Maternity
notes.
5.
BREACH OF GUIDELINES/POLICIES
5.1.
Incidents related to non-compliance will be reviewed within the risk
management framework. The impact of the incident will be reviewed by the
appropriate lead clinician and feedback/ training given to staff as required.
6.
MONITORING COMPLIANCE (see Appendix 5)
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REFERENCES
1. National Institute for Health and Clinical Excellence (NICE) (2008)
Antenatal care: routine care for the healthy pregnant woman. London:
NICE.
2. National Health Service Litigation Authority (NHSLA) (2010) Clinical
Negligence Scheme for Trusts (CNST): Maternity Clinical Risk
Management Standards. Version 1 2010/11. London: NHSLA.
3. Royal College of Anaesthetists, Royal College of Midwives, Royal
College of Obstetricians and Gynaecologists, Royal College of
Paediatrics and Child Health. (2007). Safer Childbirth: Minimum
Standards for the organisation and Delivery of care in labour. London:
RCOG. Available at www.rcog.org.uk
4. UK National Screening Committee. Information for users London: UK
NSC. Available at www.screening.nhs.uk
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MAT/GUI/0410/DISINF
APPENDIX 1
Pathway for the development and amendment of patient
information
Patient Information Leaflet need or
Review identified.
Discussed at WIG.
Author/Authors identified to develop
information leaflet
Draft leaflet reviewed by WIG
Accepted by WIG
WIG will inform
Author/s of any necessary
amendments
Sent to Communications Dept for
changes.
Changes agreed by WIG.
Ratified by Communications Dept
Committee.
BLT reference number
allocated.
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Printer instructed for quotes, orders
made and informs Maternity when
leaflet available for delivery.
MAT/GUI/0410/DISINF
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MAT/GUI/0410/DISINF
APPENDIX 2
INFORMATION IN PREGNANCY
NSC – National Screening Committee
FSA – Food Standards Agency
BFI – Baby Friendly Initiative (Unicef)
DOH – Department of Health
 The list below is not exhaustive; women may be given additional written information according to their needs, e.g. at specialist clinics.
□ = Leaflets for CNST compliance
Booking Information leaflets (to be discussed at 1st booking)
Leaflet Title
Screening Tests for you and your baby
Covers the following;
 Screening for Sickle Cell and Thalassaemia
 Down’s Syndrome testing
 Testing for infections in pregnancy
 Ultrasound including 20 week anomaly scan
 Newborn and 6-8 week physical examination
 Your baby’s hearing screening test
 Newborn blood spot screening for your baby
Choosing where to have your baby in Tower Hamlets
Document ion
(include discussions and
provision of information)
Page 7 of the pregnancy notes
Booking or baby and me clinic
Page 21 of the pregnancy notes
Issue handheld Maternity Records and discuss information
pages
Information on blood tests in Maternity Records (p.6) and
Blood Tests during pregnancy Leaflet
See page 6 and 8 of pregnancy
notes
Seat belts & child restraints
Page 19 of pregnancy notes
Healthy Start
Page 19 of pregnancy notes
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Available from
Review Date
National Screening
Committee (2008)
External leaflet NSC
BLT
March 2012
Community midwives
Office/ Antenatal
Clinic (ANC)
DOH
Maternity Records
review 2011
Department of
Transport KRIS
T/INF/251
DOH 2006
Maternity Records
reviewed 2011
Leaflet DOH update
Dept. of Transport
External leaflet DOH
MAT/GUI/0410/DISINF
FW8 form if not already given by GP
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Document on front page of
Maternity Records
Document on front page of
Maternity Records
Page 19 of pregnancy notes –
write dates for first appointment
DOH
DOH
Community Midwives
Office/ ANC
Community Midwives
Office/ ANC
Updated as necessary;
will always be current
Updated as necessary;
will always be current
Folic Acid
Page 19 of pregnancy notes
DOH
DOH update.
Parents Guide to Money, financial pack
Page 19 of pregnancy notes
Government update
Breast feeding booklet
(Off to the best start)
From bump to breastfeeding DVD
Page 19 of pregnancy notes
Financial Services
Authority
08449918282 code
no PGM0210 60 per
box
DOH (2007)
Information on how to contact midwife, according to team.
Information on antenatal classes:
given according to local community arrangements and
documented in Maternity records
Other information and leaflets to be given and discussed as indicated at booking
Obesity (Raised BMI - leaflet in preparation)
Domestic abuse leaflet – Domestic Abuse No excuse
discuss when opportunity arises and document.
Declining Blood Products or a blood transfusion BLT
has Maternity Guideline on this and consent forms for
woman refusing Blood transfusion has some patient
information contained within it
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Booking and ongoing if
applicable
Page 19 – pregnancy notes
Booking and ongoing if
applicable
Document in medical history
on page 3 pregnancy record
External leaflet
Being written 5/2010
External leaflet DOH
To be allocated for
writing July 2010
To be allocated for
writing July 2010
External leaflet
March 2012
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MAT/GUI/0410/DISINF
Questions and Answers helping pregnant women quit
smoking.
Booking and ongoing
page 3 pregnancy record
www.smokefree.nhs.uk
External leaflet
S is for smoking and pregnancy
As above
DOH
May 2012
BLT
March 2012
DOH
External Leaflet
BLT
March 2012
Gestational Diabetes
Hepatitis B How to protect your baby
Diabetes - before pregnancy
Page 19 – pregnancy notes
Special features box page 15
pregnancy notes
Booking and ongoing
page 3 pregnancy record
Information and Leaflets to be given and discussed before or at 28 weeks
Health in Pregnancy Grant Information
Page 19 – pregnancy notes
Mat B1 (21 Weeks onward)
DOH
DOH
RhD negative and care in pregnancy (only Rh negative
women) Anti D
Page 7 – pregnancy notes
BLT
External leaflet
DOH update
External Leaflet
Being rewritten
5/2010
Information and leaflets to be given and discussed at 34 weeks
Vitamin K and your baby
Monitoring your baby’s heartbeat in labour
Page 21 pregnancy notes
Page 21 pregnancy notes
BLT Update 2012
BLT
March 2012
Being Written 5/2010
Pain Relief in Labour (including regional anaesthesia)
and general anaesthesia
Page 21 pregnancy notes
Obstetric
Anaesthetists
Association (OAA)
have leaflets on
epidurals available to
External Leaflet
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MAT/GUI/0410/DISINF
Birthplans
Page 21 pregnancy notes
Review again and document on
page 2 of Yellow Intrapartum
notes
Spontaneous Rupture of Membranes
Breastfeeding Checklist (Antenatal)
Page 19 – pregnancy notes
download in various
languages
www.oaa-anaes.ac.uk
BLT
BLT
To be completed
Other information and leaflets to be given and discussed as indicated at 34-37 weeks
Vaginal Birth following a Caesarean Section (VBAC)
Document as discussed and
BLT
given page 21 pregnancy notes
Planned Caesarean Section
Document as discussed and
BLT
given page 21 pregnancy notes
External Cephalic Version (ECV)
Document as discussed and
BLT
given page 21 pregnancy notes
What can I do if my baby is lying in a breech position?
Document as discussed and
BLT
given page 21 pregnancy notes
Group B Strep (GBS)
Document in special features
BLT
pregnancy notes page 17
To be allocated
To be allocated
March 2012
March 2012
March 2012
March 2012
To be written
Information and leaflets to be given and discussed at 38-40 weeks
Being induced at The Royal London Hospital
Page 10 of 14
Document in special features
pregnancy notes page 17
Document in labour notes
BLT
March 2012
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MAT/GUI/0410/DISINF
APPENDIX 3
INFORMATION IN THE POSTNATAL PERIOD
Postnatal information (in addition to that given in antenatal period)
Leaflet title
Reduce the risk of cot death
Also contains advice on baby’s general health
and advice if baby not well
Sharing a bed with your baby
Available from
Time to be given
Review date
Review date
DOH (2009)
Complete post natal
notes mother page 18/19
All mothers
External
Leaflet
Complete post natal
notes mother page 18/19
Pre or post birth
External
leaflet
Breast feeding support in Tower Hamlets
UNICEF/
Foundation for
Sudden Infant Deaths
(2005)
PCT
Complete post natal
notes mother page 18
All breastfeeding
mothers
Off to the Best Start
DOH (2007)
Bottle feeding
NHS/DOH 278959
(2007)
Complete post natal
notes mother page 18
Complete post natal
notes mother page 19
All breastfeeding
mothers
Bottle feeding
mothers only
External
Leaflet PCT
updated
External
leaflet DOH
External
leaflet DOH
Registry Office Contact Details and website
BLT
Complete post natal
notes mother page 20
Women’s Health Physiotheraphy Service
Postnatal advice and exercises
BLT
Discuss can document
on daily post natal
checks
Sticker to go on all
postnatal leaflet
information pack
All mothers
March 2012
Contact numbers for Community midwives.
BLT
Constantly updated,
always current.
Leaflets for postnatal period
(given as necessary by Labour Ward or Postnatal Wards depending on need)
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MAT/GUI/0410/DISINF
Leaflet title
Document
Review date
Assisted vaginal delivery
(ventouse/forceps)
Document as given in labour or
post natal record
BLT
May 2012
Emergency Caesarean Section
Document as given in labour or
post natal record
Document as given in labour or
post natal record
Document as given in labour
record page 18
BLT
May 2012
BLT
May 2012
BLT
March 2012
Gestational Diabetes – after you have had your baby
Perineal Tears following childbirth
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MAT/GUI/0410/DISINF
APPENDIX 4
INFORMATION FOR BEREAVED PARENTS
Additional copies available on request from Bereavement midwife who liaises closely with the chaplaincy service, SANDS and other relevant organisations.
Bereavement
(information and leaflets given and discussed as appropriate)
Leaflet title
Available from
Information for parents who have suffered a stillbirth or neonatal death
BLT
When your baby dies
BLT
SANDS LEAFLETS (available from SANDS - Stillbirth & Neonatal Death Society)
After the death or stillbirth of your baby
Saying goodbye to your baby
The next pregnancy: Guidance for parents
For family & friends: How you can help
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MAT/GUI/0410/DISINF
APPENDIX 5
Monitoring compliance with the process or ensuring the provision and discussion of information during the antenatal / intrapartum and post natal
period
Element to be
monitored
Lead
Tool
Frequency
Responsibilities
of the relevant
staff groups
Audit and quality
midwife
Documentation
audit
10 sets monthly
Schedule of when
the
discussions/infor
mation provision
should take place
Audit and quality
midwife
Documentation
audit
10 sets monthly
Process for
providing
information for
women with
communication
/language needs
Audit and quality
midwife
Documentation
audit
10 sets monthly
Maternity service
expectations of
staff to document
in the health
records –
discussion and
provision
Audit and quality
midwife
Documentation
audit
10 sets monthly
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Review of results
Interrogation
Acting on
recommendations
Audit report to be
presented to the Labour
Ward Forum for
agreement of
recommendations.
Labour Ward
Forum will prepare
and monitor the
action plan
Labour Ward Forum
reports to the maternity
and gynaecology
governance Board
Women’s information
group to receive
feedback
Women’s
Information Group
wil respond to
feedback from the
Labour Ward
Forum in relation to
commissioning/revi
ewing information
leaflets
Change in practice
and lessons to be
shared
Required changes to
practice will be identified
and actioned within a
specific time frame
documented in the
agreed action plan. A
lead member of the team
will be identified to take
each change forward
where appropriate.
Lessons will be shared
with all the relevant
stakeholders.