Antenatal care
§ Pregnancy and childbirth is a natural life event and in most cases a normal birth occurs
§ Women with low risk factors should be cared for by midwives. Obstetricians should care for women with identified high risk factors
§ Options of care should be offered to all women in accordance with their individual needs, including:
o Midwifery continuity of care models e.g. Midwifery Group Practice, Birthing Centre, Continuity of carer
o Shared or complete care with general practitioner and / or hospital clinic
o Hospital clinic
o Choice of private obstetrician
§ The use of the SAPR is endorsed by the Department of Health as a complete record of the woman’s antenatal care
§ Women who are pregnant are required to carry their SAPR at all times and bring their SAPR to each antenatal or general practitioner (GP) visit or any admission to hospital
§ The SAPR will be added to the woman’s hospital medical record at admission for birth and will remain the property of the hospital
§ A copy may be given to the woman on request
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§ Usually occurs with a midwife at around ten week’s gestation
§ Link to first visit process:
§ Research suggests that antenatal midwife care of women with uncomplicated pregnancies is being extensively implemented with economic benefits for health institutions (Villar 2003)
§ The frequency of visits should be in accordance with the woman’s needs. For example, a healthy woman in her second pregnancy need only attend for a few visits (e.g. 5-8)
§ Suggested antenatal visits for first pregnancy are:
o Booking visit; 19-20, 24, 28, 32, 36, 38, 40 and 41 weeks
o Women in successive pregnancies may attend less often
§ Refer to the schedule of visits for each hospital
§ Healthy lifestyle programs may be offered during antenatal visits e.g. Quit
§ Link to Documentation
§ Morphology ultrasound (usually at 18 weeks)
§ Calculate final expected date of birth
§ Complete blood picture
§ Oral glucose challenge test (OGCT)
§ Antibodies
§ Prophylactic anti D to be given to Rhesus negative women having their first baby who have reached 28 weeks gestation
§ An antenatal psychosocial questionnaire is offered for women to complete (as per hospital criteria). The aim is to identify women who are in need of additional services / supports during their pregnancy or after the birth of their child
§ 2nd dose of prophylactic anti D to be given to Rhesus negative women at 34 weeks gestation
§ Visit with Consultant Obstetrician is required at 36 weeks for GP shared care
§ Each hospital has a protocol for the screening and management of Group B Streptococcus colonisation. Refer to the particulars of each hospital
§ Discussion / education with woman on the benefits of breastfeeding
§ Discuss induction of labour
Supplements in pregnancy
§ Calcium, vitamins and fluoride are not usually necessary
§ Offer screening for vitamin D insufficiency to at risk women (see chapter 5c – Antenatal screening of at risk mothers and prevention of deficiency in their infants)
§ Supplemental iron will only be required after proof of iron deficiency
§ Folic acid 0.5 mg / day should be taken at least one month before conception and until 12 weeks gestation. If the woman is at increased risk of neural tube defect, on antiepileptic drugs or has hyperhomocysteinaemia the dose should be 5 mg / day
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