Maternity standards
High-quality, compassionate and integrated antenatal care has positive outcomes for both the woman/birthing person and her baby.24. Timely access to antenatal care supports relationship building between the woman and her midwife and the wider maternity team as well as the early identification of care and support needs, including ultrasound scans, screening, vaccinations and referrals. NHS boards should ensure services and staff are supported to implement the national maternity pathway alongside other local and national clinical guidance.
Antenatal healthcare begins early in pregnancy (usually at 8-10 weeks gestation) with a first antenatal (or booking) appointment recommended to take place before 10-weeks’ gestation. The primary midwife has specific responsibility for continuity and coordination of midwifery care, ensuring appropriate referral and access to the multidisciplinary team. Antenatal care incorporates evidence-based assessments, including monitoring of pre-existing or pregnancy-related medical conditions, mental health and social circumstances. Antenatal discussions should include nutrition, use of health-harming products (including tobacco), mental health (see Standard 10), gender-based violence and access to housing and financial support. Staff should refer to the national maternity pathway and local pathways on timing of antenatal visits, investigations, health visitor appointments, pregnancy screening and referral for other support opportunities.
Person-centred communication, monitoring and assessment within a continuity of care model supports planning for pregnancy and birth ensuring further investigation, referral for additional support or specialist care planning, where required. The maternity team may arrange home monitoring as appropriate, for example, blood pressure monitoring (see Standard 4). Where further investigation or specialist support is required, this should be in line with related guidance.
High-quality antenatal education equips women for childbirth and the transition to parenthood. Women (and, where appropriate, their care partners) should be signposted to antenatal classes, including those provided by the local NHS board, and national resources, for example, Ready Steady Baby!.
Fetal movement is an important indicator of fetal wellbeing. Women should have discussions about fetal movements in pregnancy with their midwife (or where appropriate obstetrician) and be advised to contact their local maternity unit or hospital maternity triage immediately if they have any concerns about reduced movement. Clear guidance on how to access maternity triage assessment and when it may be required should also be provided (see Standard 9).
Where a woman has complex care needs, an obstetrician may be identified as the lead professional. The primary midwife should ensure timely collaboration with, and escalation and referral to, multidisciplinary and multiagency colleagues where appropriate. For example, obstetrician, obstetric anaesthetist, family nurse practitioner, social worker or specialist care team, depending on assessed need and in line with the national maternity pathway or related guidance.
Women with complex care needs may experience increased clinical risks during pregnancy, including risks associated with continuing their pregnancy. NHS boards should ensure staff provide tailored information to help women to understand these risks and consider their options. Providing care that is compassionate, person centred and trauma informed enables women to make informed and autonomous decisions regarding their pregnancy. NHS boards should ensure that clear and effective referral pathways are in place so that women can access the care and support most appropriate to their needs, including counselling and other specialised services.
NHS boards should have systems to ensure women who require antenatal anaesthetic referral are assessed by a senior obstetric anaesthetist within a suitable time frame in line with national guidance.
Towards the end of pregnancy, a primary midwife should revisit discussions to support the woman to plan labour and birth in line with the national maternity pathway. Discussions should be evidence and risk based and include the options available, for example, access to provision of a home birth service, induction, access to pain relief or likelihood of an obstetric supported birth. Women should be provided with the Birthplace decisions leaflet.