Pregnancy & Post Natal Care

There is a centralised call centre and 1st antenatal appointment system for pregnant women who wish to continue their pregnancy.

The aims of this approach are to :

allow women to self refer to a midwife in line with the national campaign and the national objectives set out in the Scottish Government Health Department initiative ‘Keeping Childbirth Natural and Dynamic’.
facilitate earlier referral and booking in line with new antenatal screening requirements.
improve the sharing of important information about the pregnant woman between GP and midwife in advance of the first maternity appointment.
promote SCI gateway as the common portal for GP obstetric referral.
improve the provision of interpreters for non English speaking women at appointments.
improve appointment management and birth planning arrangements across Lothian.
reduce the time spent by community midwives doing administrative work e.g. creating records, sending in referrals and arranging scanning appointments.
provide a co-ordinated approach for dealing with maternity referrals and appointments management across Lothian.

See referral pathway above.

Women can access maternity care in 3 ways following a positive pregnancy test and where she wishes to continue with the pregnancy :

A woman can contact the maternity 1^st appointment centre on the direct line 0131-536-2009. During the call she will be given the time, date and venue of her 1^st appointment with her community midwifery team together with a scan appointment. Details of these appointments will also be sent to the woman’s GP together with an e-mail request to the practice’s clinical e-mail box requesting that the GP complete and forward a SCI Gateway Obstetric referral.
‘Information only from GP’ should be selected in the ‘Referral Source’ box in this protocol.
High risk referrals will be triaged by a Senior Midwife who will re-direct these to the appropriate high risk clinics or discuss with a Consultant Obstetrician.
If the woman chooses to see her GP the GP should refer the woman via SCI gateway using the Obstetric referral template. In this case ‘Referral from GP’ should be chosen in the ‘referral source’ box.
If the woman contacts a community midwife directly the community midwife should complete a pro-forma and forward this in the usual way.

GP’s can refer or send information back to either St John’s or RIE as it will be received at a single destination i.e it does not imply that is the hospital the women is choosing to deliver the baby in.
When GPs are asked to send information back via SCI Gateway they are only expected to complete the protocol sections with information they hold in their clinical records. If they don’t know or can’t find this information readily then they should leave the relevant sections blank.
The maternity 1^st appointment centre will use call queuing and monitoring technology. All calls will be r ecorded and performance will be audited.

What about folic acid?
Women can’t currently get folic acid free WITHOUT A PRESCIPTION. It isn’t covered by the minor ailments service. It is, however, very cheap . Alternatively pregnant women should request a prescription from their GP.

Who will triage high risk referrals including those for St Johns?
All referrals to the Maternity 1^st appointment centre will be triaged by a senior midwife including those women who wish to deliver at St John Hospital. A list of consultant antenatal clinics and consultant contact details will be maintained in the centre to ensure good communication between the triaging midwife and consultant obstetrician. In addition all community midwives undertake a risk assessment as part of the maternal history taking process and will make appropriate referrals as recommended by the Lothian Antenatal Referral Guidelines. Any concerns regarding the referral of a high risk woman should be escalated to the Community Midwifery Manager, Women’s Services, Lothian
The GP referral/information sharing protocol will ensure that important information relevant to the management of the pregnant woman is available in advance of the 1^st antenatal appointment and will inform the triaging process.
How can appointments be changed?
Women wishing to change their 1^st appointment or scanning arrangements should do this by contacting the Maternity 1^st appointment centre. If midwives are changing appointments then they should do this directly with the woman.

2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum https://www.liebertpub.com/doi/pdfplus/10.1089/thy.2016.0457

Ready Steady Baby websiteThis site has links to a other useful sites and documents.