A Framework for Maternity Services in Scotland: page 6

A Framework for maternity services in Scotland

This Framework sets out a number of guiding principles for maternity care. These are grouped in the following sections,

Pre-conception and very early pregnancy
Pregnancy
Childbirth

Clear and consistent themes have emerged from developing the Framework in a multi-disciplinary forum. These themes have been addressed throughout the Framework and have also formed the basis of further work to be carried out.

This Framework captures guiding principles, local action and further work to be carried out, both nationally and locally. It is not a strategy document and it does not provide a model service specification.

The Clinical Standards Board for Scotland will develop standards that will reinforce the principles outlined in the Framework and allow their implementation to be monitored and audited. These standards will be developed during 2001.

Postnatal and parenthood
Service organisation and provision
Risk assessment and management
Information and communication

Pre-conception and very early pregnancy

This section reflects on the importance of planning and preparation for pregnancy with an emphasis on good health and consistent support from professionals.

Principle 1

Good health before and during early pregnancy benefits the woman, her unborn baby and the wider family. All women of reproductive age should be empowered and encouraged to be as healthy as possible.

Local Action

NHS Boards should address the health promotion needs of school age children and women of reproductive age;
NHS Boards should make sure that information and routes of access to maternity services are available to a woman who accesses any element of the reproductive health care spectrum;
NHS Boards should actively engage with Social Inclusion Partnership initiatives to ensure a proactive, joint approach to improving the health of the more disadvantaged woman;
NHS Boards should make sure that women planning a pregnancy have easy access to a package of information on lifestyle, pregnancy, and how and where to access local services;
Health education and advice should be given at every opportunity by Primary Health Care Teams when they are providing services for women of reproductive age. This should include advice and support on Folic Acid, Physical Activity, Diet, Rubella, Toxoplasmosis, Chlamydia, HIV/AIDS, Smoking, Alcohol, Drugs and Sexually Transmitted Disease.

Smoking

Maternal smoking in the first 12 weeks of pregnancy (until the end of the first trimester) is responsible for up to 25% of all low birth weight infants. In Scotland (1998) this equals 1,016 low birth weight infants.

Alcohol

Estimates from the United States of America Centres for Disease Control for Fetal Alcohol Syndrome (FAS), of 6.7 births per 10,000 live births suggests around 38 births per year with FAS in Scotland.

Principle 2

Specific pre-conception services should be available to women with a poor obstetric or medical history, a previous poor fetal or obstetric outcome, or where there is a family history of significant illness.

Local Action

NHS Boards should review pre-conception services, including advice and counselling services, to make sure they meet the needs of all women and their partners;
Table 12 outlines a possible model for pre-conception and very early emergency antenatal care. It identifies the lead professional, location of care and care delivered. NHS Boards should consider this model when planning and providing these services.

Table 12 Model for pre-conception and very early emergency antenatal care

Level of care	Lead professional	Location of care	Clinical category	Care delivered	Investigation and location
Pre- Conception	Consultant Obstetrician (+ Consultant specialist)	Maternity unit	Poor obstetric or medical history, previous poor fetal outcome, previous fetal disease or family history of inherited disease	Pre-pregnancy counselling, Dietary advice including folic acid supplement	Genetic counselling and biomedical investigation	Maternity unit
Early Pregnancy	GP or Midwife or Consultant Obstetrician	Community Maternity unit or Consultant Maternity unit	Threatened or inevitable miscarriage, suspected ectopic or abdominal pregnancy	Medical or surgical treatment as appropriate	Ultrasound and biochemical investigation	Maternity unit, early pregnancy assessment unit or in-patient ward

Further work to be undertaken

The Scottish Executive Health Department and the Health Education Board for Scotland should develop an assessment sheet to guide professionals in their discussions with women about folic acid, diet, smoking, drugs and alcohol.

Principle 3

There should be specific services for women with complications in early pregnancy.

Local Action

NHS Trusts should make sure that Early Pregnancy Assessment Units or Services are available, both in the community and hospital setting. Women should have access without undue delay to ultrasound scanning and specialist advice. Their GP and midwife should have direct channels of referral to these units;
NHS Trusts should make sure that the recommendations of the National Medical Advisory Committee Report on The Management of Early Pregnancy Loss (1996) are implemented.

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