The Scottish Woman-Held Maternity Record (SWHMR) Version 4, January 2008

 Handheld records introduced in many parts of UK from 1993  Two Randomised Controlled Trials of handheld v traditional records identified no negative consequences (including no more lost notes than traditional system) with positive effects on communication, women’s sense of control, reduction in clerical time and reduction in repetition of care (Elbourne et al 1987, Lovell et al 1986)  Scotland- wide record identified as an aspiration in policy since 1995 and in the “Framework for Maternity Services in Scotland” in 2001  Benefits of a national record include reduction of “postcode lottery” of care provision; encouragement of adoption of evidence based care in all parts of the country; reduction in repetition of care when women move health boards Why SWHMR?

History of SWHMR Framework for Maternity Services in Scotland and 2002 EGAMS report state that development of a national unified handheld record a priority NHS QIS commissioned by the Scottish Executive to develop SWHMR Project midwife appointed by NHS QIS for 2 year secondment; multi-disciplinary steering group set up to develop the record Consultation exercise carried out across the service and with service user groups during 2003 Early 2004, version 1 of the SWHMR passed from NHS QIS to Scottish Executive with project report and guidance for professionals

History of SWHMR 2 Further implementation delayed until Autumn 2006 when small number of revisions requested by Lead Midwives Scotland group Revisions made Autumn 2006 by Practice Development Unit at NHS QIS to produce version 2 Version 2 – six month print run produced for NHS Scotland by NHS QIS and sent out in February 2007 March 2007 Health Department Letter from Chief Nursing officer calling for national implementation of the SWHMR

History of SWHMR 3 (it’s a long story) Feedback sought from service about the SWHMR following implementation Problems identified which threatened full national implementation including concern about loose leaf nature of record, concerns about a perceived lack of logical flow in documentation NHS QIS commissioned by the Scottish Government in July 2007 to work with the service to resolve the identified issues and produce an amended version by January 2008 July – October 2007 National Solutions Group discussed and agreed amendments to binding, order and content of the record October- November 2007 Pilot and national Consultation on version 3 of the SWHMR

Underlying principles of SWHMR Focusing on normality Encouragement of holistic maternity care Responding to diversity Promoting woman-centred care Encouraging high standards of record keeping Encouraging high quality communication between professionals Encouraging multi-disciplinary maternity care

The Pregnancy Record One bound record for woman to hold for pregnancy, plastic zip wallet for storage Front 9 pages and Plan of care for pregnancy at back of record to be completed at booking Women to be encouraged to write in their record where symbol appears Back up of booking information in maternity summary record – to be stored in maternity unit or with community team Sensitive information re domestic abuse to be stored in maternity summary record Booking questions identify women at higher risk – medical, obstetric, social, psychological and in need of additional care Booking questions encourage health promotion and referral on to support services as needed Consent included for antenatal maternal and fetal screening tests Women should be encouraged to see last 5 pages of record as theirs to complete and refer to

Other Specific Points of Interest in Pregnancy Record Family health section includes question whether mother and baby’s father are blood relatives due to increased risk of congenital abnormalities Question on female circumcision is asked as women who have had FGM need antenatal assessment, clear plan for labour management Mental health questions screen for risk factors associated with poor perinatal mental health, as advised by Confidential Enquiries into Maternal Death Routine random blood glucose is not included in the routine screening tests as it is evidence based practice recommended by latest NICE guidance Ultrasound scan pages allow for hand plotting of scan growth results, but computer print out can be attached as alternative

Intrapartum Record Bound smaller sized pages to allow “Special Features” to be visible – where risk factors for pregnancy, intrapartum, postnatal and baby can be clearly highlighted Bound in partogram for quick visual summary of labour – with blue side flashes to allow easy identification Induction and Complications of labour and birth (assisted deliveries, caesarean sections, third stage complications) in separate bound booklet which can be inserted as needed; with blue side flashes to allow easy identification

Postnatal Records Use SBR discharge or local discharge summary print out and attach to inside front cover as appropriate to avoid repetition of hand documentation Consent for newborn blood spot screening contained in baby’s midwifery care record Space to prompt discussions with mothers about their feelings and any reflections about the birth Confirmation that early parenting education has taken place in relation to baby care and feeding Discharge from community midwifery care summarising mother’s and baby’s care at back of each record – can be photocopied to facilitate handover to health visitor Neonatal record documenting routine examination of the newborn does not go home with the baby, but is the ‘base document’ in the hospital Maternal and baby records returned to the hospital following discharge from community midwifery care and put in mother’s and baby’s records

SWHMR Next Steps Implementation support including site visits at units’ request from NHS QIS Practice Development Unit Give the Record time to embed – allow extra time for appointments in first weeks Feedback any concerns to local implementation lead or NHS QIS PDU National evaluation to take place mid-2008 Further amendments planned for 2009/10 based on changes in practice and evidence

Thank you and Good Luck