1. Ante natal care Sharon Wallis Senior Matron

2. Importance of AN care Appropriate care pathway from start Assessment of maternal & fetal well being Early detection of pregnancy induced conditions or exacerbation of pre exisiting ones Appropriate & timely referral Support women & their families

3. Choice, continuity & control! Place of birth – hospital or home Choice of pain relief in labour Continuity of care / carer

4. Booking Ideally between 8 – 10 weeks gestation Thorough social / obstetric /medical /family history Includes mental health history Routine enquiry into domestic abuse Health advice – smoking / substance & alcohol misuse / diet / exercise Maternity benefits Screening / blood tests

5. Social history Support - benefits Teenage Safe guarding Learning disabilities Non English speaking / reading Interpreters

6. Obstetric history Previous C/S PPH 3 rd degree tear IUFD / stillbirth Baby >4.5 kg IUGR Preterm labour Grand multip Retained placenta x 2 Shoulder dystocia 3 x consecutive 1 st trimester miscarriage 2 nd trimester miscarriage

7. Relevant medical history Cardiac disease Endocrine disease Genital tract surgery Haemaglobinopathies BBV BMI >35 /<18 Skeletal / spinal problems Declines blood products Malignancies Severe asthma

8. Family history 1 st degree relative with IDDM FH Pre eclampsia Thromboembolic disorders Congenital abnormalities / deafness FH – poor obstetric outcome

9. Mental health Past hx of severe MH disorders especially following childbirth FH of severe MH disorders especially that required hospitalisation Emphasis on early detection and referal to maternal MH team

10. Domestic abuse Routine enquiry at least 3 times during pregnancy episode All women asked RE + /- Contact numbers highlighted Safeguarding issues with disclosure

11. Health advice Smoking Alcohol Substance misuse Don’t do it! Referal to Fresh start / drug and alcohol specialist midwife if necessary

12. Screening All women offered NT+ (combined screening) between 11+ - 13+ weeks FBC Sickle + thalasaemia screening Blood group & anti bodies Microbiology screening MSU

13. AN visit schedule Based on individual clinical need As a minimum, women are seen;  At booking (8-10 weeks)  Dating scan +/- NT+ (RDH)  16 weeks  Anomaly scan (RDH)  24 weeks  28 weeks – repeat FBC / anti bodies / anti D if Rh neg  31 weeks  34 weeks – repeat FBC  36 weeks  38 weeks  Term  Manual BP / urinalysis / SF height measurement as minimum