Pregnancy Notes

Pregnancy Notes Version 11.1 - Updated September 2011
Pages from the notes

The Pregnancy Notes aim to facilitate a partnership between the principal stakeholders in antenatal care – mother, baby and care provider – and place emphasis on patient safety and informed choice. These notes are designed to support comprehensive history taking, promote effective communication between the mother and the multi-disciplinary care team and between members of that team.
The comprehensive risk assessment identifies individual risk factors for the expectant mother, thus assisting identification of the correct maternity pathway for her. This information should then be used to develop a management plan individualised to the needs of the woman ensuring safe, high quality maternity care.

The notes are hand-held by the woman, this approach encourages two-way communication so the expectant mother and her family are fully informed and able to contribute to the decision making process. Documenting all clinical care and management plans within the hand held record encourages openness and transparency. Effective communication within the multi-disciplinary team helps to prevent avoidable loss and accurate, contemporaneous record keeping is a fundamental component of good maternity practice.

The Pregnancy Notes contain:

Explanatory notes on ‘what to expect’, discusses options and answers to common problems. Mothers want information that is up-to-date and evidence based; socially disadvantaged mothers want at least as much information as other groups.
Prompts for midwives to discuss various public health issues which are relevant during pregnancy e.g. employment rights, emotional support and domestic violence, the baby friendly initiative, smoking cessation.
Further prompts to discuss individual needs, access to services, and preferences for birth.
Information on antenatal screening tests consistent with aims of the National Screening Committee; prompts to confirm that information has been given to allow informed choice.
Details of family history consistent with recommendations from working party of the Joint Royal College Committee on Medical Genetics.
An emphasis on improved fetal growth screening, consistent with lessons from analyses of perinatal mortality. The Notes incorporate ‘customised antenatal growth charts’ which adjust for individual maternal variation due to constitutional differences, ethnic group etc. The use of these charts improves the detection of fetal growth problems and reduces unnecessary investigations and admissions to hospital.
Guidance for professionals in accordance with recommendations outlined by NICE.

Some of the key documents used in the development of these notes:

Clinical Negligence Scheme for Trusts (2010) Maternity- Clinical Risk Management Standards 2010/11 www.nhsla.co/riskmanagement/cnststandards
Centre for Maternal and Child Enquires (2011) Saving Mothers’ Lives: reviewing maternal deaths to make motherhood safer: 2006 -08. 8th Report, BJOG 2011; 118.
Confidential Enquiry into Stillbirths and Death in Infancy (2001) - 8th Annual Report.
Department of Health (2001) Building a safer NHS www.dh.gov.uk
epartment of Health (2009) Healthy child programme: Pregnancy and the first five years www.dh.gov.uk
Department of Health (2007) Maternity Matters www.dh.gov.uk/publications
Department of Health (2003) Tackling Health Inequalities www.dh.gov.uk/publications
National Screening Committee (2010) Antenatal and newborn screening www.screening.nhs.uk/an
National Institute of Clinical Excellence (2008) Antenatal Care Clinical Guideline. www.nice.org.uk
National Institute of Clinical Excellence (2007) Antenatal and Postnatal Mental Health www.nice.org.uk
National Institute of Clinical Excellence (2006) Brief interventions and referral for smoking cessation in primary care and other settings www.nice.org.uk
National Institute of Clinical Excellence (2008) Improving the nutrition of pregnant and breastfeeding mothers and children in low-income households www.nice.org.uk
Nursing and Midwifery Council (2009) Record Keeping: Guidance for nurses and midwives
www.nmc-uk.org
UNICEF (2010) UK Baby Friendly Initiative – Maternity best practice standards www.babyfriendly.org.uk

PREGNANCY NOTES	Page 1	Page 1: Lists personal details as well as a 'plan of care' - including planned place of birth and lead professional - and place to record reasons if the plan had to be changed.

Pages 2 & 3: Booking Assessment, details are asked about medical, social and mental health history including smoking, alcohol intake, and drug use. There is space to repeat the assessments once more during the pregnancy. We ask about Ethnic Origin instead of Ethnic Group. The classification is needed for customised growth charts, and to identify who should be offered screening for haemoglobinopathies. Family history is in accordance with recommendations of the Joint Royal Colleges' working party on Medical Genetics.	Pages 2 & 3

	Pages 4 & 5	Pages 4 & 5: Previous pregnancies: An explanation of the terms and their relevance to this pregnancy is given. There is space to summarise ante-and postnatal care etc. Early pregnancy losses are listed separately.

Pages 6 & 7: Antenatal Investigations: Investigations are explained, including the limitations of screening. Text follows current National Screening Committee guidelines. Prompts are provided to ensure that various tests have been discussed with the mother, and whether she agrees to have them.	Pages 6 & 7

	Pages 8 & 9	Pages 8 & 9: Ultrasound: Investigations are described - reason, possible findings, accuracy etc. Prompts to discuss implications and whether mother has agreed. Reasons for the preferred method of dating pregnancy by ultrasound, is explained. Diagnostic tests under ultrasound control (CVS, amniocentesis) are described. Ultrasound measurements are recorded in tabular form, including estimated fetal weight which can be plotted on a customised growth chart.

Pages 10 & 11: Space is included to record that discussion has taken place regarding patient data collection. Space included to record discussion about Seasonal Flu, Blood Products and Important symptoms, with prompts to confirm that they have been discussed. Risk Assessment: space to document any risks identified. Pregnancy planner: Visit schedule can be recorded here.	Pages 10 & 11

Page 12: Includes an explanation of some of the more common pregnancy symptoms and complications. These can be referred to as and when necessary by the expectant mother.	Pages 12 & 13	Page 13: Regular Medication: space to document any on-going medication or changes to drug dosages. Management Plan: space to document specific care requirements, based on the individual’s needs.

Page 14: The nature of antenatal checks, are explained as well as, fetal growth monitoring and customised growth charts.	Pages 14 & 15	Page 15 This page (the reverse of the sheet on which the growth chart is printed out and attached into the notes) is blank and can be 'customised' according to each individual unit's wishes.

Page 16: The customised growth chart is generated after the pregnancy dates have been determined by ultrasound, and attached in the notes by the adhesive strip on page 14. The chart can be used for plotting fundal height and estimated fetal weight and is printed with the gestation week as well as the actual date (day, month), calculated by the software from the given EDD. The program also calculates BMI. The software is available free from www.gestation.net with support provided by the Perinatal Institute.	Pages 16 & 17	Pages 17: Provides space to record clinical findings from antenatal visits. Follow-on sheets with a gummed strip are available.

Pages 18: Provides space to record clinical findings from antenatal visits. Follow-on sheets with a gummed strip are available.	Pages 18 & 19	Page 19: Summaries of contacts with other health professionals such as day unit, inpatient episodes or contacts with external agencies can be recorded here.

Pages 20 & 21: gives general pregnancy information and public health messages - smoking, diet, domestic violence, and prompts for discussion between the midwife and the expectant mother, with space to record maternal preferences. These can be discussed at any point in the pregnancy. An important Special Features box for risk factors and action plans is on the top of page 21.	Pages 20 & 21

.	Page 22 & 23	Pages 22 & 23: Preparing for your new baby, includes information from the Baby Friendly Initiative for breast feeding and prompts about newborn screening tests.

Pages 24 & 25: Explanations and choices about labour and birth - where to have the baby; fetal monitoring, pain relief etc, and prompts for discussion, with space to record maternal preferences.	Page 24 & 25

Page 26: Appointments and why they have been given; section for recording signatures of every professional who writes in these notes; and a list of support groups.	Page 26	NOTE: Frequent reference is made to the web address, www.preg.info where mothers and professionals are able to gather further information. It also has a link to the DOH website, allowing mothers to view the Pregnancy Book using a search engine to access individual topics. For professionals, there are references and links to evidence and guidelines to support the statements made in the Notes.