Publication - Advice and guidance

Maternity pathway and schedule of care: clinical guidance and schedule

Published: 13 February 2025
Directorate: Children and Families Directorate
Topic: Children and families, Health and social care
ISBN: 9781836913283

This pathway illustrates the core care that women and their babies should receive. All core contacts antenatally and postnatally (other than 32 weeks antenatal visit for primigravid and parous as required) should be face to face as they include physical examination.

Supporting documents

3. Antenatal Pathway

The following schedule outlines the antenatal care contacts every woman should receive and is intended to cover the majority of care and clinical judgement required. It is to be used in conjunction with and complement existing local information and/or guidance.

First Trimester
First Trimester (0 – 12 weeks)	Gestation	Content of Care - Prior to this appointment review any previous maternity records. Woman should be given screening information prior to booking appointment
8 – 10 weeks	Introduction to primary midwife and provide information about the continuity team. Introduce role of the midwife (and wider team). Ensure plan of care is co produced with woman and takes into account “what matters to me”. Complete obstetric and medical history/family/social. Complete Mental Health Risk Assessment. Complete GIRFEC wellbeing assessment and create plan if required. Initial holistic assessment, BP (Blood Pressure), Height, Weight, BMI. Carbon monoxide testing. Refer to smoking cessation team if reading >4. Perform and record initial Maternity risk assessment category and care provider. Introduction to Health Plan Indicator. Incorporate appropriate private time and private space. Ensure interpreter is provided for scheduled appointments if required/requested. Tests: full blood count, group and screen, booking virology screen, haemoglobinopathy screening, urinalysis and MSSU (Mid-Stream Sample of Urine). Consider further screening following review of previous history (for example previous gestational diabetes). Discuss and document: (refer to Ready, Steady Baby) Financial inclusion and referral to welfare rights Smoking. CO (Carbon Monoxide) monitoring Nutrition and exercise. Discuss Best Start Foods if appropriate Substance and alcohol use Gender based Violence – routine enquiry Mental health and well being Safety and security of accommodation and planning where mother and baby will sleep as per RCM guidance Discuss vaccination Discuss pregnancy screening options. Ensure consent obtained. Folic acid and Healthy Start vitamins/vitamin supplements Consider prevention of anaemia regarding prophylactic iron therapy Consider anaesthetic referral as appropriate Introduction of options of place of birth Explore what parents already know about infant feeding and provide information about feeding options Raised BMI: implement additional care plan. Refer to local guideline Discuss the significance of having a raised BMI and managing a raised BMI in pregnancy. Focused discussion on nutrition and exercise including positive health behaviour changes. PHS Weight Stigma hub can support conversations: Course: Challenging weight stigma learning hub \| PHS Learning (publichealthscotland.scot) VTE (Venous thromboembolism) risk assessment Consider local aspirin in pregnancy guidance Initiate interaction with all obstetric and social needs providers to establish a care plan for pregnancy and birth. Identify notes for consultant review and plan if appropriate. Notify GP and Health Visitor (HV) or Family Nurse Written information/leaflets provided in appropriate language and format if required. Contact GP and HV/Family Nurse to share booking information and request relevant history. Inform about Parentclub website. Additional Care Needs Assessment of maternal/family health, wellbeing and early identification of social complexities or additional care needs including those with lived experience of care. Ensure early referral for appropriate support as per local pathways to ensure supportive networks are established. Follow local concern for unborn baby process as appropriate. Consider arranging joint Midwifery / Health Visitor / Family Nurse Partnership appointment. If complex social support to be offered, commence chronology. Use of Substances: Implement individual care plan. Explain and offer routine bloods and Hepatitis C. Urine toxicology with consent. Refer to drug/alcohol specialist. Explain and offer, with informed consent, information sharing and multiagency working and liaison. Clarify professional responsibility. Consider / discuss with FNP if 24 years or under. Mental Health: Follow Perinatal Mental Health Pathway: Antenatal: Consider / discuss with FNP if 24 years or under Learning Disabilities: For women with learning disabilities, give a a copy of My Pregnancy My Choice. Refer to Learning Disabilities Service. Consider / discuss with FNP if 24 years or under. Individualised plan of care. Teenage Pregnancy: If 19 years or under send notification to the Family Nurse Partnership (FNP). Young Parents: Where available at local Health Board - 20 years or under send notification to FNP - 25 years or under, with a history of being looked after as a child, send notification to FNP. If under 16 years follow local guidelines for child and adult protection. If currently under 18 and in school or college, with consent, consider notifying relevant school nursing team in line with GIRFEC information sharing guidance.
11 – 14 weeks Dating Scan	Ultrasound – Calculate EDD (Estimated Due Date) based on Ultrasound Scan. Generate growth chart. Combined ultrasound and biochemistry screening. Nuchal Translucency Screening. HV sends out introductory letter and service information leaflet. FNP arranges contact and gives written information at the engagement visit.

First Trimester

First Trimester (0 – 12 weeks)

Gestation

Content of Care - Prior to this appointment review any previous maternity records. Woman should be given screening information prior to booking appointment

8 – 10 weeks

Introduction to primary midwife and provide information about the continuity team. Introduce role of the midwife (and wider team).

Ensure plan of care is co produced with woman and takes into account “what matters to me”.

Complete obstetric and medical history/family/social. Complete Mental Health Risk Assessment. Complete GIRFEC wellbeing assessment and create plan if required.

Initial holistic assessment, BP (Blood Pressure), Height, Weight, BMI.

Carbon monoxide testing. Refer to smoking cessation team if reading >4.

Perform and record initial Maternity risk assessment category and care provider.

Introduction to Health Plan Indicator.

Incorporate appropriate private time and private space.

Ensure interpreter is provided for scheduled appointments if required/requested.

Tests: full blood count, group and screen, booking virology screen, haemoglobinopathy screening, urinalysis and MSSU (Mid-Stream Sample of Urine). Consider further screening following review of previous history (for example previous gestational diabetes).

Discuss and document: (refer to Ready, Steady Baby)

Financial inclusion and referral to welfare rights
Smoking. CO (Carbon Monoxide) monitoring
Nutrition and exercise. Discuss Best Start Foods if appropriate
Substance and alcohol use
Gender based Violence – routine enquiry
Mental health and well being
Safety and security of accommodation and planning where mother and baby will sleep as per RCM guidance
Discuss vaccination
Discuss pregnancy screening options. Ensure consent obtained.
Folic acid and Healthy Start vitamins/vitamin supplements
Consider prevention of anaemia regarding prophylactic iron therapy
Consider anaesthetic referral as appropriate
Introduction of options of place of birth
Explore what parents already know about infant feeding and provide information about feeding options
Raised BMI: implement additional care plan. Refer to local guideline Discuss the significance of having a raised BMI and managing a raised BMI in pregnancy. Focused discussion on nutrition and exercise including positive health behaviour changes. PHS Weight Stigma hub can support conversations: Course: Challenging weight stigma learning hub | PHS Learning (publichealthscotland.scot)
VTE (Venous thromboembolism) risk assessment
Consider local aspirin in pregnancy guidance

Initiate interaction with all obstetric and social needs providers to establish a care plan for pregnancy and birth.

Identify notes for consultant review and plan if appropriate.

Notify GP and Health Visitor (HV) or Family Nurse

Written information/leaflets provided in appropriate language and format if required.

Contact GP and HV/Family Nurse to share booking information and request relevant history.

Inform about Parentclub website.

Additional Care Needs

Assessment of maternal/family health, wellbeing and early identification of social complexities or additional care needs including those with lived experience of care. Ensure early referral for appropriate support as per local pathways to ensure supportive networks are established. Follow local concern for unborn baby process as appropriate. Consider arranging joint Midwifery / Health Visitor / Family Nurse Partnership appointment. If complex social support to be offered, commence chronology.

Use of Substances: Implement individual care plan. Explain and offer routine bloods and Hepatitis C. Urine toxicology with consent. Refer to drug/alcohol specialist. Explain and offer, with informed consent, information sharing and multiagency working and liaison. Clarify professional responsibility. Consider / discuss with FNP if 24 years or under.

Mental Health: Follow Perinatal Mental Health Pathway: Antenatal: Consider / discuss with FNP if 24 years or under

Learning Disabilities: For women with learning disabilities, give a a copy of My Pregnancy My Choice. Refer to Learning Disabilities Service. Consider / discuss with FNP if 24 years or under. Individualised plan of care.

Teenage Pregnancy: If 19 years or under send notification to the Family Nurse Partnership (FNP).

Young Parents: Where available at local Health Board

- 20 years or under send notification to FNP
- 25 years or under, with a history of being looked after as a child, send notification to FNP.

If under 16 years follow local guidelines for child and adult protection.

If currently under 18 and in school or college, with consent, consider notifying relevant school nursing team in line with GIRFEC information sharing guidance.

11 – 14 weeks

Dating Scan

Ultrasound – Calculate EDD (Estimated Due Date) based on Ultrasound Scan. Generate growth chart.

Combined ultrasound and biochemistry screening. Nuchal Translucency Screening.

HV sends out introductory letter and service information leaflet. FNP arranges contact and gives written information at the engagement visit.

Second Trimester
Second Trimester (13 – 26 weeks)	Gestation	Content of Care
	16 weeks	Ensure plan of care is updated, co produced with woman and takes into account “what matters to me”. Review, discuss and record the results of screening tests the woman has accepted, including BP and urinalysis. Investigate a haemoglobin level below 11g/100ml and consider offering iron supplements if not following prophylactic iron therapy guideline or recommend increasing iron supplements if on prophylactic iron therapy. Give specific information on the detailed fetal anomaly scan offered in the second trimester. Reinforce information re anti-D if RhNeg and document woman’s decision regarding this. Consider joint 16 week appointment with HV/FNP as appropriate. Consider, discuss and document as required: financial inclusion and referral to welfare rights Smoking. CO monitoring Mental health and wellbeing The importance of developing a positive relationship with their growing baby. Review and update risk assessments Safer sleep discussion - Safer Sleep for Babies resource Nutrition and exercise Gender based violence Consider introduction to continuity team member/s Raised BMI: weigh, discuss and document VTE risk Assessment Consider local aspirin in pregnancy guidance Discuss vaccination Discuss pelvic floor health Explore what parents already know about infant feeding and provide information about feeding options Use of Substances: Prepare and agree care plan and ongoing management of use of substances. Consider joint visit with appropriate professional colleague e.g. Substance use Worker or HV. Continual liaison with appropriate services. Teenage Pregnancy: Discuss and agree care plan. Continual liaison with appropriate services. Consider joint FNP visit. Raised BMIRefer to local guideline. Focused discussion on nutrition and exercise including positive health behaviour changes. Reminder Ensure referrals have been received and actioned. Notification to HV/FNP if not already made. Contact Health Visitor (HV) and Family Nurse (FN) to share booking information if not already done. Remind/encourage women to take Healthy Start Vitamins/vitamin supplements. Discuss vaccination. Referral to financial inclusion services if not already. Written Information/leaflets provided: Baby Box leaflet, Bookbug Antenatal Leaflet: “Sharing songs, rhymes and stories before birth” and webpage: Sharing songs, rhymes and stories before birth - Scottish Book Trust.
	20 weeks (Fetal anomaly scan)	Detailed Ultrasound Scan. (USS). Any abnormal finding from USS must be escalated appropriately.
	25 weeks	Ensure plan of care is updated, co produced with woman and takes into account “what matters to me”. Offer investigations of: BP, urinalysis, abdominal palpation, measure fundal height - plot on growth chart, record fetal heart in conjunction with maternal pulse and fetal movements. Reassess and discuss planned care for the pregnancy and identify any emerging additional or complex support that should be offered. Start discussion of birth preferences and place of birth. Use of Substances: Urine toxicology with consent, monitor substance use & progress of care. Discuss Neonatal Abstinence Scoring System. Raised BMI: Refer to local guideline. Focused discussion on nutrition and exercise including positive health behaviour changes. Consider, discuss and document as required Financial inclusion/referral to welfare rights if not completed previously. Discuss Best Start Grant if appropriate Smoking. CO monitoring Mental health and wellbeing Safety and security of accommodation and planning where mother and baby will sleep as per RCM guidance Nutrition and exercise The importance of developing a positive relationship with baby Gender based violence Update any care plans and/or referrals for substance/alcohol use Care Pathway Consider introduction to continuity team member/s VTE risk Assessment Review and update risk assessments Importance of monitoring fetal movements Link with stillbirth discussed. Use teach back tool Discuss vaccination Discuss pelvic floor health Reminder: Notification to HV/FNP if not already made. Parent education and infant feeding workshops. Solihull online access. Update GIRFEC Wellbeing Plan as required. Mat B1 certificate. Remind/encourage women to take Healthy Start Vitamins/vitamin supplements. Discuss the value of skin to skin contact for all mothers and babies. Sign Baby Box form. Outcomes of wellbeing assessment discussed – refer to resources and third sector agencies to optimise parenting skills Mental Health: individual care plan, discuss with Perinatal Mental Health team Learning Disabilities: give a copy of You & Your Baby. One to one parent education should be offered if they do not wish to attend the generic programme. Teenage Pregnancy: All young women to be offered specific antenatal education tailored to suit their needs. One to one parent education should be offered if they do not wish to attend the generic programme.

Third Trimester
Third Trimester (27 – 41 weeks)	Gestation	Content of Care
28 weeks	Ensure plan of care is updated, co produced with woman and takes into account “what matters to me”. Offer investigations: of BP, urinalysis, oedema, abdominal palpation, measurement of fundal height and plot on growth chart, auscultate fetal heart in conjunction with maternal pulse and fetal movements. Offer anti-D if Rh Neg. Bloods: full blood count, antibody screen – offer to all women. Use of Substances: Urine toxicology. Pre-birth case discussion (single or multiagency as required); reassess social circumstances/risk; discuss infant feeding including evidence of benefits of breastfeeding; consider growth scan /fetal monitoring; reiterate Neonatal Abstinence Scoring System; discuss and plan contraception. Communicate update with FNP/HV. Mental Health: Request a network meeting if appropriate. Communicate update with FNP/HV. Teenage Pregnancy: Re-assess social circumstances. Communicate update with FNP/HV. Raised BMI: : Refer to local guideline. Focused discussion on nutrition and exercise including positive health behaviour changes. Consider, discuss and document as required: Financial inclusion/referral to welfare rights if not completed previously Smoking. CO monitoring Mental health and wellbeing VTE risk Assessment PPH (Postpartum Haemorrhage) Risk Assessment Review and update risk assessments Nutrition and exercise Gender based violence Update any care plans and/or referrals for substance/alcohol use Care pathway Consider introduction to continuity team member/s Importance of monitoring fetal movements. Link with stillbirth. Use teach back tool. Fetal movements leaflet Reminder: Share Off to a Good Start: all you need to know about breastfeeding booklet Parent education and infant feeding workshops. Solihull online access Pregnancy Conversation Sheet to be completed by 34 weeks Update GIRFEC Wellbeing Plan as required Remind/encourage women to take Healthy Start Vitamins/vitamin supplements
32 weeks (All primigravid. Parous as required.)	Ensure plan of care is updated, co produced with woman and takes into account “what matters to me”. Offer investigations of: BP, urinalysis, oedema, abdominal palpation, measurement of fundal height and plot on growth chart, auscultate fetal heart in conjunction with maternal pulse and fetal movements. Review, discuss and record the results of screening tests undertaken at 28 weeks. Consider, discuss and document as required: Financial inclusion and referral to welfare rights Smoking. CO monitoring Mental health and wellbeing Nutrition and exercise Consider introduction to continuity team member/s Gender based violence Update any care plans and/or referrals for substance/alcohol use Review birth preferences document, discuss anything woman has recorded, update individual plans and make any appropriate referrals The importance of developing a positive relationship with their growing baby. Reminder about Bookbug resources Use of Substances, Mental Health, Learning Disabilities: Consider one to one parent education sessions. Discuss any multi agency reports/child protection case conference as appropriate. Teenage Pregnancy: Consider one to one parent education sessions. Raised BMI: Refer to local guideline. Focused discussion on nutrition and exercise including positive health behaviour changes. Reminder: Update GIRFEC Wellbeing Plan as required Parent education and infant feeding workshops. Solihull online access Complete and discuss and child protection birth response plan (if required) by 34 weeks. Allocate Health Plan Indicator if not completed Remind/encourage women to take Healthy Start Vitamins/ vitamin supplements
34 weeks	Ensure plan of care is updated, co produced with woman and takes into account “what matters to me”. Follow anaemia guideline. Offer investigation of: BP, urinalysis, oedema, abdominal palpation, measurement of fundal height and plot on growth chart, presentation, fetal heart in conjunction with maternal pulse and fetal movements, if abnormal presentation at 36 weeks, refer for presentation scan and Consultant review. Weight to be recorded at 35 weeks. Review, discuss and record the results of screening tests undertaken at 28 weeks. All concern for unborn baby referrals should aim to have a birth response plan completed by the midwife by 34 weeks. This plan should be discussed with the parents. Use of Substances, Mental Health, Learning Disabilities: Birth plan put in place. Continue one to one parent education sessions. Use of Substances: 34 and 36 weeks – monitor drug/alcohol use; discuss and plan contraception. 36 weeks – Urine toxicology. Mental Health: – Individualised care plan Teenage Pregnancy: Continue one to one parent education sessions as appropriate; contraception information and discussion. Raised BMI: Refer to local guideline. Focused discussion on nutrition and exercise including positive health behaviour changes discussed. Consider, discuss and document as appropriate: financial inclusion/referral to welfare rights Smoking. CO monitoring Mental health and wellbeing Benefits of perineal massage Nutrition and exercise Gender based violence Review birth preferences document, discuss anything woman has recorded, update individual plans and make any appropriate referrals Review and update risk assessments Update any care plans and/or referrals for substance/alcohol use Care of the new baby, vitamin K prophylaxis and newborn screening tests Consider introduction to continuity team member/s Discuss vaccination VTE Risk Assessment PPH Risk Assessment Postnatal self-care, Awareness of baby blues Contraceptive choices postnatally to be documented in notes Review infant feeding information, have meaningful conversation, share evidence of benefits of breastfeeding The importance of developing a positive relationship with their growing baby. Reminder about Bookbug resources Discuss fetal movements and use teach back tool Reminder: Encourage women to have their birth preferences document updated prior to labour Remind/encourage women to take Healthy Start Vitamins/vitamin supplements. All women to be offered a home visit from HV between 30 – 34 weeks.
36 weeks	Ensure plan of care is updated, co produced with woman and takes into account “what matters to me”. Follow anaemia guideline. Offer investigation of: BP, urinalysis, oedema, abdominal palpation, measurement of fundal height and plot on growth chart, presentation, fetal heart in conjunction with maternal pulse and fetal movements, if abnormal presentation at 36 weeks, refer for presentation scan and Consultant review. Weight to be recorded at 35 weeks. Review, discuss and record the results of screening tests undertaken at 28 weeks. All concern for unborn baby referrals should aim to have a birth response plan completed by the midwife by 34 weeks. This plan should be discussed with the parents. Use of Substances, Mental Health, Learning Disabilities: Birth plan put in place. Continue one to one parent education sessions. Use of Substances: 34 and 36 weeks – monitor drug/alcohol use; discuss and plan contraception. 36 weeks – Urine toxicology. Mental Health: – Individualised care plan. Teenage Pregnancy: Continue one to one parent education sessions as appropriate; contraception information and discussion. Raised BMI: Refer to local guideline. Focused discussion on nutrition and exercise including positive health behaviour changes. Consider, discuss and document as appropriate: financial inclusion/referral to welfare rights Smoking. CO monitoring Mental health and wellbeing Safety and security of accommodation and planning where mother and baby will sleep as per RCM guidance Benefits of perineal massage Nutrition and exercise Gender based violence Consider introduction to continuity team member/s Review birth preferences document, discuss anything woman has recorded, update individual plans and make any appropriate referral Update any care plans and/or referrals for substance/alcohol use Care of the new baby, vitamin K prophylaxis and newborn screening tests Discuss vaccination Postnatal self-care, Awareness of baby blues Contraceptive choices postnatally to be documented in notes Review infant feeding information, have meaningful conversations, share evidence of benefits of breastfeeding Antenatal colostrum harvesting can be discussed on an individual basis The importance of developing a positive relationship with their growing baby Discuss fetal movements and use teach back tool Review and update risk assessments VTE Risk Assessment PPH Risk Assessment Reminder: Encourage women to have their birth preferences document updated prior to labour. Remind/encourage women to take Healthy Start Vitamins/vitamin supplements.
38 weeks	Ensure plan of care is updated, co produced with woman and takes into account “what matters to me”. Offer investigation of: BP, urinalysis, oedema, fetal heart in conjunction with maternal pulse and fetal movements, abdominal palpation, measure fundal height plot on growth chart, palpate for presentation. Use of Substances: Urine toxicology. Liaison with appropriate professional colleague re pregnancy outcome; Neonatal Abstinence Syndrome assessment and care; discharge plan (include prescription arrangements and contraception); follow postnatal care plan/inform HV & GP; discharge information. Teenage Pregnancy: Continue individualised birth preparation session. Raised BMI: Refer to local guideline. Focused discussion on nutrition and exercise including positive health behaviour changes. Consider, discuss and document as required: Financial inclusion/referral to welfare rights Smoking CO monitoring Mental health and wellbeing Review birth preferences document, discuss anything woman had recorded, update individual plans and make any appropriate referrals Review and update risk assessments Nutrition and exercise Gender based violence Consider introduction to continuity team members Discuss vaccination The importance of building a positive relationship with baby VTE Risk Assessment PPH Risk Assessment Update any care plans and/or referrals for substance/alcohol use Care of the new baby, vitamin K prophylaxis, and newborn screening tests Postnatal self-care Awareness of baby blues Contraceptive choices – document Review infant feeding information, have meaningful conversations, share evidence of benefits of breastfeeding Antenatal colostrum harvesting can be discussed on an individual basis Discuss fetal movements, link with still birth and use teach back tool Reminder: Encourage women to have their birth preferences updated prior to labour Update GIRFEC Wellbeing Plan as required.
40 weeks	Ensure plan of care is updated, co produced with woman and takes into account “what matters to me”. Offer investigations of: BP, urinalysis, oedema, abdominal palpation, measurement of fundal height and plot on growth chart, auscultate fetal heart in conjunction with maternal pulse and fetal movements. Discuss possible induction of labour. Offer to have a discussion regarding the risks and benefits of membrane sweep at this appointment. Raised BMI: Refer to local guideline. Focused discussion on nutrition and exercise including positive health behaviour changes. Update GIRFEC Wellbeing Plan as required. Remind/encourage women to apply for Best Start Foods. Remind/encourage women to take Healthy Start Vitamins/vitamin supplements. Consider, discuss and document as required: Financial inclusion/referral to welfare rights Smoking. CO monitoring Mental health and wellbeing Review birth preferences document, discuss anything woman had recorded, update individual plans and make any appropriate referrals Review and update risk assessments VTE Risk Assessment PPH Risk Assessment Nutrition and exercise Gender based violence Consider introduction to continuity team member/s Benefits of perineal massage Care of newborn, vitamin K prophylaxis and newborn screening tests Antenatal colostrum harvesting can be discussed on an individual basis Update any care plans and/or referrals for substance/alcohol use Fetal movements, link to still birth and use teach back tool Discuss vaccination Postnatal self-care Awareness of baby blues Contraceptive choices – document Review infant feeding information, have meaningful conversations, share evidence of benefits of breastfeeding Importance of developing a positive relationship with growing baby Discussion of management of prolonged pregnancy. Discuss induction of labour including risks, benefits, procedure and current evidence. Ensure discussion is documented in full. Document woman’s choice and plan including ongoing review and care. Update birth preferences document accordingly.
41 weeks	Ensure plan of care is updated, co produced with woman and takes into account “what matters to me”. Offer investigations of: BP, urinalysis, oedema, abdominal palpation, measure fundal height plot on growth chart, presentation, fetal heart in conjunction with maternal pulse and fetal movements. Offer to have a discussion regarding the risks and benefits of membrane sweep at this appointment. Raised BMI: refer to local guideline. Discuss induction of labour including risks, benefits, procedure and current evidence. Ensure discussion is documented in full. Document woman’s choice and plan including ongoing review and care. Update birth preferences document accordingly. Consider, discuss and document as required: Financial inclusion/referral to welfare rights Smoking. CO monitoring Mental health and wellbeing Nutrition and exercise Gender based violence Consider introduction to continuity team member/s VTE Risk Assessment PPH Risk Assessment Review and update risk assessment Update any care plans and/or referrals for substance/alcohol use Fetal movements, link to still birth and use teach back tool Discuss vaccination Ensure any recommended previous discussions have taken place – care of newborn, baby blues, vitamin K prophylaxis, birth plan discussion etc. Reminder: Update GIRFEC Wellbeing Plan as required.
From 42 weeks	Ensure plan of care is updated, co produced with woman and takes into account “what matters to me”. Offer women who decline induction of labour a Consultant Obstetrician appointment, increased monitoring as per local guideline.

Third Trimester

Third Trimester (27 – 41 weeks)

Gestation

Content of Care

28 weeks

Ensure plan of care is updated, co produced with woman and takes into account “what matters to me”.

Offer investigations: of BP, urinalysis, oedema, abdominal palpation, measurement of fundal height and plot on growth chart, auscultate fetal heart in conjunction with maternal pulse and fetal movements.

Offer anti-D if Rh Neg.

Bloods: full blood count, antibody screen – offer to all women.

Use of Substances: Urine toxicology. Pre-birth case discussion (single or multiagency as required); reassess social circumstances/risk; discuss infant feeding including evidence of benefits of breastfeeding; consider growth scan /fetal monitoring; reiterate Neonatal Abstinence Scoring System; discuss and plan contraception. Communicate update with FNP/HV.

Mental Health: Request a network meeting if appropriate. Communicate update with FNP/HV.

Teenage Pregnancy: Re-assess social circumstances. Communicate update with FNP/HV.

Raised BMI: : Refer to local guideline. Focused discussion on nutrition and exercise including positive health behaviour changes.

Consider, discuss and document as required:

Financial inclusion/referral to welfare rights if not completed previously
Smoking. CO monitoring
Mental health and wellbeing
VTE risk Assessment
PPH (Postpartum Haemorrhage) Risk Assessment
Review and update risk assessments
Nutrition and exercise
Gender based violence
Update any care plans and/or referrals for substance/alcohol use
Care pathway
Consider introduction to continuity team member/s
Importance of monitoring fetal movements. Link with stillbirth. Use teach back tool. Fetal movements leaflet

Reminder:

Share Off to a Good Start: all you need to know about breastfeeding booklet
Parent education and infant feeding workshops. Solihull online access
Pregnancy Conversation Sheet to be completed by 34 weeks
Update GIRFEC Wellbeing Plan as required
Remind/encourage women to take Healthy Start Vitamins/vitamin supplements

32 weeks

(All primigravid. Parous as required.)

Ensure plan of care is updated, co produced with woman and takes into account “what matters to me”.

Offer investigations of: BP, urinalysis, oedema, abdominal palpation, measurement of fundal height and plot on growth chart, auscultate fetal heart in conjunction with maternal pulse and fetal movements.

Review, discuss and record the results of screening tests undertaken at 28 weeks.

Consider, discuss and document as required:

Financial inclusion and referral to welfare rights
Smoking. CO monitoring
Mental health and wellbeing
Nutrition and exercise
Consider introduction to continuity team member/s
Gender based violence
Update any care plans and/or referrals for substance/alcohol use
Review birth preferences document, discuss anything woman has recorded, update individual plans and make any appropriate referrals
The importance of developing a positive relationship with their growing baby. Reminder about Bookbug resources

Use of Substances, Mental Health, Learning Disabilities: Consider one to one parent education sessions. Discuss any multi agency reports/child protection case conference as appropriate.

Teenage Pregnancy: Consider one to one parent education sessions.

Raised BMI: Refer to local guideline. Focused discussion on nutrition and exercise including positive health behaviour changes.

Reminder:

Update GIRFEC Wellbeing Plan as required
Parent education and infant feeding workshops. Solihull online access
Complete and discuss and child protection birth response plan (if required) by 34 weeks. Allocate Health Plan Indicator if not completed
Remind/encourage women to take Healthy Start Vitamins/ vitamin supplements

34 weeks

Ensure plan of care is updated, co produced with woman and takes into account “what matters to me”.

Follow anaemia guideline. Offer investigation of: BP, urinalysis, oedema, abdominal palpation, measurement of fundal height and plot on growth chart, presentation, fetal heart in conjunction with maternal pulse and fetal movements, if abnormal presentation at 36 weeks, refer for presentation scan and Consultant review.

Weight to be recorded at 35 weeks.

Review, discuss and record the results of screening tests undertaken at 28 weeks.

All concern for unborn baby referrals should aim to have a birth response plan completed by the midwife by 34 weeks.

This plan should be discussed with the parents.

Use of Substances, Mental Health, Learning Disabilities: Birth plan put in place. Continue one to one parent education sessions.

Use of Substances: 34 and 36 weeks – monitor drug/alcohol use; discuss and plan contraception. 36 weeks – Urine toxicology.

Mental Health: – Individualised care plan

Teenage Pregnancy: Continue one to one parent education sessions as appropriate; contraception information and discussion.

Raised BMI: Refer to local guideline. Focused discussion on nutrition and exercise including positive health behaviour changes discussed.

Consider, discuss and document as appropriate:

financial inclusion/referral to welfare rights
Smoking. CO monitoring
Mental health and wellbeing
Benefits of perineal massage
Nutrition and exercise
Gender based violence
Review birth preferences document, discuss anything woman has recorded, update individual plans and make any appropriate referrals
Review and update risk assessments
Update any care plans and/or referrals for substance/alcohol use
Care of the new baby, vitamin K prophylaxis and newborn screening tests
Consider introduction to continuity team member/s
Discuss vaccination
VTE Risk Assessment
PPH Risk Assessment
Postnatal self-care,
Awareness of baby blues
Contraceptive choices postnatally to be documented in notes
Review infant feeding information, have meaningful conversation, share evidence of benefits of breastfeeding
The importance of developing a positive relationship with their growing baby. Reminder about Bookbug resources
Discuss fetal movements and use teach back tool

Reminder: Encourage women to have their birth preferences document updated prior to labour Remind/encourage women to take Healthy Start Vitamins/vitamin supplements.

All women to be offered a home visit from HV between 30 – 34 weeks.

36 weeks

Ensure plan of care is updated, co produced with woman and takes into account “what matters to me”.

Weight to be recorded at 35 weeks.

Review, discuss and record the results of screening tests undertaken at 28 weeks.

All concern for unborn baby referrals should aim to have a birth response plan completed by the midwife by 34 weeks. This plan should be discussed with the parents.

Use of Substances, Mental Health, Learning Disabilities: Birth plan put in place. Continue one to one parent education sessions.

Use of Substances: 34 and 36 weeks – monitor drug/alcohol use; discuss and plan contraception. 36 weeks – Urine toxicology.

Mental Health: – Individualised care plan.

Teenage Pregnancy: Continue one to one parent education sessions as appropriate; contraception information and discussion.

Raised BMI: Refer to local guideline. Focused discussion on nutrition and exercise including positive health behaviour changes.

Consider, discuss and document as appropriate:

financial inclusion/referral to welfare rights
Smoking. CO monitoring
Mental health and wellbeing
Safety and security of accommodation and planning where mother and baby will sleep as per RCM guidance
Benefits of perineal massage
Nutrition and exercise
Gender based violence
Consider introduction to continuity team member/s
Review birth preferences document, discuss anything woman has recorded, update individual plans and make any appropriate referral
Update any care plans and/or referrals for substance/alcohol use
Care of the new baby, vitamin K prophylaxis and newborn screening tests
Discuss vaccination
Postnatal self-care,
Awareness of baby blues
Contraceptive choices postnatally to be documented in notes
Review infant feeding information, have meaningful conversations, share evidence of benefits of breastfeeding
Antenatal colostrum harvesting can be discussed on an individual basis
The importance of developing a positive relationship with their growing baby
Discuss fetal movements and use teach back tool
Review and update risk assessments
VTE Risk Assessment
PPH Risk Assessment

Reminder: Encourage women to have their birth preferences document updated prior to labour.

Remind/encourage women to take Healthy Start Vitamins/vitamin supplements.

38 weeks

Ensure plan of care is updated, co produced with woman and takes into account “what matters to me”.

Offer investigation of: BP, urinalysis, oedema, fetal heart in conjunction with maternal pulse and fetal movements, abdominal palpation, measure fundal height plot on growth chart, palpate for presentation.

Use of Substances: Urine toxicology. Liaison with appropriate professional colleague re pregnancy outcome; Neonatal Abstinence Syndrome assessment and care; discharge plan (include prescription arrangements and contraception); follow postnatal care plan/inform HV & GP; discharge information.

Teenage Pregnancy: Continue individualised birth preparation session.

Raised BMI: Refer to local guideline. Focused discussion on nutrition and exercise including positive health behaviour changes.

Consider, discuss and document as required:

Financial inclusion/referral to welfare rights
Smoking CO monitoring
Mental health and wellbeing
Review birth preferences document, discuss anything woman had recorded, update individual plans and make any appropriate referrals
Review and update risk assessments
Nutrition and exercise
Gender based violence
Consider introduction to continuity team members
Discuss vaccination
The importance of building a positive relationship with baby
VTE Risk Assessment
PPH Risk Assessment
Update any care plans and/or referrals for substance/alcohol use
Care of the new baby, vitamin K prophylaxis, and newborn screening tests
Postnatal self-care
Awareness of baby blues
Contraceptive choices – document
Review infant feeding information, have meaningful conversations, share evidence of benefits of breastfeeding
Antenatal colostrum harvesting can be discussed on an individual basis
Discuss fetal movements, link with still birth and use teach back tool

Reminder: Encourage women to have their birth preferences updated prior to labour Update GIRFEC Wellbeing Plan as required.

40 weeks

Ensure plan of care is updated, co produced with woman and takes into account “what matters to me”.

Offer to have a discussion regarding the risks and benefits of membrane sweep at this appointment.

Raised BMI: Refer to local guideline. Focused discussion on nutrition and exercise including positive health behaviour changes.

Update GIRFEC Wellbeing Plan as required.

Remind/encourage women to apply for Best Start Foods.

Remind/encourage women to take Healthy Start Vitamins/vitamin supplements.

Consider, discuss and document as required:

Financial inclusion/referral to welfare rights
Smoking. CO monitoring
Mental health and wellbeing
Review birth preferences document, discuss anything woman had recorded, update individual plans and make any appropriate referrals
Review and update risk assessments
VTE Risk Assessment
PPH Risk Assessment
Nutrition and exercise
Gender based violence
Consider introduction to continuity team member/s
Benefits of perineal massage
Care of newborn, vitamin K prophylaxis and newborn screening tests
Antenatal colostrum harvesting can be discussed on an individual basis
Update any care plans and/or referrals for substance/alcohol use
Fetal movements, link to still birth and use teach back tool
Discuss vaccination
Postnatal self-care
Awareness of baby blues
Contraceptive choices – document
Review infant feeding information, have meaningful conversations, share evidence of benefits of breastfeeding
Importance of developing a positive relationship with growing baby

Discussion of management of prolonged pregnancy.

Discuss induction of labour including risks, benefits, procedure and current evidence. Ensure discussion is documented in full. Document woman’s choice and plan including ongoing review and care. Update birth preferences document accordingly.

41 weeks

Ensure plan of care is updated, co produced with woman and takes into account “what matters to me”.

Offer investigations of: BP, urinalysis, oedema, abdominal palpation, measure fundal height plot on growth chart, presentation, fetal heart in conjunction with maternal pulse and fetal movements. Offer to have a discussion regarding the risks and benefits of membrane sweep at this appointment.

Raised BMI: refer to local guideline.

Consider, discuss and document as required:

Financial inclusion/referral to welfare rights
Smoking. CO monitoring
Mental health and wellbeing
Nutrition and exercise
Gender based violence
Consider introduction to continuity team member/s
VTE Risk Assessment
PPH Risk Assessment
Review and update risk assessment
Update any care plans and/or referrals for substance/alcohol use
Fetal movements, link to still birth and use teach back tool
Discuss vaccination

Ensure any recommended previous discussions have taken place – care of newborn, baby blues, vitamin K prophylaxis, birth plan discussion etc.

Reminder: Update GIRFEC Wellbeing Plan as required.

From 42 weeks

Ensure plan of care is updated, co produced with woman and takes into account “what matters to me”.

Offer women who decline induction of labour a Consultant Obstetrician appointment, increased monitoring as per local guideline.

Contact

Email: MaternalandInfantHealth@gov.scot

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Information

3. Antenatal Pathway

Contact

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