Pathways of maternity care - patient leaflet: equality impact assessment

Pathways for Maternity Care and Choice of Place of Birth

Since 2009, risk assessment of pregnant women has been defined by the current NHS Quality Improvement Scotland (QIS) Pathways for Maternity Care. These Pathways are used to determine the type of care (obstetric or midwife-led) that women should receive, and the antenatal risk identified through the Pathway is a factor when identifying the place of birth. During the development of The Best Start, staff and women indicated that the existing national pathways for maternity care were perceived as too restrictive and not reflective of current maternity care, with too many women categorised as high risk and little potential for transfer either way between pathways once allocated at antenatal booking.

In response to this feedback, Recommendation 11 of the Best Start was drafted: “The 2009 Pathways for Maternity Care should be revised at a national level to facilitate an individualised approach to the management of risk through the development of a personalised care plan which is regularly reassessed”.

An expert group was convened to undertake the work to revise the 2009 NHS QIS Pathways for Maternity Care Guidance and Schedule. As part of that work, a literature review was commissioned and undertaken by the University of the West of Scotland to identify any new evidence surrounding place of birth choices and care for pregnant woman with a range of medical or social considerations in line with the requirements. Following this, the expert group, whose members included clinical experts, educators, the Senior Medical Officer for Maternity and Women’s Health (Scottish Government), and the Chief Midwifery Officer (Scottish Government) developed the revised care Pathway. The revised care Pathway is also underpinned by the NICE guidelines on intrapartum (NG121) and postnatal care (NG194). The Pathway constitutes national guidance on clinical expectations at scheduled visits. It should be used in conjunction with any local guidelines currently in place within Health Boards.

The main principle of the revised Pathway is that routine antenatal care will be provided by the primary midwife who, in conjunction with the woman, will identify and agree a plan of care to ensure all aspects of a woman's circumstances are considered and addressed, including personal and lifestyle factors - a 'whole-person' approach. Any additional care required will be brought around a woman, with the woman and her primary midwife remaining at the centre. The guidance also maps out the updated postnatal care plan.

The Best Start also identified that evidence-based accessible information and decision aids for women, families and health professionals should be developed to enable real choice of place of birth.

Recommendation 15 of the Best Start is that “Each NHS Board should ensure that they are able to provide the full range of choice of place of birth within their region. National, standardised core information should be made available on the range of safe birth settings to support women’s choice.”

The revised Birthplace Decisions leaflet has been designed to meet the second part of this recommendation. It is based on the Birth place decisions: Information for women and partners on planning where to give birth - leaflet, developed by King’s College London. The revised version has been updated to reflect the most recent evidence and tailored to the Scottish healthcare context.

The refreshed leaflet has been developed by the Pathways working group. Members of Maternity Voices Partnerships were invited to review an early version of this leaflet, and their feedback has been considered in the revised version of the document.