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A Framework for maternity services in Scotland
This Framework sets out a number of guiding principles for maternity care.
These are grouped in the following sections,
Pre-conception and very early
pregnancy
Pregnancy
Childbirth
Clear and consistent themes have emerged from developing the Framework in a
multi-disciplinary forum. These themes have been addressed throughout the Framework
and have also formed the basis of further work to be carried out.
This Framework captures guiding principles, local action and further work to
be carried out, both nationally and locally. It is not a strategy document
and it does not provide a model service specification.
The Clinical Standards Board for Scotland will develop standards that will
reinforce the principles outlined in the Framework and allow their implementation
to be monitored and audited. These standards will be developed during 2001.
Postnatal and parenthood
Service organisation and provision
Risk assessment and management
Information and communication
Pre-conception and very early pregnancy
 This
section reflects on the importance of planning and preparation for pregnancy
with an emphasis on good health and consistent support from professionals.
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Principle 1
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Good health before and during early pregnancy benefits the woman, her
unborn baby and the wider family. All women of reproductive age should
be empowered and encouraged to be as healthy as possible.
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Local Action
- NHS Boards should address the health promotion needs of school age children
and women of reproductive age;
- NHS Boards should make sure that information and routes of access to maternity
services are available to a woman who accesses any element of the reproductive
health care spectrum;
- NHS Boards should actively engage with Social Inclusion Partnership initiatives
to ensure a proactive, joint approach to improving the health of the more
disadvantaged woman;
- NHS Boards should make sure that women planning a pregnancy have easy access
to a package of information on lifestyle, pregnancy, and how and where to
access local services;
- Health education and advice should be given at every opportunity by Primary
Health Care Teams when they are providing services for women of reproductive
age. This should include advice and support on Folic Acid, Physical Activity,
Diet, Rubella, Toxoplasmosis, Chlamydia, HIV/AIDS, Smoking, Alcohol, Drugs
and Sexually Transmitted Disease.
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Smoking
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Maternal smoking in the first 12 weeks of pregnancy (until the end of
the first trimester) is responsible for up to 25% of all low birth weight
infants. In Scotland (1998) this equals 1,016 low birth weight infants.
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Alcohol
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Estimates from the United States of America Centres for Disease Control
for Fetal Alcohol Syndrome (FAS), of 6.7 births per 10,000 live births
suggests around 38 births per year with FAS in Scotland.
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Principle 2
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Specific pre-conception services should be available to women with a
poor obstetric or medical history, a previous poor fetal or obstetric
outcome, or where there is a family history of significant illness.
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Local Action
- NHS Boards should review pre-conception services, including advice and counselling
services, to make sure they meet the needs of all women and their partners;
- Table 12 outlines a possible model for pre-conception and very early emergency
antenatal care. It identifies the lead professional, location of care and
care delivered. NHS Boards should consider this model when planning and providing
these services.
Table 12 Model for pre-conception and very early emergency antenatal care
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Level of care
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Lead professional
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Location of care
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Clinical category
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Care delivered
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Investigation and location
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Pre- Conception
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Consultant Obstetrician (+ Consultant specialist)
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Maternity unit
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Poor obstetric or medical history, previous poor fetal outcome, previous
fetal disease or family history of inherited disease
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Pre-pregnancy counselling, Dietary advice including folic acid supplement
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Genetic counselling and biomedical investigation
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Maternity unit
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Early Pregnancy
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GP or Midwife or Consultant Obstetrician
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Community Maternity unit or Consultant Maternity unit
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Threatened or inevitable miscarriage, suspected ectopic or abdominal
pregnancy
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Medical or surgical treatment as appropriate
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Ultrasound and biochemical investigation
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Maternity unit, early pregnancy assessment unit or in-patient ward
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Further work to be undertaken
- The Scottish Executive Health Department and the Health Education Board
for Scotland should develop an assessment sheet to guide professionals in
their discussions with women about folic acid, diet, smoking, drugs and alcohol.
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Principle 3
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There should be specific services for women with complications in early
pregnancy.
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Local Action
- NHS Trusts should make sure that Early Pregnancy Assessment Units or Services
are available, both in the community and hospital setting. Women should have
access without undue delay to ultrasound scanning and specialist advice. Their
GP and midwife should have direct channels of referral to these units;
- NHS Trusts should make sure that the recommendations of the National Medical
Advisory Committee Report on The Management of Early Pregnancy Loss (1996)
are implemented.
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