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Aim
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To have an appointment at 26 - 28 weeks gestation with every woman who is booked into the Royal Women's Hospital for confinement.
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To discuss each woman's physical, social, emotional and spiritual needs.
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To respond to any immediate concerns, to prepare the woman for her hospital stay and to enable appropriate discharge planning to begin.
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What is antenatal pre admission?
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The antenatal pre admission appointment (PAC) is conducted by a midwife. It involves:
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- a discussion with the woman with written material being given out
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- the woman usually having a glucose challenge test (GCT)
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- a full antenatal check for some women
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An appointment where the midwife discusses admission to hospital. This is the beginning of discharge planning for women. The CareMap (a document outlining the plan of care) is an important part of this discussion. This interview is an opportunity for the midwife to give the woman appropriate information eg: SIDS, breastfeeding, car restraints, etc, but is also to link her up to internal and external supports, if needed. It is also an opportunity for the woman to discuss any concerns regarding the birth, her family, partner etc.
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At this appointment most women will have a glucose challenge test. The woman attends pathology where she is given the glucose drink (which she must drink in five minutes). She is instructed not to eat, chew gum or smoke for the next hour. She can drink water. A blood test (FBE, GCT & Rh antibodies (Vitamin D if required)) is then taken exactly one hour after the completion of the drink.
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Allocation to pre admission appointments (PAC)
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MCP clinics
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- Women will attend the pre admission visit with the clinic that they attend normally ie: women seeing midwives will have their PAC visit with their midwife (Team C or D or in Family Birth Centre).
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- Women in MCP C and D clinics who normally see a doctor will see one of the Outpatient midwives for their pre admission visit. These appointments are called "old" appointments on the template. This appointment is allocated 20 minutes.
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MFM clinics
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- Women in MFM A and MFM B clinics will see the pre admission midwife in the MFM A and MFM B clinics.
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Specialist clinics
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- Women attending other specialist clinics will have their PAC appointment with a midwife in the specialist clinics eg: perinatal medicine, diabetes clinic, young mothers' and WADS
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Satellite clinics
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- Women attending satellite clinics will have their pre admission visit (PAC) at the clinic.
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Shared care patients
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- Women who are having Shared Care will be allocated an appointment with an Outpatient midwife. This appointment is called "shared care" on the template and is allocated 45 minutes. In this visit the midwife also does an antenatal check.
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Evening clinic (not seeing a Team Midwife)
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- Women who chose to come to the evening clinic for their regular antenatal appointments (not seeing a Team midwife) will be booked to come back during the day to see one of the Outpatient midwives for their pre admission visit (PAC). This visit is an "old" on the template.
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Outline of the pre admission appointment
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The midwife introduces herself to the woman and checks where appropriate that she has had the glucose drink. (This will ensure that the woman is not kept waiting any longer than necessary). Check what time the woman is due back at Pathology i.e. 1 hour post glucose drink.
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Begin with a brief outline of the purpose of this visit setting the scene so that the woman will hopefully feel comfortable to bring up issues that may be of a concern eg: financial, partner, breastfeeding, birthing issues.
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Introduce the birthing CareMap (noting that some women will know that they will be having a Caesarean section and will therefore need the Caesarean section CareMap).
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Briefly go through the CareMap, giving further information as you go along. Ensure the woman knows where to ring and where to present to (Emergency Department) when she is in labour.
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While going through this information there will be opportunities to discuss more fully particular concerns and refer on if necessary.
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The pre admission visit (PAC) will be different with each woman. There will be women who require information about everything, there will be other women who will only need reminders and up to date information since their previous baby.
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| | | - CareMap* (vaginal/ caesarean)
| | - National Immunisation Program
| - Sids and kids (Sudden Infant Death Syndrome)
| - Newborn screening program
| | - Choosing and using restraints/ restraint fitting stations*
| | - PaNDa (Post & antenatal depression association). Beyond Blue information if indicated
| - Contraception the basic facts
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| - Women's Social Support Services (WSSS)
| | | | - FGM (female genital mutilation) liaison workers
| - FARREP (Family and Reproductive Rights Education Program) workers
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| - Community health services
| | - Community midwives attached to community health services
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*Items currently available in languages other than english
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Documentation
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Record of pregnancy care - the hand held record
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Complete the following areas:
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| All women: |
- Page five: Ensure all pathology/ultrasound results have been recorded and the Glucose challenge test (GCT), FBE and antibody tests are written in.
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- Page nine: Hospital pre admission visit
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For women with RH negative blood group:
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- Refer to Page six and page 10: If the woman is 28 weeks gestation you will need to organise the prophylactic anti D.
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- If she is less then 28 weeks you will need to ensure the woman has a 28 week visit made for prophylactic anti D.
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- NB: It is important that the woman is fully informed about prophylactic anti D and is agreeable to have the injection.
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For women who are still smoking:
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- Page eight: Smoking assessment before 30 weeks gestation.
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For women participating in Shared Care:
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- Page 11 onwards: Full antenatal check to be recorded, including blood pressure, fundal height and fetal heart.
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- Any concerns are to be reported to the Registrar of the Team.
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Antenatal Clinic Summary Sheet
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Record appointment on this summary sheet (part of medical record).
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Discharge Care Plan
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This document is started in Pregnancy Booking Clinic (PBC). Section two is completed in the pre admission visit PAC). It is necessary to read section one before the interview as important information may be recorded.
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Private patients
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Note
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- If private patients need a referral to any other service eg: WSSS, dietician, etc they need to be referred back to their own doctor.
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- For women attending a private doctor: the pre admission visit does not include the glucose drink or an antenatal check; this will be done by their doctor.
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- Private patients who are birthing at the Women's are not charged for Childbirth Education classes.
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- Private patients are charged for Domiciliary visits in some of the Teams, so it will depend which Team they are allocated to when they arrive in hospital.
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Royal Women's Hospital Clinical Practice Guidelines (CPGs) are intended to provide guidance to health care professionals, based on a thorough evaluation of research evidence, on the practical assessment and management of specific clinical issues or situations. The guidelines allow some flexibility on the part of the health care professional based on the needs of the specific patient for whom they are caring.
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Please remember to read our disclaimer.
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