Key priorities for implementation

General recommendations

The recommendations in this section apply to all pregnant women covered in this guideline.

Service organisation

  • In order to inform mapping of their local population to guide service provision, commissioners should ensure that the following are recorded:

    • The number of women presenting for antenatal care with any complex social factor. Examples of complex social factors in pregnancy include: poverty; homelessness; substance misuse; recent arrival as a migrant; asylum seeker or refugee status; difficulty speaking or understanding English; age under 20; domestic abuse. Complex social factors may vary, in both type and prevalence, across different local populations

    • The number of women within each complex social factor grouping identified locally.

  • Commissioners should ensure that the following are recorded separately for each complex social factor grouping:

    • The number of women who:

      • attend for booking by 10, 12+6 and 20 weeks.

      • attend for the recommended number of antenatal appointments, in line with national guidance, see NICE's guideline on antenatal care.

      • experience, or have babies who experience, mortality or significant morbidity. Significant morbidity is morbidity that has a lasting impact on either the woman or the child.

    • The number of appointments each woman attends.

    • The number of scheduled appointments each woman does not attend.

  • Commissioners should ensure that women with complex social factors presenting for antenatal care are asked about their satisfaction with the services provided; and the women's responses are:

    • recorded and monitored

    • used to guide service development.

Care provision

Information and support for women

  • For women who do not have a booking appointment at the first contact with any healthcare professional:

    • discuss the need for antenatal care

    • offer the woman a booking appointment in the first trimester, ideally before 10 weeks if she wishes to continue the pregnancy, or offer referral to sexual health services if she is considering termination of the pregnancy.

  • In order to facilitate discussion of sensitive issues, provide each woman with a one-to-one consultation, without her partner, a family member or a legal guardian present, on at least one occasion.

Pregnant women who misuse substances (alcohol and/or drugs)

Service organisation

  • Healthcare commissioners and those responsible for the organisation of local antenatal services should work with local agencies, including social care and third-sector agencies that provide substance misuse services, to coordinate antenatal care by, for example:

    • jointly developing care plans across agencies

    • including information about opiate replacement therapy in care plans

    • co-locating services

    • offering women information about the services provided by other agencies.

Training for healthcare staff

  • Healthcare professionals should be given training on the social and psychological needs of women who misuse substances.

  • Healthcare staff and non-clinical staff such as receptionists should be given training on how to communicate sensitively with women who misuse substances.

Pregnant women who are recent migrants, asylum seekers or refugees, or who have difficulty reading or speaking English

Service organisation

  • Those responsible for the organisation of local antenatal services should provide information about pregnancy and antenatal services, including how to find and use antenatal services, in a variety of:

    • formats, such as posters, notices, leaflets, photographs, drawings/diagrams, online video clips, audio clips and DVDs

    • settings, including pharmacies, community centres, faith groups and centres, GP surgeries, family planning clinics, children's centres, reception centres and hostels

    • languages.

Young pregnant women aged under 20

Service organisation

  • Commissioners should consider commissioning a specialist antenatal service for young women aged under 20, using a flexible model of care tailored to the needs of the local population. Components may include:

    • antenatal care and education in peer groups in a variety of settings, such as GP surgeries, children's centres and schools

    • antenatal education in peer groups offered at the same time as antenatal appointments and at the same location, such as a 'one-stop shop' (where a range of services can be accessed at the same time).

Pregnant women who experience domestic abuse

Service organisation

  • Commissioners and those responsible for the organisation of local antenatal services should ensure that a local protocol is written, which:

    • is developed jointly with social care providers, the police and third-sector agencies by a healthcare professional with expertise in the care of women experiencing domestic abuse.

    • includes:

      • clear referral pathways that set out the information and care that should be offered to women

      • the latest government guidance on responding to domestic abuse, see Domestic abuse: a resource for health professionals

      • sources of support for women, including addresses and telephone numbers, such as social services, the police, support groups and women's refuges

      • safety information for women

      • plans for follow-up care, such as additional appointments or referral to a domestic abuse support worker

      • obtaining a telephone number that is agreed with the woman and on which it is safe to contact her

      • contact details of other people who should be told that the woman is experiencing domestic abuse, including her GP.