Quality statement 1: Access to antenatal care
Supporting women to attend their first antenatal ('booking') appointment by 10 weeks of pregnancy will enable early identification of potential risks and ensure that care is planned according to their needs. This may not always be possible as some women may be unaware of their pregnancy or may choose not to access antenatal care early. All women who present after 10 weeks of pregnancy should be supported to access antenatal care as soon as possible. Some pregnant women and their babies have a higher risk of adverse outcomes or have complex social factors and may need additional support to access antenatal care.
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
The proportion of booking appointments held by 10 weeks of pregnancy.
Numerator – the number in the denominator held by 10 weeks of pregnancy.
Denominator – the number of booking appointments.
Data source: NHS Digital's Maternity Services Data Set includes gestational age at the booking appointment and the NHS Digital's Maternity Services dashboard can be used to monitor performance and compare services.
a) Rates of maternal mortality.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from antenatal care records on provider systems. The MBRRACE-UK Confidential Enquiries into Maternal Deaths and Morbidity reports on the number of maternal deaths attributed to pregnancy and non-pregnancy related causes.
b) Perinatal mortality rates.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from antenatal care records. Trusts report on late fetal losses, stillbirths and neonatal deaths (up to 4 weeks of life) as part of reporting on perinatal mortality rates using the MBRRACE-UK National Perinatal Mortality Review Tool for ongoing audit. The NHS Digital Maternity Services dashboard can be used to monitor performance and compare services for stillbirth and neonatal mortality rates.
Service providers (NHS hospital trusts and community providers) ensure that local systems are in place to encourage pregnant women to access antenatal care by 10 weeks. They also ensure that a booking appointment can be arranged as soon as possible for women who access antenatal care after 10 weeks. They provide accessible information about pregnancy and antenatal care services, and a variety of options for women to start their antenatal care. Providers ensure that healthcare professionals have the skills and knowledge they need to support women who have a high risk of adverse outcomes or who have complex social factors to access antenatal care.
GPs and allied health professionals support and encourage pregnant women who want to continue the pregnancy to access antenatal care by discussing the need for antenatal care with them. They tell women that their partner can be involved according to her wishes, highlighting that it is her choice.
Midwives offer a booking appointment in the first trimester, ideally within 10 weeks of pregnancy. They offer women who access antenatal care after 10 weeks of pregnancy a booking appointment as soon as possible.
Commissioners (integrated care systems) ensure that they commission antenatal care services which pregnant women can access easily by 10 weeks of pregnancy. They ensure that services arrange a booking appointment as soon as possible for pregnant women who present late. Commissioners work with providers to use data and intelligence to improve access to antenatal care by 10 weeks for pregnant women with a higher risk of adverse outcomes. This includes pregnant women:
from Black, Asian (excluding Chinese), and mixed ethnic family backgrounds
living in the most deprived areas
with 1 or more complex social factors
who access antenatal care late.
Pregnant women can easily find information about pregnancy and how to access antenatal care. They can get a first appointment within the first 10 weeks of pregnancy which means that any problems can be spotted early, and that care can be tailored and sensitive to their needs. They can get a first appointment quickly if they access antenatal care after 10 weeks of pregnancy. Pregnant women can involve their partner (if applicable) in their antenatal care if they wish and can invite them to attend the booking appointment.
Antenatal care. NICE guideline NG201 (2021), recommendations 1.1.1 and 1.1.4
Pregnancy and complex social factors: a model for service provision for pregnant women with complex social factors. NICE guideline CG110 (2010), recommendations 1.1.11, 1.3.1 and 1.3.5
There should be different ways to start antenatal care, depending on women's needs and circumstances (for example, by self-referral, or referral by a healthcare professional, a school nurse, community centre or refugee hostel).
Those responsible for the organisation of local antenatal services should provide information about pregnancy and antenatal services, including how to find and use them. The information can be presented in a variety of settings (such as pharmacies, children's centres, reception centres and hostels) and languages
It should be clear that an interpreter can be provided when needed. [Adapted from NICE's guideline on antenatal care, recommendations 1.1.1 and 1.1.2 and NICE's guideline on pregnancy and complex social factors, recommendations 1.3.5 and 1.3.10]
offer age-appropriate services in the community
use a variety of means to communicate (for example, text messages) to remind women of upcoming and missed antenatal appointments)
provide information about help with transportation to and from appointments.
Service providers should ensure that digital access to antenatal care does not prevent women who do not have IT literacy or access to IT equipment from accessing antenatal care and that additional support is available if needed. They should ensure that a choice of a digital or face-to-face appointment is offered, taking into account the woman's clinical needs and preferences, including those arising from disability or sensory loss. The physical environment of the clinic room may need to be adjusted to take account of additional needs (for example, lighting). [Adapted from NICE's guideline on pregnancy and complex social factors, recommendations 1.2.8, 1.2.11, 1.3.1 and 1.4.1 and expert opinion]
For pregnant women (and if applicable, their partner) with additional needs related to a disability (including those arising from neurodiversity), impairment or sensory loss, information and referral forms should be provided as set out in the NHS Accessible Information Standard, or the equivalent standards for the devolved nations. This is to help them understand information about accessing antenatal services and how to use them. Some pregnant women with additional needs may need longer antenatal appointments.