Quality statement 1: Services – access to antenatal care
Pregnant women are supported to access antenatal care, ideally by 10 weeks 0 days.
a) Evidence of local services that ensure antenatal care is readily and easily accessible.
b) Evidence of local arrangements to encourage pregnant women to access and maintain contact with antenatal care services.
Data source: a) and b) Local data collection. The NICE guideline CG110 baseline assessment tool can be used to assess current activity related to recording information for women presenting to antenatal care with complex social needs to inform mapping of the local population and to guide service provision.
Proportion of pregnant women missing a scheduled antenatal appointment who are followed up within locally defined timescales.
Numerator – the number of women in the denominator followed up within locally defined timescales.
Denominator – the number of pregnant women missing a scheduled antenatal appointment.
Data source: Local data collection.
a) Pregnant women accessing antenatal care who are seen for booking by 10 weeks 0 days.
b) Pregnant women accessing antenatal care who are seen for booking by 12 weeks 6 days.
c) Pregnant women accessing antenatal care who are seen for booking by 20 weeks 0 days.
d) Median gestation at booking.
e) Pregnant women accessing antenatal care attend at least the recommended number of antenatal appointments.
Data source: a), b) c) and d) The Maternity Services Secondary Uses Dataset, once implemented, will collect data on booking appointment dates and estimated dates of delivery. The Care Quality Commission Maternity Services Survey 2010 asks the question 'Roughly how many weeks pregnant were you when you had your 'booking' appointment (the appointment where you were given your pregnancy notes?)'. Possible responses are: before 8 weeks, 8 or 9 weeks, 10 or 11 weeks, 12 weeks and 13 or more weeks. The total number of respondents is also stated.
b) The Integrated Performance Measure Access to Midwifery is the collection of data to monitor women seen by a midwife or maternity health professional. This includes a national performance measure on the 'percentage of women who have seen a midwife or a maternity healthcare professional for health and social care assessment of needs, risks and choices by 12 weeks and 6 days'. This is monitored by the Department of Health on a quarterly basis.
e) The Maternity Services Secondary Uses Dataset, once implemented, will collect data on the date of attendance at an antenatal appointment (excluding first contact and booking). The Care Quality Commission Maternity Services Survey 2010 asks the question 'Roughly how many antenatal check-ups did you have in total?' Possible responses are: none, 1–6, 7–9, 10–14, 15 or more. The total number of respondents is also stated.
Service providers ensure that systems are in place to support pregnant women to access antenatal care, ideally by 10 weeks 0 days.
Health and social care professionals support pregnant women to access antenatal care, ideally by 10 weeks 0 days. This includes following up women who have missed a scheduled antenatal appointment.
Commissioners ensure they commission services that are readily and easily accessible and that support pregnant women to access antenatal care, ideally by 10 weeks 0 days.
Pregnant women are encouraged to see a healthcare professional about their pregnancy as early as possible and have regular check-ups from their midwife or doctor throughout their pregnancy (antenatal care). This may include being contacted by their midwife or doctor if they miss a check-up.
Antenatal care (2008) NICE guideline CG62, 18.104.22.168, 22.214.171.124, 126.96.36.199, 188.8.131.52 and appendix D (antenatal appointments).
Pregnancy and complex social factors: A model for service provision for pregnant women with complex social factors (2010) NICE guideline CG110, recommendations 1.1.1, 1.1.2 (key priorities for implementation) and 1.2.8.
NICE full guideline CG62 acknowledges that the 'booking appointment' needs to be earlier in pregnancy (ideally by 10 weeks) than may have traditionally occurred.
NICE guideline CG62 recommends that the schedule of antenatal appointments is determined by the woman's needs. For a woman who is nulliparous with an uncomplicated pregnancy, a schedule of 10 appointments should be adequate. For a woman who is parous with an uncomplicated pregnancy, a schedule of 7 appointments should be adequate.
Follow-up after a missed appointment may be undertaken by the maternity service or other community-based service the woman is in contact with, such as a children's centre, addiction service or GP. Follow-up should be via a method of contact that is appropriate to the woman, which may include:
community or home visit.
Pregnant women include women with complex social needs who may be less likely to access or maintain contact with antenatal care services. Examples of women with complex social needs include, but are not limited to, women who:
have a history of substance misuse (alcohol and/or drugs)
have recently arrived as a migrant, asylum seeker or refugee
have difficulty speaking or understanding English
are aged under 20
have experienced domestic abuse
are living in poverty
It is therefore appropriate that localities give special consideration to these groups of women within the measures. NICE guideline CG110 has recommendations about how to make antenatal care accessible to pregnant women with complex social needs and how to encourage women to maintain ongoing contact with maternity services.