Abstract
A system of midwife-led care supported by six integrated care documents was developed at Taunton & Somerset Hospital according to Trust guidance on ICPs. An audit at 12 months showed that >50% of women can be Cared for by midwives alone. Sample documents for antepartum haemorrhage and suspected pre-eclampsia are presented.
Introduction
Maternity care involves a large number of ad hoc attenders with urgent rather than emergency problems. Traditionally these have been seen by doctors, but true emergencies such as caesarean section for fetal distress often take priority and can result in long waits, sometimes for several hours.
We developed a system of midwife-led care supported by six integrated care documents (mild abdominal pain, small antepartum haemorrhage, suspected preterm membrane rupture, suspected membrane rupture at term, suspected pre-eclampsia and suspected obstetric cholestasis). These were written according to Trust guidance on ICPs. 1
An audit at 12 months has shown that an average of 10 women are seen each day and that overall >50% of the woman can be cared for by midwives alone. The proportion ranged from 45% for abdominal pain to 80% for suspected membrane rupture at term. In over two years there have been no clinical incidents and the service has proved popular with the women, with prolonged wait times reducing greatly to less than 5%. It has also proved to be a popular venture with the six senior midwives who feel their working lives have improved greatly.
We present two examples of our documents (small antepartum haemorrhage and suspected pre-eclampsia), which have been written to national standards such as PRECOG and RCOG guidelines.
