CLINICAL PRACTICE GUIDELINES Antenatal care - Module I Clinical Practice Guidelines: Antenatal Care - Module I ISBN: 978-1-74241-730-1 Online ISBN: 978-1-74241-731-8 Publications approval number: D0791 Copyright Statements: Paper-based publications © Commonwealth of Australia 2012 This work is copyright. You may reproduce the whole or part of this work in unaltered form for your own personal use or, if you are part of an organisation, for internal use within your organisation, but only if you or your organisation do not use the reproduction for any commercial purpose and retain this copyright notice and all disclaimer notices as part of that reproduction. Apart from rights to use as permitted by the Copyright Act 1968 or allowed by this copyright notice, all other rights are reserved and you are not allowed to reproduce the whole or any part of this work in any way (electronic or otherwise) without first being given the specific written permission from the Commonwealth to do so. Requests and inquiries concerning reproduction and rights are to be sent to the Online, Services and External Relations Branch, Department of Health and Ageing, GPO Box 9848, Canberra ACT 2601, or via e-mail to [email protected]. Internet sites © Commonwealth of Australia 2012 This work is copyright. You may download, display, print and reproduce the whole or part of this work in unaltered form for your own personal use or, if you are part of an organisation, for internal use within your organisation, but only if you or your organisation do not use the reproduction for any commercial purpose and retain this copyright notice and all disclaimer notices as part of that reproduction. Apart from rights to use as permitted by the Copyright Act 1968 or allowed by this copyright notice, all other rights are reserved and you are not allowed to reproduce the whole or any part of this work in any way (electronic or otherwise) without first being given the specific written permission from the Commonwealth to do so. Requests and inquiries concerning reproduction and rights are to be sent to the Online, Services and External Relations Branch, Department of Health and Ageing, GPO Box 9848, Canberra ACT 2601, or via e-mail to [email protected]. Publication Approval These guidelines were approved by the Chief Executive Officer (CEO) of the National Health and Medical Research Council (NHMRC) on 6 December 2011 (with a minor amendment approved by the CEO on 17 December 2012), under Section 14A of the National Health and Medical Research Council Act 1992. In approving these guidelines the NHMRC considers that they meet the NHMRC standard for clinical practice guidelines. This approval is valid for a period of 5 years. NHMRC is satisfied that they are based on the systematic identification and synthesis of the best available scientific evidence and make clear recommendations for health professionals practising in an Australian health care setting. The NHMRC expects that all guidelines will be reviewed no less than once every five years. This publication reflects the views of the authors and not necessarily the views of the Australian Government. Disclaimer This is a general guide to appropriate practice, to be followed subject to the relevant clinician’s judgement in each individual case. The Commonwealth has taken all reasonable steps to ensure that the Guidelines are based on, and accurately represent, the best available published evidence on key areas of antenatal care. However, the Commonwealth does not accept any legal liability for any loss, damage costs or expenses that may result from reliance on the information and recommendations contained in these Guidelines. Suggested Citation Australian Health Ministers’ Advisory Council 2012, Clinical Practice Guidelines: Antenatal Care – Module 1. Australian Government Department of Health and Ageing, Canberra. http://www.health.gov.au/antenatal i CLINICAL PRACTICE GUIDELINES | ANTENATAL CARE – MODULE 1 INTRODUCTION Foreword We are pleased to issue these Clinical Practice Guidelines: Antenatal Care — Module I as approved by Australian Health Ministers’ Advisory Council on 31 August 2012. The purpose of the Guidelines is to provide evidence-based advice on the care of pregnant women in a range of settings. There are numerous aspects to antenatal care and reviewing the evidence in all areas is a lengthy process. For this reason, the project is being completed in stages. The clinical topics discussed in this module of the Guidelines were selected after a process of consultation designed to identify the areas where specific guidance is required. The topics discussed are generally specific to the first trimester. Some other aspects of first trimester care (eg screening for diabetes) will be included in the subsequent module of the Guidelines, which will be developed over the next two years. Module II will also include an expanded section related to care for women from culturally and linguistically diverse communities. The Guidelines summarise published evidence and make recommendations on key areas of antenatal care. The development of the draft Guidelines has followed the key principles and processes outlined in the document NHMRC Standards and Procedures for Externally Developed Guidelines (2007). In areas for which there is insufficient evidence for recommendations, the Guidelines include practice points that are based on best practice clinical judgement. To provide guidance in a single resource, recommendations from evidence-based national guidelines relevant to antenatal care in the first trimester have also been included and their evidence base summarised. Specific reference is made to antenatal care for Aboriginal and Torres Strait Islander women and expert input has been included to ensure that the recommendations are relevant and culturally appropriate. The Guidelines are not meant to be a textbook of antenatal care. The management of conditions identified through the screening procedures addressed in this module is not discussed; health professionals are directed to appropriate resources where available. The Guidelines are intended as a resource for all health professionals working with women in the early antenatal period. They will be relevant to the work of a variety of health professionals in many different settings. Women should be at the centre of care, wherever it is provided. Summary resources and companion documents for women and their families, and for specific groups of health professionals, will be developed from the Guidelines. The Guidelines will be implemented within the context of significant current activity at national, jurisdictional and local levels in relation to maternity care and health reform more broadly. It is envisaged that the Guidelines will support activities and Budget initiatives arising from the National Maternity Services Plan. Monitoring the uptake of the Guidelines will assess their contribution to changes in practice and potentially to health outcomes. It is anticipated that the Guidelines will contribute to greater consistency in antenatal care and improve the experience and outcomes of antenatal care for women and their families. Prof Caroline Homer and Prof Jeremy Oats Dr Jenny Hunt and Dr Marilyn Clarke on behalf of the Expert Advisory Committee on behalf of the Working Group for Aboriginal and Torres Strait Islander Women’s Antenatal Care ii ANTENATAL CARE – MODULE 1 | CLINICAL PRACTICE GUIDELINES Contents Foreword ............................................................................................ ii Summary ............................................................................................vii Summary of recommendations ...................................................................... ix Introduction ...................................................................................... xviii Part A — Basics of antenatal care ................................................................. 1 1 Principles of care ................................................................................. 1 2 Providing woman-centred care ................................................................... 3 2.1 Understanding the woman’s context ............................................................3 2.2 Cultural safety in antenatal care .................................................................4 2.3 Providing information and support so that women can make decisions ..........................5 2.4 Involving the woman’s family ...................................................................7 2.5 Resources ......................................................................................7 2.6 References .....................................................................................8 3 Antenatal care for Aboriginal and Torres Strait Islander women ....................................9 3.1 Background to culturally safe antenatal care .....................................................9 3.2 Providing woman-centred care ............................................................... 11 3.3 Service delivery issues for Aboriginal and Torres Strait Islander women ......................... 13 3.4 Resources .................................................................................... 15 3.5 References ................................................................................... 15 4 Population groups with specific care needs ...................................................... 18 4.1 Women from culturally and linguistically