These Guidelines provide evidence-based recommendations to support high quality, safe antenatal care and contribute to improved outcomes for all mothers and babies. The Guidelines have been developed in collaboration with State and Territory governments and sponsored by the Maternity Services Inter-Jurisdictional Committee (MSIJC), a subcommittee of the Community Care Population Health Principal Committee (CCPHPC) of the Australian Health Ministers’ Advisory Council (AHMAC). Full funding for the Guidelines was provided by the AHMAC.
The lengthy process of reviewing the evidence on the numerous aspects of antenatal care necessitated completion of the project in two modules, which are intended to be used together. Clinical Practice Guidelines on Antenatal Care — Module I was released in March 2013.
The development of Module II has followed the key principles and processes outlined in the document Procedures and Requirements for Meeting the 2011 NHMRC Standard for Clinical Practice Guidelines. This involved convening a multidisciplinary committee, the membership of which included a range of health professionals with expertise in providing, developing and researching antenatal care, a consumer representative with experience of antenatal care and a methodology expert. Input was also sought from a Working Group for Aboriginal and Torres Strait Islander Women’s Antenatal Care and a Working Group for Migrant and Refugee Women’s Antenatal Care. The content of the Module was developed by these groups and was not influenced by the funding body.
More detail on the guideline development process is included in the appendices.
Application of the Guidelines Objective of the Guidelines
The Guidelines take a woman-centred approach, which includes considering the woman’s context, ensuring cultural safety and enabling the woman to make informed decisions and choices about assessments and tests. They aim to improve the health of women and babies by promoting consistency of care and providing a summary of the currently available evidence on aspects of antenatal care.
Scope
The two modules of the Guidelines cover the antenatal care of healthy pregnant women (ie those who do not have identified pre-existing conditions or complications, such as multiple pregnancy). They are intended for use in all settings where antenatal care is provided, including primary care, obstetric and midwifery practice and public and private hospitals.
Module I of the Guidelines includes principles for providing woman-centred care and discusses optimising antenatal care for a range of groups of women, including Aboriginal and Torres Strait Islander women, migrant and refugee women, adolescent women, women in rural and remote areas and women with serious mental health disorders. Clinical topics included are largely specific to the first trimester, although the timing of a woman’s first antenatal contact and the availability of services may mean that some of the clinical assessments or screening tests discussed are carried out later in pregnancy. As well, some assessments are repeated throughout pregnancy (eg blood pressure measurement) and social and lifestyle advice (eg smoking) is beneficial at all stages of pregnancy.
Module II of the Guidelines presents the evidence for core practices in antenatal care, lifestyle considerations, specific clinical assessments, common conditions during pregnancy, maternal health screening tests and clinical assessments in late pregnancy. While clinical topics discussed in Module I are generally specific to the first trimester, Module II covers some topics that are relevant to the first trimester (eg anaemia), later stages of pregnancy (eg 18–20 week ultrasound, pre-eclampsia) or throughout pregnancy (eg nutrition, physical activity). Revised advice on optimising care for migrant and refugee women and women with mental health disorders is also included.
The Guidelines do not include:
information on the additional care that some women will require (eg while they discuss tests to identify clinical signs of pre-eclampsia, they do not give information about its management) — resources providing guidance in these areas are listed where relevant;
discussion of models of antenatal care, as the Australian Institute of Health and Welfare is in the process of developing standardised definitions that will enable future evaluation of different models of care; or
discussion of specific topics where a practice is established (eg testing of blood group and rhesus D status) or where the topic was not considered a priority for inclusion in these Guidelines and advice is given by other organisations (eg vaginal discharge, backache).
Intended audience
The Guidelines are intended for all health professionals who contribute to antenatal care, including midwives, general practitioners (GPs), obstetricians, maternal and child health nurses,2 Aboriginal and Torres Strait Islander Health Practitioners; Aboriginal and Torres Strait Islander Health Workers, multicultural health workers, practice nurses, allied health professionals, childbirth and parenting educators and sonographers. The way in which different professionals use these Guidelines will vary depending on their knowledge, skills and role, as well as the setting in which care is provided.
These Guidelines will be of interest and relevance to pregnant women in Australia. In addition, it is expected that policy makers will be able to draw on the Guidelines in the development of policy and health services.
How to use the Guidelines
Part A of the Guidelines includes information on optimising antenatal care for specific groups of women — migrant and refugee women and women with mental health disorders. It is intended to be used in conjunction with Part A of Module I, which outlines the basics of providing woman-centred care and includes information on optimising antenatal care for Aboriginal and Torres Strait Islander women, adolescent women and women in rural and remote settings.
Part B of the Guidelines discusses aspects of clinical care during pregnancy. Each section provides background information about the topic, discusses the available evidence and highlights points to include when discussing the topic with women. A practice summary is included for each topic. These provide information on when during pregnancy a topic is relevant and who may be involved in providing care and/or information. The role of the health professionals involved will depend on their expertise, a woman’s needs and the setting where care is provided.
Part C outlines areas for further research identified through the process of reviewing the evidence.
The appendices include details on the membership of the working committees, the process of developing the guidelines and reviewing the evidence (including specific research questions, search strategies and findings) and the economic analyses conducted to inform the Guidelines.
Implementation and review
It is anticipated that a web-based approach be taken to dissemination, with the Guidelines being published on the Department of Health website.
A multidisciplinary team has been convened with the aim of increasing the uptake of the Guidelines through liaison with professional groups and promotion of the recommendations. The team includes representation from midwifery, general practice, obstetrics, rural and remote health, Aboriginal and Torres Strait Islander health, and consumers. Potential implementation strategies include: education through meetings, conferences and presentations; outreach education; and opinion leaders. Implementation of the Guidelines is discussed in greater detail in Appendix C.
It is recommended that the Guidelines be updated within 5 years, should the evidence base indicate updating is required and subject to AHMAC consideration.
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