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Antenatal Care 

The information below detail contacts with the Maternity unit during the antenatal stage of pregnancy

Referral and Community care

Referral

Women may be referred to their Community Midwife by their GP or they may refer themselves by making a Booking Appointment.

Community care

Booking

The midwife may well contact the mother in the early weeks, but will not make a formal Booking Appointment until 8-11 weeks. This appointment will take at least one hour.

The midwife will take a complete history, explain about the routine antenatal visits and clinics. She will also take urine and blood samples to check the mother is healthy at the start of the pregnancy.

Weight and height will be measured to calculate BMI. Blood pressure will be checked.Healthy diet, foods to avoid,and exercise will be discussed. Further screening will also be discussed.

It is at this initial booking visit that you are given your hand held notes.

Visits

Unless there are any medical concerns e.g previous medical history or a new problem, you will be looked after by your Community Midwife. She is the expert in normal midwifery.

If your condition/ situation changes in pregnancy your Community Midwife may refer you to the hospital, for you to be reviewed by a doctor.

As a guide,antenatal visits are now at 15,24,28,31,34,36,38,40,41 weeks.

If you have had a normal pregnancy before, appointments at 24 and 31 weeks are optional.

If you are planning a homebirth your named midwife may not be on duty when you go into labour. To cover this possibility, it is usual for you to meet some of the team of midwives who might attend your delivery if your named midwife is unavailable.

Team areas

As the Maternity Unit in Salisbury covers such a wide geographical area, the Community Midwives are divided up into teams covering GP surgeries in the following areas:

  • City Team - Salisbury, Wilton and surrounding villages
  • Forest Team - Downton, Whiteparish, Fordingbridge, Ringwood
  • Shaftesbury/Gillingham Team - Shaftesbury, Gillingham, Tisbury, Mere
  • Tidworth Team - Tidworth and surrounding villages
  • Stonehenge Team - Amesbury, Bulford, Larkhill

Urgent messages can be left for a Community Midwife via the hospital switchboard 24hours a day (01722 336262).

Non urgent messages can be left at the Day Assessment Unit (01722 425185), the midwives generally collect their messages after 4:00 p.m.

Antenatal clinic / Screening and Scanning

Antenatal Clinic

The Antenatal Clinic provides screening, ultrasound scanning services and specialised antenatal care

Screening

Currently Salisbury Maternity Unit offers a full antenatal screening service.

Early in pregnancy screening is offered in line with national policy for:

  • Sickle Cell Disease and Thalassaemia
  • Infectious diseases – Syphilis, HIV and Hepatitis B

Down’s syndrome – for those women that book at an appropriate gestation the first trimester combined scan/screening test is available (see below). For those women that book at a later gestation a blood test alone is available

Ultrasound Scanning

A dating scan will be offered between 10 and 14 weeks into the pregnancy.

There is an option to have 1st trimester screening for Downs syndrome, your community midwife will make a referral if you choose this option. (for further information see National Screening booklet).

A further scan is offered at around 20 weeks to check your baby has physically developed as expected. (For further information see National screening booklet).

Scans will be offered more frequently if a multiple birth is expected or where required due to medical need.

Specialised Care

If your pregnancy requires specilaised care you will be allocated to the appropriate Consultant Obstetrician. Each consultant has a team of doctors who all work closely together.

You will be given a plan of care specifically tailored for you and your pregnancy needs.

We have a specialist endocrine clinic on Tuesday Morning, ( Diabeties and Thyroid problems) This clinic is supported by Consultant Endocrinologist, Consultant Obstetrician, Diabetic nurse specialist, Diabetic Dietician and Midwives.

Day Assessment Unit

Day Assessment Unit

Day Assessment Unit

The Maternity Day Assessment Unit is run by a small team of Midwives and Maternity Assistants. We provide an Outpatient service where women over 20 weeks gestation can be referred by their Midwife, GP, or Obstetric Doctor for urgent investigation and/or ongoing monitoring of high risk or acute problems in pregnancy.

Women can also telephone the DAU for advice (01722 425185) and if appropriate, will be advised to attend the DAU.

We also provide a phone messaging service, enabling women to contact their Community Midwives at any point in pregnancy or postnatally with non urgent messages.

We are located adjacent to the Antenatal Clinic and are open weekdays from 9:15am until 8:15pm and Saturday 10:00am until 4:00pm.

Specialist Midwives Clinic

Specialist Midwives Clinic (VBAC)

Our aim is to encourage women who have previously experienced a caesarean section to make informed choices during the next pregnancy about the mode of delivery. We are committed to the philosophy of facilitating a normal birth for women who have experienced a Caesarean Section (CS) .

When ‘booking’ for a subsequent pregnancy all women are given a “Vaginal Birth after Caesarean” (VBAC) information booklet and referred for consultant led care. Provided a VBAC is clinically appropriate, women will be offered a referral to the Specialist Midwives Clinic if they are:

  • Requesting a CS following a previous CS
  • Considering a VBAC, and would benefit from further discussion

A woman can be referred at any time to the Specialist Midwives Clinic via O&G clinic or the community midwife. The aim is to see women at 18 – 20 weeks gestation. If a woman requests an elective CS she will be referred back to the Consultant for review and to make the final arrangements for delivery.

What are the advantages of a vaginal birth this time?
  • Overall, vaginal birth following a previous Caesarean section (CS) is associated with a lower risk of complications for the mother than having another routine CS
  • Recovery time after a vaginal birth is quicker than a Caesarean section so you will be able to return home and care for your other child/children sooner
  • You are less likely to develop problems such as infection, severe bleeding and thrombosis (blood clot)
  • You are less likely to need further surgery or intensive care
  • A vaginal delivery lowers your risk of developing complications in future pregnancies
  • If further pregnancies are planned, a successful vaginal delivery this time increases the chance of a future vaginal delivery
  • Labour and a vaginal delivery enhances your oxytocin levels which are vital for breastfeeding
  • Less need for strong pain relief after the birth
  • For the baby there is less risk of respiratory problems (breathing difficulties) following VBAC than elective CS

The benefits of a repeat elective LSCS are -

  • The scar on the uterus is less likely to thin or separate
  • An emergency CS in labour is avoided
  • The risks associated with induction of labour, should it be required, are avoided

If you have any questions or concerns talk to your Community Midwife or the Doctor.

Birth Planning

Birth Planning

Your midwife will make an appointment with you when you are around 34 weeks pregnant to discuss labour and birth and create a personal birth plan that becomes part of your hospital notes.

The birth plan gives the midwife that looks after you in labour an understanding of any wishes you and your partner may have regarding your labour care.

You may have attended antenatal classes or have had a baby before and these may inform your ideas of what you would like in labour. Birth plans are personal to each woman and their partner taking into account their individual needs.

It is very important that birth plans are flexible to accommodate for changes in circumstances. These can arise if you develop complications in later in pregnancy or labour that require additional intervention, or if particular facilities such as birthing pools are not available at the time required.
The midwife caring for you will endeavour to support your preferences as fully as possible whilst providing care that is safe for you and your baby.

Reference: National Health Service, 2013 How to make a birth plan

Options – choosing where and how to give birth:

Hospital or Home

There are advantages and disadvantages to a home or hospital birth. You and your partner need to consider these for each option.

Hospital Birth

You may feel safer and more comfortable having your baby in hospital, especially if it is your first child.

In the Salisbury area about 2,400 mothers a year choose to have their baby in the maternity unit at Salisbury District Hospital.

Our newly refurbished (summer 2013) Labour ward has ten ensuite rooms (including two pool rooms and an Obstetric Theatre).

You will be looked after by experienced midwives and have access to a range of types of analgesia (see Pain Relief).

If your labour deviates from the normal, there will be a Senior Doctor available at all times and a Consultant Obstetrician on call out of Hours. Experienced paediatricians are available within the hospital, 24 hours a day and the newly extended and refurbished Neonatal Unit is situated close to the Labour Ward.

Depending on the type of delivery and whether or not this is your first child, you may go home directly from the Labour Ward or you may go to the Postnatal ward to take some time to recover.

The Midwives and Maternity Care Assistants on the Postnatal Ward will check both you and your baby. They will also introduce you to the basic care of your baby (or give reminders) as necessary e.g.help with breast feeding, bathing and nappy changing.

When you go home you will still receive support from the Community Midwives for postnatal checks.

Home Birth

Talk to your Community Midwife, she will be happy to discuss the possibilities of Home Birth with you.

You should consider:

  • The distance that you live from the hospital should a transfer in become necessary
  • In familiar surroundings you may be more relaxed and able to cope with the pain
  • You are likely to be looked after by a midwife that you know
  • The limited analgesia options available at home
  • If there is an older sibling, childcare may be easier with a home birth but a backup plan will be needed in case a transfer into hospital is needed.
  • You will not need to be separated from your partner after the birth

There may be factors that would reduce the suitability of a home birth.
Certain diseases which you have already had or an illness you develop during pregnancy or other factors may mean that you will be advised to have your delivery in hospital e.g. if you are expecting twins, if you have high blood pressure, high BMI or factors related to previous births.

Wherever you decide to give birth, you can change your mind at any stage of the pregnancy (subject to medical limitations on home birth).

Further advice on where to give birth can be obtained from:

Water birth

We have two rooms with birthing pools. Some mothers choose to use a pool in the early part of establishing labour (see below in “Pain Relief”).

Although many women choose to get out of the pool to deliver or have alternative pain relief, some women feel comfortable and choose to deliver in the pool. We need to be able to listen to the baby’s heart whilst the mother is in the pool. For this we have waterproof sonicaids which can be used without disturbing the mother.

Sometimes however, either due to the position of the baby or the position the mother has adopted, it may be difficult to hear the fetal heart and we have to ask the mother to change position, stand up or even leave the pool briefly so that we can hear the fetal heart rate clearly.

Some fathers want to get into the pool with the mother to be more involved with the birth. This can be really helpful and some mothers find it a great comfort. (Fathers – please bring a pair of trunks if this is in your plan.) Please note, this is not for all dads. They can be just as supporting from dry land. Also the pools are not so large that having two people in the pool may restrict the mother’s ability to move freely. It will be up to the mother where she finds her partner most helpful.

Our priority is always a good birth experience for the parents resulting in a healthy child. Sometimes where that experience happens may change from your first choice. We would only ask you to get out of the pool if we were not happy with the well-being of the mother and/or baby.

Water Birth room
Elective Caesarean Section

There are some cases when it will be recommended for you to have a planned caesarean section.
You will be given a date and time to come in and (unless there are exceptional circumstances) your baby will be delivered by caesarean section (LSCS) that day. Salisbury Maternity Unit has an obstetric theatre which is open 24 hours a day. Before your elective Caesarean Section you'll be advised not to eat from midnight and not to drink anything after 6:00am. You will be given an antacid tablet to be taken at 6:00am.

Common reasons for Elective Caesarean Section include:

  • Baby presenting by the breech
  • Previous LSCS
  • Maternal illness
  • Fetal problems
  • Placenta praevia

A decision on an elective caesarean will follow investigations and tests in the Antenatal Clinic, by the Consultant Obstetrician and in discussion with the parents.

Relevant factors in choosing where to have your baby

Your Community Midwife will be discussing these with you.
If your midwife is concerned that your pregnancy is deviating from the norm, she may refer you to the Antenatal Clinic at the hospital to be reviewed by a Consultant Obstetrician. The obstetrician will assess you and carry out any relevant tests or scans.

There are many considerations when deciding on the most appropriate mode and place of delivery, including:

  • Parity i.e. first, second or more babies
  • Gestation – length of pregnancy
  • Presentation of baby
  • Maternal age
  • Maternal BMI
  • Maternal health e.g. diabetes, infectious conditions, anaemia, vascular problems etc.
  • Previous obstetric history
  • Previous perineal trauma

The discussion and choice will always be focused on providing a good birth experience resulting in a safe birth.

Pain Relief (inc Aromatherapy):

TENS Machine

Stimulates the body’s own natural pain relievers called endorphins. It works by blocking the pain signals from the uterus to the brain.
Many women find it useful in the first stage of labour and it may reduce the need for drugs however it can be used in conjunction with other pain relief options TENS machines are available to hire from the maternity unit for £25 plus a £20 refundable deposit.

Aromatherapy

Helps to create a calming and relaxing atmosphere, may aid contractions and can help to ease nausea and sickness. It also enhances mood to create an uplifting feeling. This can be used in a birthing pool, through an aroma stream or added to oil for a relaxing massage.

Water

Our maternity unit has two birthing pools that are available to use if the rooms are free, please enquire when you ring up in labour.
Water can be relaxing; you feel weightless in the water and can move around with ease. The water is kept at body temperature and gas and air is available to use in the pools.
Pools are also available to hire for home births.

Gas and Air

It is a mixture of oxygen and nitrous oxide (laughing gas), it is breathed in through a mouth piece and you are in control of how much you breathe in. This is available for both home birth and hospital birth.
It does not take the pain away but takes the edge off and makes the contractions more bearable.

Pethidine

Pethidine is an opioid and is available in the form of an injection for pain relief and this is used by a small number of women to help them to relax during labour.

Diamorphine

Diamorphine is similar to Pethidine as it is from the opioid family and is given by injection, its effects can last longer than Pethidine and it has fewer side effects.

Epidural

An epidural is a drug that is inserted into the epidural space of the lower back near the nerves. It offers complete pain relief. It can be useful for women who are having long labours or who are very anxious.

Parent Classes

Parent Classes

Your Community Midwife will explain what is available in your area when you have your booking appointment.

There are various options available:

Community Midwives Parentcraft Classes

Some Community midwives run their own small groups, teaching mothers and their partners about pregnancy and the myriad of changes that it will bring.

This may include preparation for labour, diet, relaxation techniques, pain relief, how to feed your baby, and the birth itself (vaginal birth, assisted delivery & Caesarian Section).
A tour of the Maternity Unit may be included.

The classes are usually held locally e.g. at the GP Surgery
The Community Midwife will advise about booking these classes.

Parentcraft Classes at the Hospital

These are run by a Community Midwife and held on the first Saturday of each month at the Hospital from 10:00 – 15:00.
This class can be booked through the day Assessment Unit on 01722 425185.

Parentcraft for parents expecting a Multiple Pregnancy

This is designed for parents expecting a multiple birth.
They are held 4 times a year on a Saturday from 10:00 – 15:00.
This class can be booked through the day Assessment Unit on 01722 425185.

National Childbirth Trust (NCT) Classes

See NCT local branch website for details or contact Maternity Reception for advice on cost and availability of classes held at the Hospital Staff Club - 01722 425177.

easibirthing® Workshops

The easibirthing® workshops teach parents about relaxation and breathing techniques for use in labour and life skills for parenthood.
The sessions are held in Fordingbridge and Salisbury and a CD is provided, both free to women booked with Salisbury District Hospital.
To book, contact Sharon Mustard on 01980 623089, or via the website.






A supervisor is always available to provide support, advice and guidance to mothers, families and midwives. Mothers may contact us to talk about the standard of care they have received or to discuss if they have not felt supported. Midwives may contact us for professional advice and guidance.
Supervisor of Midwives on call: Salisbury District Hospital via switchboard 01722 336262

Page Last Updated: 02/12/2016 13:46 
Printed from Salisbury NHS Foundation Website http://www.salisbury.nhs.uk