EEPD Volume 3. Datasets
B. Datasets used at the Initial Assessment
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"More data is collected on a greater proportion of humankind
at the time of the Initial Assessment in Pregnancy
than at any time anywhere else on earth"
. Special Features / Risk Factors Checklists /
Criteria for Midwifery Care
Princess Royal Maternity Hospital, Glasgow “Exit Criteria for Midwives Birthing Unit” (2008)
Bradford GP Obstetric Booking Form (1999?)
WHO Risk Factors - At Initial Assessment (1994)
A Schematic Approach to Pre-Natal Care, Edinburgh (1994) Historical
Dr. Ken Boddy and his colleagues’ pioneering initiative to encourage more appropriate antenatal care.
The 2003 version of the NICE Clinical Guideline 62 (2003) has now rightly been replaced by the new 2009 version (PDF of full NICE Guideline revised June 2009)in a way which clearly illustrates the following earlier comment
On page 2 of the 2003 version it was noted that “Pregnant women with the following conditions usually require care additional to that detailed in this guideline”. It then gave a list of such conditions with the implication that those with “the following conditions” were to be considered as “high risk” and needed “additional (unspecified) care”
The problem is that, while expectant mothers who have in the past been simply classified as “Low Risk” are a relatively single entity, whereas those classified as having “Special Features” or being “High Risk” belong to a multitude of different sub-groups, only some of which require hospital-based, consultant specialist ante-natal care. The kind of extra care, and when they might need such care, will often be different for each sub-group; yet such detailed further information is missing from such simple lists.
This can be vividly illustrated by the situation where an expectant mother has had a previous abruptio followed by a stillbirth. Too often in the past such a mother risks being labelled as “high risk” needing “hospital/specialist care”, whereas she needs to build up a supportive relationship with a good community midwife, not as too often in the past, been told she must be seen by a series of total strangers, ofter trainees in the consultant based hospital clinic.
The new 2009 guidelines fully accept this problem and instead of separating all pregnant women in to “low” and “high” risk, now lists individual problems and suggests good management options regardless as to who is providing the care. Hopefully, in time, Volume 7 of the EEPD (Future / Prognosis) will, directly or indirectly, provide more detailed electronic information about relative risks; and Volume 8. (Guidelines/Trigger Data/Action Suggestions) will, in time, suggest appropriate management suggestions for each sub-group or condition.
II. Midwifery Care Plan Datasets
The following is more of a questionnaire than a data set; but it illustrates the different perspective of midwives regarding initial assessment data collection.
Shetland Version (2007)
Scan of Original (Awaiting Scanning) www.fawdry.info/eepd/16_qui/a_init/Shetland_S.pdf ???
“Cut & Paste” version www.fawdry.info/eepd/16_qui/a_init/Shetland.pdf√
III. All Pregnancies : Initial Investigation Request and Report Datasets
In time, samples of existing request form datasets will be documented in the EEPD. Volume XII. Proforma section; with a suggested “best practice” dataset accessible from here.