Maternity

Risk assessment and referral forms

All referrals to maternity services should be made via the GP or midwife.

All referrals to maternity services, except from surgeries in Totton, Hythe, Lymington and Romsey, are made by completing the Princess Anne Hospital risk assessment and referral form. This should be signed and either faxed or sent to the Maternity Administration Team at the Princess Anne Hospital.

Surgeries in Totton, Hythe, Lymington and Romsey should refer to the Maternity Administration Team at the New Forest Birth Centre, using the New Forest Birth Centre risk assessment and referral form.

• GP risk assessment and referral form - Princess Anne Hospital (Word)
• GP risk assessment and referral form - New Forest Birth Centre (PDF)
• GP risk assessment and referral form - New Forest Birth Centre (Word)

Additional information

1. Why is this form being updated?
2. Why is it called a risk assessment and referral form rather than a referral form?
3. Why is there a question asking for ethnicity?
4. Why is there a tick box for the provision of the UK National Screening Committee (NSC) ‘Screening tests for you and your baby’ leaflet?
5. Why is there a tick box for folic acid?
6. Why is there a tick box for an FW8 form?
7. Why is there a box asking for gestational age even if unsure?
8. Why is cervical incompetence not included?
9. Why is height requested?
10. Why is so much information pertaining to ‘social factors’ required?

1. Why is this form being updated?

A review of the booking process was recently undertaken at UHS. This found that referrals were often being sent for unnecessary obstetric consultation by the maternity administration team prior to the midwife receiving the booking referral and thus delayed the process. Reasons for this included the lack of specific obstetric referral guidance available and lack of detailed information provided within the referral forms. Changes were made to the obstetric referral criteria and booking process at UHS to ensure that only those women who required early or urgent obstetric review were sent for obstetric consultation initially. This process was undertaken in collaboration with the consultant obstetricians at UHS. The risk assessment and referral form was adapted to reflect these changes.

In addition recent recommendations from the Safeguarding Children Review Board emphasised that it was necessary to ensure that any pertinent information about a woman’s social history, including those of her family or partner, was shared appropriately between care providers at the earliest opportunity in pregnancy. The referral form was adapted to ensure that there were appropriate prompts for the sharing of this information.

2. Why is it called a risk assessment and referral form rather than a referral form?

Completion of the form enables the maternity administration team to ensure that early obstetric appointments are made for those women highlighted as needing such an appointment following referral. The provision of information about any complex health or social factors also enables the midwife to ensure that the referral is prioritised and followed up appropriately should the woman not attend her booking appointment.

3. Why is there a question asking for ethnicity?

This ensures that early appropriate advice regarding screening for haemoglobinopathies can be provided at the earliest opportunity as recommended by local and National guidance (NCCWCH, 2008; NSC, 2010). It also enables an appropriate translator to be booked if necessary.

4. Why is there a tick box for the provision of the UK National Screening Committee (NSC) ‘Screening tests for you and your baby’ leaflet?

National guidance (NCCWCH, 2008; NSC, 2010) recommend that all women should receive written information about screening in their spoken language at first contact with a health professional in pregnancy. The provision of this information at first contact in pregnancy ensures that women have the opportunity to read this information prior to their booking appointment where they can discuss any concerns or queries further with their midwife.

For those women who refer to their GP after 10 weeks the midwife will often arrange a telephone consultation with the woman to discuss her screening options prior to her booking appointment. This is to ensure that any first trimester screening can be arranged in a timely manner. The early provision of the screening leaflet ensures that women have time to make informed decisions and have the opportunity to discuss further any questions they might have.

The link to the extranet page (previously sent to all GPs) also provides further detail about this leaflet.

5. Why is there a tick box for folic acid?

Dietary supplementation with folic acid before conception and up to 12 weeks of gestation reduces the risk of women having a baby with neural tube defects. It is important that women are informed of this and have the opportunity to take folic acid supplements (if they are not already doing so) at the earliest opportunity in pregnancy.

6. Why is there a tick box for an FW8 form?

Pregnant women and those who have had a baby in the last 12 months are entitled to free NHS prescriptions, and free NHS dental treatment (provided that they are pregnant when accepted for the course of treatment or have had a baby up to 12 months before the treatment).

To enable women to get free prescriptions the application form FW8 must be completed and signed by either the GP, midwife or health visitor. This should be sent to the address provided on the FW8 form following which a Maternity Exemption Certificate will be sent to the woman. This can be presented to her pharmacist/ dentist in order to obtain a free prescription/treatment. Midwives also carry these forms but the earlier they are sent the earlier women receive and can use their Maternity Exemption Certificate. Further information on free prescriptions from NHS Choices.

7. Why is there a box asking for gestational age even if unsure?

This was requested by the screening midwives during consultation and is to help prevent women being booked inappropriately for first trimester screening and wasting a valuable appointment slot

8. Why is cervical incompetence not included?

This is in alignment with the revised timings and indications for obstetric referral criteria following consultation with the consultant obstetricians.

9. Why is height requested?

To ensure that midwives are able to calculate an accurate BMI at booking as midwives do not always have access to equipment to measure height and women do not always know how tall they are. It is imperative that midwives are able to measure BMI correctly at booking and plan care accordingly. This is in alignment with National and local guidance.

10. Why is so much information pertaining to ‘social factors’ required?

This is following the recommendations from the Safeguarding Children Review Board as detailed in question one.

References

Expert Advisory Group. Department of Health, Scottish office Home and Health Department, Welsh Office, and Department of Health and Social Services, Northern Ireland (1992). Folic acid and the prevention of neural tube defects. London: HMSO 

National Institute for Health and Clinical Excellence (updated March 2008) Antenatal care: Routine care for the healthy pregnant woman.

UK National Screening Committee (2010) Screening tests for you and your baby: Important information for you to keep with your hand-held maternity records, available from NHS Screening.