Frequently Asked Questions
The FAQs section is designed to be used by maternity care health professionals across Scotland, particularly those charged with leading the implementation of the Scottish Woman-Held Maternity Record (SWHMR). The section may also be of interest to health professionals from outside Scotland considering development of a unified maternity record, to women given the SWHMR for their pregnancy care and to midwifery students. The FAQs represent the key questions that have been put to the Practice Development Unit during the process of implementing the SWHMR since January 2007. If you have any further questions that are not covered in this section please email the PDU at swhmrpdu.qis@nhs.net
The published version of the leaflet may be also be downloaded. (PDF, 162K, 28secs)
1.Why is a national maternity record needed? We liked our local maternity records.
2. Why do women hold their own records?
3. Why is SWHMR so big – women can’t fit it in their handbags?
6. Why are there so many questions for the booking interview?
7. What if women don’t want to hold their own records?
8. What if women lose their handheld records or forget to bring them to appointments?
9. How can women protect their own confidentiality when holding their maternity record?
11. Why are there 3 postnatal records – we used to just have one?
13. Why could we not have one pregnancy, intrapartum and postnatal record?
15. How do we get supplies of the new version of the SWHMR?
16. What support is available to health boards for implementation of the SWHMR?
17. What are the next steps for the SWHMR project?
18. What guidance and evidence is there to support practitioners using the SWHMR?
20. What information is there for women using the SWHMR?
A national unified maternity record is a priority set by the Scottish Government:
“There should be a national, unified and standardised woman-held maternity record that is available and accessible to both women and professionals” (SEHD 2001).
The benefits of a national record are:
- it reduces local variations in service and practice
- women can move between different NHS boards during their pregnancy; taking their records with them
- the history taking process does not need to be repeated with each new health professional
- data about care provided and outcomes is easier to capture using the core data set facilitated by the Scottish Woman-Held Maternity Record (SWHMR)
- the data can be used for audit and statistical research and can help with the development of a national electronic record
- the SWHMR encourages continuous care and promotes pregnancy and childbirth as a normal life event. It focuses on holistic woman-centred care, good record keeping and good communication between different professionals and the patient.
Trials (Elbourne et al, 1987. Lovell et al, 1987) show there are a number of benefits for women holding their own maternity records:
- women in Scotland have expressed a desire to hold their own records
- women are given a sense of control and involvement in their pregnancy care
- women are fully aware of all the information that has been documented about them and are encouraged to take responsibility for care of their own record and therefore to take a greater degree of responsibility for their own health and well-being during their pregnancy and postnatal care (Kirkham M et al, 1997)
- women report feeling more in control of their pregnancy and that they were more able to communicate effectively with staff (Elbourne et al, 1987. Lovell et al, 1987)
- woman-held records have been found to reduce the number of times women have to repeat information to health care professionals, under former record-keeping systems women became frustrated by being asked the same questions many times (Macintyre S, 1982)
- the practice of women carrying their own notes saved many hours of clerical time (searching for records, transporting them from one clinical area to another etc), thus the handheld records save NHS resources
- records were lost no more frequently than in the previous system (Elbourne et al, 1987)
(Elbourne et al, 1987, ‘The Newbury Maternity Care Study: a randomised controlled trial to assess a policy of women holding their own obstetric records’, British Journal of Obstetrics and Gynaecology, 94:612-619)
(Lovell et al, 1987, ‘The St Thomas’ Hospital maternity case notes study: A randomised controlled trial to assess the effects of giving expectant mothers their own maternity case notes’, Paediatric and Perinatal Epidemiology,1:57-66)
(Kirkham M et al, 1997 ‘Client-held notes: talisman or a truly shared resource?’ Modern Midwife, 7(3):15-17)
(SEHD 2001, ‘A Framework for Maternity Services in Scotland’ SEHD, Edinburgh 2001)
(Macintyre S, 1982, ‘Communications between pregnant women and their medical and midwifery attendants’, Midwives Chronicle & Nursing Notes 95: 387-94)
The ‘special features’ section would not be possible with a smaller record, making it more difficult to locate important information.
A smaller A5 document would have been much thicker proving difficult to store the record for 25 years in medical records departments.
The size of the document is sufficient to allow it to be used as a functional healthcare record which can be used in both community and hospital settings.
It is hoped that NHSScotland will have an electronic system which will match all the data items from the SWHMR by 2010.
This is part of the Scottish Government’s e-health programme which supersedes the e-SWHMR project, originally set-up to devise the electronic version.
This is an issue being addressed by local board areas.
- Computer systems and the Scottish Birth Record (SBR) system can be used to collate all electronically available information and print and attach this to the SWHMR. For example, the SBR discharge summary given to a woman and her baby when transferring them to the community can be attached to the front page of the postnatal maternal and postnatal baby records
- Some NHS boards have made the decision to send the pregnancy record to the woman prior to the booking appointment with directions on completing some parts before attending the appointment
- Another possible approach is to involve the woman by asking her to complete the maternity summary record while the midwife is completing the pregnancy record during the “booking appointment”. Or to ask a midwifery student that is present to complete one part of the record, while the midwife completes the other part
- A photocopy can be taken of the relevant pages of the booking appointment record and used as the basis for the “maternity summary record”
- If maternity summary record information is collected electronically during or following booking, this can then be used in lieu of the hand written maternity summary record
- If either of these last two approaches are used it is essential that there are local systems available for recording enquiries about domestic abuse.
New guidance in relation to perinatal mental health, child protection, domestic abuse, care of children of parents with substance misuse problems, haemoglobinopathy screening, bcg and hepatitis B vaccination have meant that the number of questions that need to be asked in early pregnancy are ever increasing.
The additional questions in the new version of the SWHMR are based on best current evidence and guidance.
It is envisaged that the first 8 pages of the pregnancy record will be completed as early as possible in pregnancy. The first contact with a health professional during pregnancy and the history taking or booking appointment are valuable opportunities to assess any risks for the mother and her unborn baby that will require additional specialist care and to commence health promotion.
It is suggested in the 2008 Nice Institute for Health and Clinical Excellence Antenatal Care guidelines that it may be of benefit to divide the history taking over two early pregnancy appointments rather than try to put more and more into the first “booking” appointment. The increase in the number and depth of questioning in early pregnancy needs to be taken into account when allocating midwifery time to booking appointments. In some parts of the UK and in Scotland this division of the history taking has already been implemented.
If a woman feels that she would find the responsibility too great or if the midwife feels that the woman’s life is currently too chaotic, then the pregnancy record can be stored with the main antenatal care provider in the community or hospital. Arrangements need to be made to ensure that the record can be easily transferred to the place of birth when the woman goes into labour.
Each woman and her midwife should discuss whether the woman holds her own maternity record. The midwife booking the woman should discuss the issues with her and stress the importance of bringing the record with her to all appointments.
If the woman forgets to bring her handheld record to an appointment then the health professional should ensure that an appropriate record is made of the care provided and findings.
Important information should be backed up by the midwife or primary care provider in order that a new record can be quite easily populated in the event of loss. This generally means completing the “maternity summary record” by hand but may also include any local computerised back-up.
If a woman arrives in labour at a maternity unit without her record, it is advisable to ask whether arrangements can be made for a member of her family to collect the record from her home and bring it to the unit.
Women should be reminded to bring their records with them at every opportunity;
- verbally when making an appointment
- in writing via local appointment letters
- on the telephone when women or their partners call and are advised to come into the maternity unit for assessment
It is the woman’s responsibility to store her record in a way that ensures that her privacy is not compromised. She needs to decide who she feels comfortable having access to her record and store it accordingly.
The woman can decide not to hold her own record or to record particular information in the maternity summary record only. For example, if a woman does not want her partner to know information on her previous obstetric history, the full history can be held in the maternity summary record. A locally recognised ‘flag’ system can be used to alert health professionals that the maternity summary record also needs reviewed.
Questions about mental health have been included in the handheld record to help reduce the stigma relating to mental health and encourage the provision of support for mental health problems in pregnancy alongside providing support for physical problems.
Questions about domestic abuse are not included in the handheld record and are only recorded in the maternity summary record.
The “cut down” pages have been designed to ensure that the “special features” are clearly visible at any care episode throughout the pregnancy and intrapartum period.
These special features include key clinical information about estimated date of delivery, blood group, age and parity, thrombosis risk, allergies, smoking status and Body Mass Index and allow for description of any particular risk factors or plans for pregnancy, labour or for the baby postnatally.
If any additional local sheets are added to the record antenatally or intrapartum then they should be added after the special features section to ensure that it is not obscured.
The baby is a separate legal entity from birth and therefore requires a separate medical record. The neonatal hospital record is the baby’s equivalent of the “maternity summary record” in that it forms the base back-up document and does not go home with the baby on transfer to community care.
The postnatal baby record – midwifery care is where the care provided to the baby in the first 28 days postnatally is recorded, wherever the baby is being cared for, whether that is in hospital or at home. If a baby is requiring higher dependency or “transitional” care including phototherapy, monitoring of feeds and blood glucose etc, then local care charts should be inserted.
The postnatal maternal record is where the care provided to the woman in the first 28 days postnatally is recorded, wherever the woman is being cared for. If a woman is requiring high dependency care then local care charts such as fluid balance charts, 4 hourly blood pressure charts, blood transfusion charts, should be inserted.
The postnatal maternal record and postnatal baby record – midwifery care should be returned to the maternity unit by the midwife upon discharge from community midwifery care to be stored in the mother and baby’s hospital healthcare records respectively.
It was not felt to be appropriate for the SWHMR to create national equivalents of health board-wide additional sheets for higher dependency care in these higher risk aspects of care at this stage.
The SWHMR aims to record the majority of the care provided for the majority of women and babies during their maternity care. It maintains a focus on the pathway that the majority of women and their babies will follow.
In the future, maternity service providers may decide that such standardised national documentation could be usefully added to the handheld record. The SWHMR will continue to evolve over the coming years as practice and evidence develop.
The great majority of professionals involved in NHSScotland wide consultation, felt that it would not be suitable for women to go home postnatally with the intrapartum record as there would be no back-up copy of the record and the intrapartum record is an important legal document.
NHS Quality Improvement Scotland (NHS QIS) have sought advice from the health literacy project about ensuring that the style of the record is as accessible as possible to all women, including women with poor literacy skills.
NHS Boards were asked by NHS Health Scotland to identify the most common languages/dialects requested for translation. NHS QIS have produced a leaflet for women which is translated into the nine most commonly requested languages used in Scotland to explain what the pregnancy record is and the importance of keeping the record safe and bringing it to appointments with all professionals. An electronic copy of these leaflets is available on this website.
Good advocacy and interpreting services need to be engaged to work with women during their maternity care to ensure that they fully understand the plan of care.
The PDFs of version 4 of SWHMR are available to be downloaded from the NHS QIS website.
All NHS Boards across Scotland will need to make arrangements for printing an adequate supply of all parts of the record from January 2008. A CD with the print-ready PDFs has been sent from NHS QIS to each NHS board in Scotland in early January 2008.
It is envisaged that the cost of printing the new version of the SWHMR will be similar to the cost of printing version 2 as there are fewer separate inserts and more bound together, although it has been designed to be a two colour rather than black and white document.
A small supply of the amended version of the SWHMR in hard copy will be produced by NHS QIS in January 2008 and distributed to key clinical leads so that example copies can be referred to.
NHS QIS Practice Development Unit is offering on-site visits to all maternity units that request a visit to support SWHMR implementation. If you would like a site visit from one of the practice development team please email swhmrpdu.qis@nhs.net.
We have also produced a PowerPoint training presentation which you can use for local training sessions to support SWHMR implementation in your area. An electronic copy of this presentation is available on this website.
Approaches which have been used in different health board areas which appear to have worked well to promote local implementation of SWHMR are:
- identification of a local implementation lead, who is enthusiastic about the positive impact a national unified record can make, to whom feedback and queries can be addressed,
- small local (including community based) training/information sessions about SWHMR for health professionals affected by SWHMR including community midwives, health visitors, GPs, ultrasonographers, neonatologists and obstetricians,
- local written guidance on practical questions relating to the use of SWHMR locally (including any additional inserts that are to be used locally, where additional sheets are stored, use and storage of the maternity summary record and the interface with local IT systems),
- a ‘change management’ approach that recognises that it will take time for the new record to become embedded in the system. Consideration that initially the new record will make appointments longer as practitioners become used to the record and so perhaps a longer time should be allocated for booking appointments during the first weeks of implementation,
- enabling staff to become familiar with the record before using it in practice – one health board took a “story board” approach by pulling the SWHMR apart and putting it up on a notice board with annotations.
If you have any questions or queries about SWHMR and how it should be used, please contact the PD team at swhmrpdu.qis@nhs.net
The SWHMR will always be a live and evolving document as it will need to be updated as evidence, service provision and practice develop. In early 2008 a national steering group, led by the Scottish Government health and well-being directorate will be set up. A national evaluation project of the impact of the SWHMR will be commissioned by this group during 2008.
Following the results of the evaluation project it is likely that amendments will be required and that Version 5 of the SWHMR will be developed in 2009.
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A detailed guidance document for professionals document was produced in 2004 to support version 1 of the SWHMR – much of this guidance is still very useful and relevant.
A succint updated guidance for professionals document has been produced in late 2007 to support version 4 of the SWHMR. The policy and evidence base for the care promoted by version 4 of the SWHMR is also included in this updated guidance for professionals.
It is possible to download the PDFs of all parts of the SWHMR and the loose continuation sheets form this site.
An information leaflet to be given to women at the booking appointment to explain the use of the SWHMR is available in English, Arabic, Bengali, Chinese (traditional), Lithuanian, French, Hindi, Polish, Russian and Urdu.
The information for women to support the care offered and described in SWHMR is contained in ‘Ready Steady Baby’ which should be given to all women in early pregnancy