The booking history

Chapter 3. The booking history




Introduction



Depending on the locality and model of antenatal care practised (see Ch. 2) the booking history may be conducted by the community midwife either in the woman’s home or at the local clinic, or by a midwife at the hospital. It is usually conducted between 8–12 weeks of pregnancy, although there is some evidence that women feel the need for antenatal care before this time (Sanders 2000). NICE (2008) recommends that booking is undertaken by 10 weeks of pregnancy.


We shall explore each in turn.


Developing relationships


Fundamental to all aspects of midwifery care is the need for the midwife to communicate effectively with the woman. There are aspects of the booking that the midwife can influence in order to help make the experience a positive one.


Place of booking


The place where the woman will be most comfortable and able to talk openly about how she feels is probably her own home. There are several advantages to conducting the booking history at the woman’s home address. The balance of power between woman and health professional is more even. The woman is in her own familiar environment, on her own territory, the midwife is a guest. Clinics and hospitals can be daunting places for women to attend. They may be associated with difficult memories, clinical smells and there are often unfamiliar protocols to follow. Of course, many measures have been taken to make such environments more friendly and relaxed, but the privacy and familiarity associated with one’s own home cannot be replicated.

It may take longer to book a woman in her own home, as such an event often involves an element of tea-drinking and social chit-chat about the dog/other children/the new kitchen. Time spent by the community midwife during the booking visit getting to know the woman, not just as an individual but as a member of a family and a community, is an investment for future care. Development of trust and mutual respect at the beginning of pregnancy will enable the woman to ask questions and seek advice throughout the childbirth continuum. Worries can be discussed before they become problems. Booking a woman at home enables the midwife to gain a deeper understanding of the woman’s social circumstances, who she lives with and how supported she will be by them.



Information


The woman should be aware of what the meeting is about and what is expected of her, preferably before the meeting takes place. For example, the midwife will be asking her questions about her past medical history asking her if there have been any babies on either side of the family with congenital health problems.

If the woman is expecting to be able to provide such information she can ask her partner if he is aware of any children on his side of the family who have a condition that might be passed on to their baby. She can ask her mother about her own health as a child and if her mother experienced any complications during her pregnancies. The community midwife may have composed a simple, friendly letter of introduction that outlines the content of the booking visit, giving her contact details if the woman needs to clarify anything or make alternative arrangements.


Communication


Midwives care for women from a range of cultural backgrounds and it is vital that they understand each other. Whilst occasionally relatives undertake the role of interpreter until an appropriate link worker can be located, there is no excuse when a pre-planned meeting such as a booking interview is conducted without a skilled interpreter. In a review of the literature in relation to communication and cultural diversity (Robinson 2002) it is apparent that trained interpreters enhance communication.

We tend to get on best with people who show an interest in what we are saying and who appear to be concerned about our welfare. The midwife can demonstrate that she is there to listen to the woman by sitting down with her. If she is standing up this may convey to the woman that she is on the move and has not got time to talk. If the midwife is doing other things at the same time and not looking at the woman, this may suggest to the woman that she is not listening. While it is important that midwives document significant issues, the midwife should put down her pen when the woman is speaking. The midwife can create an opportunity to pick up her pen again, perhaps by reflecting back what the woman has said (‘so let me see if I have got this right…’) before she writes it down. The woman then knows that the midwife a) had been listening and b) correctly interpreted what was said.

Clinical results should be recorded contemporaneously but the midwife can continue to nod and smile in affirmation that she is still listening or simply say, ‘just let me write this down before I forget’, to avoid appearing rude. Pressure of work can make it easy to revert to a list of closed questions, as observed in Methven’s revealing study (1989). McCourt (2006) describes three styles of communication by midwives during the booking history: professional, providing expertise and guidance; disciplinary, providing expertise and surveillance and partnership which is much more participative and collaborative, following a conversational style rather than a ceremonial order.

Eye contact is an important aspect of showing attention to another. Less gaze is associated with inattention on the part of the listener (Rungapadiachy 1999).

The physical environment is also important. Whilst in a woman’s home the midwife cannot start rearranging the furniture but she can make best use of the layout by endeavouring to ensure that there are no physical barriers between them and that they can face each other at the same level.


Discuss place of birth


Women need to be aware of the options available about place of birth before they can make a decision about what might be best for them. Place of birth is a complicated issue and many factors need to be considered before a fully informed decision can be made. The booking visit is an ideal opportunity to raise the issue, to let the woman know that she has a choice, but not necessarily the right time to seek a definitive decision. In some services, for example the Albany Group Practice (Reid 2002) women are not asked to make a decision until they go into labour. In 2005–6 only 2.6% of women had a planned home birth (The Information Centre 2007). The government are committed to ensuring that, by the end of 2009, ‘all women will have a choice in where and how they have their baby’ (Department of Health 2007:09).

Although many midwives freely offer choice regarding place of birth, some do not. This may be due to a range of reasons including lack of confidence due to infrequent demand. Some midwives feel that they are not supported by their colleagues (Baston & Green 2002). A midwife may work in a team where the other midwives would not be able to cover her clinic or visits if she was called to a home birth. Crises of low staffing levels sometimes lead units to temporarily withdraw home birth as an option.

Home birth presents the ideal scenario of one to one care in labour for low-risk women. A woman booked for a hospital birth may be cared for by a midwife who is also looking after other women at the same time. However, it would be inappropriate for all women to give birth at home as there are limited options for pharmacological methods of pain relief and many women, especially those experiencing their first labour, wish to have an epidural (Leighton & Halpern 2002). Others have or develop complications either during their pregnancy or birth that preclude home birth as a suitable option as they require the facilities of an obstetric unit and medical or surgical support.



Discuss antenatal screening


The booking interview is often the time when women are given information about the options available to them regarding antenatal screening for fetal abnormality. They may have already heard about some of the tests, through relatives or friends. However, women need to make choices that are right for them as individuals and may require support and guidance about the risks and benefits of the test on offer. The midwife needs to be able to present the facts, without prejudice or personal influence.


The range of tests available varies from locality to locality, and may change as new tests become available. Keeping up-to-date with all the tests on offer presents a challenge to midwives, as they need to know what the test involves, when it is performed, how it is obtained and what the results mean. They also have to be able to translate this into meaningful information for women of all cultures and backgrounds. Keeping abreast of changes in clinical practice is a midwife’s professional responsibility (NMC 2008:09).

All women have the right to this information. If a test can only be undertaken through a private company and requires payment, it is not for the midwife to decide if a woman of low socio-economic status should have it or not. Women may face dilemmas about the choices they make, but they cannot address them unless they know that the choices exist. Midwives may have their assumptions challenged with regard to who will benefit from information (Kirkham et al 2002). See Chapter 8 for information about the screening tests available.


Risk assessment


Taking a booking history is an opportunity to undertake a risk assessment of the pregnancy, as recommended by recent confidential enquiries into maternal death (Lewis 2004; Lewis 2007). In the latest report it was highlighted that there were some cases where midwifery-led care had been provided to women who were known to be high-risk. The use of risk assessment tools varies between maternity services, and their previous value has been questioned, especially for first pregnancies (Enkin et al 2000). It is part of government policy that ‘each woman should undergo a standardised risk and needs assessment to help in her decision making process’ (Department of Health 2007:14). It is part of the National Institute for Health and Clinical Excellence (NICE 2008) remit to develop an ‘antenatal assessment tool’ with the proviso that it must be subjected to a multi-centred validation study with the aim of identifying a third of women who are at increased risk of maternal death.


Completion of the maternity record


The national maternity records used for antenatal care encourage the woman to contribute to and be directly involved in her care. There are sections that she can complete herself and identify any questions she might have. As she holds the records throughout the pregnancy she has the opportunity to read them in intimate detail. It is important, therefore, that whenever the midwife makes an entry in the records she explains it to the woman and ensures that she knows not only what it says but also what it means. A systematic review to evaluate the effects of women carrying their own case notes during pregnancy concluded that this system improves women’s feeling of control, satisfaction and the availability of antenatal records (Brown & Smith 2004).


Personal information


The national maternity record begins with an important section which the woman can complete herself. It includes details about her full name and title, and what she likes to be called. There are important contact details, essential for the return of lost records, and boxes to record the names of the professionals involved in the woman’s maternity care.

It is on this page that the woman also records her occupation and that of the baby’s father. This is important information as there may be occupational hazards associated with particular kinds of work that the midwife can give general advice about. Women may need to be encouraged to talk to their employer about reassignment of duties during their pregnancy, depending on the nature of their role. For example, if their job involves heavy lifting or standing for long periods, an alternative office role might be available during the term of the pregnancy.



Current medical history


Women may become pregnant with an underlying medical disorder. Often, women confirm their pregnancy with their GP first, hence the woman’s medical condition is already known. For example, if the woman has diabetes, the GP would refer the woman directly to a clinic that caters for pregnant women with medical conditions. These clinics have different names, such as ‘joint care clinic’, where arrangements are made for both the medical team and the obstetric team to see the woman at the same time. Thus care is planned and coordinated to meet the needs of the pregnant woman in the light of her underlying medical condition. Individual maternity services may have alternative systems in place to support the care of local women.


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Jun 18, 2016 | Posted by in MIDWIFERY | Comments Off on The booking history

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