Mothers-to-be are receiving too much care in pregnancy, causing them inconvenience and anxiety and possibly reducing their chances of having a normal birth, official guidance said yesterday.
There are too many checks and measures during the nine-month antenatal period that serve no useful purpose and are based on ritual not science.
Better care, but less of it, would improve the experience of the 600,000 women who give birth each year, the guidance, published by the National Institute for Clinical Excellence (Nice), says. Its verdict marks one of the first occasions on which a group of health professionals has recommended a reduction in the care given to their patients.
The guidance was produced for Nice by the National Collaborating Centre for Women's and Children's Health, an umbrella group representing obstetricians, paediatricians, epidemiologists and consumers.
Women routinely pay up to 14 visits to their GP's surgery or local hospital to be weighed and have their blood pressure and urine checked, not including visits for scans. The schedule of visits was developed in the 1920s and has been added to, but not substantially changed, in more than 80 years.
The new guidance, which NHS trusts are required to follow, says the number of visits should be halved to seven for women who have already had one child and reduced to ten for women having their first.
The first appointment should be held earlier, at eight weeks of pregnancy, so women have time to think about screening for foetal abnormalities, with fewer appointments in mid-pregnancy. The guidance applies only to healthy women with uncomplicated pregnancies.
Jane Thomas, the director of the collaborating centre, said: 'We know more about what works and what doesn't work in pregnancy than in other areas of medicine. In that way, maternity care benefits.' Evidence showed the number of antenatal visits could be safely cut even further, to four or five, but the group feared this would be 'too radical'.
Peter Brocklehurst, the director of the National Perinatal Epidemiology Unit, who chaired the expert group that produced the guidance, said all women should be offered an ultrasound scan at three months to date the pregnancy accurately, and screening for Down's syndrome.
But routine screening for gestational diabetes - a form that develops in pregnancy - should be abandoned. He said the test was unreliable, doctors did not know how to treat it and anxiety in the minds of the woman and her carers could be raised, increasing the risk of the pregnancy ending in a Caesarean section.
Mary Newburn, head of policy research at the National Childbirth Trust, warned that the guidance was based on what was clinically necessary in pregnancy but it ignored women's need for emotional support. She said: 'We should be more imaginative about how we meet the needs of women.'
Women could be granted more time to talk to their midwife or doctor. Dr Brocklehurst said: 'This should open the door for longer consultations, particularly in early pregnancy.'
There were unlikely to be cost savings from the cut in antenatal appointments, or the ending of tests for gestational diabetes, because the guidance also called for an increase in other screening tests and more ultrasound scans.
ANTENATAL CHECKS FOR FIRST-TIME MOTHERS
At eight to 12 weeks: Ultrasound scan, discuss screening tests, offer folic acid, help to stop smoking. Measure blood pressure, weight and test urine.
16 weeks: Discuss and record results of screening tests. Measure blood pressure and test urine.
25 weeks: Check size of abdomen, blood pressure and urine.*
28 weeks: More tests. Take anti-D treatment if rhesus negative blood group. Check abdomen, blood pressure and urine.
31 weeks: Check abdomen, blood pressure and urine.*
34 weeks: Second anti-D treatment. Measure abdomen, blood pressure and urine.
36 weeks: Check position of baby is head first. Measure abdomen, blood pressure and urine.
38 weeks: Measure abdomen, blood pressure and urine.
40 weeks: Measure abdomen, blood pressure and urine.*
*Starred checks can be omitted for mothers who have already had a baby.
Source: medicalnewstoday.com
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