ANSC February Update: RPA Women and Babies/Canterbury Hospital

ANSC GP Program feedback? 

To ensure ongoing program quality improvement, we would like to know your thoughts and/or feedback regarding the ANSC program. Please take the time to complete this brief program survey. To complete the survey click here.

Important reminder: Group B Streptococcus (GBS) screen at 35 week GP visit  (patient self-collection)  
   
Women should have their GBS screen collected at their 35-37 week GP visit as per GP ANSC Protocol. This needs to be collected prior to hospital review at 37 weeks. A number of women attending their 37 week hospital visit have not had their GBS screen collected at their scheduled GP ANSC visit causing delay in their care.

The GBS screen can be attended as a patient self- collection. The collection procedure is outlined as per instruction diagram. You may like to print this diagram to have available for your practice. On request specify “GBS screening”. Selective enriched media is used to improve sensitivity.

Identifying women who are at risk of having a baby with GBS enables treatment to be given during labour to prevent transmission of infection to the baby. Discussion about GBS should take place at around 35 weeks gestation so that women have received information about preventive treatment before they go into labour.  
 
Clinical risk factors for early onset GBS sepsis (EOGBS) are: 

  •  Spontaneous onset of labour at ≤ 37 weeks gestation
  •  Rupture of membrane ≥ 18 hours
  •  Maternal fever ³ 38°C
  •  A previous infant with EOGBS
  •  GBS bacteruria during the current pregnancy
  •  Known carriage of GBS in current pregnancy
  •  Clinical diagnosis of chorioamnionitis 
  •  Other twin with current EOGBS 

Accessing GP ANSC Resources 

As an ANSC GP it is essential that you are utilising the most current ANSC resources. A number of GPs are viewing out-dated protocols, unfamiliar with referral forms etc.

The CESPHN website and HealthPathways Sydney provides a comprehensive collection of resources for GPs participating in the GP ANSC Program with RPA Woman and Babies and Canterbury Hospital. 

Please ensure that you download and view the following current resources: 

  1. GP ANSC Resource Manual v 8.0  
    (On opening PDF, Click Bookmark icon on top bar (right side) to view contents page and navigate through manual)    

  2. ANSC GP Protocol Summary:   

RPA Women and Babies / Canterbury Hospital Antenatal Clinic 

RPA Women and Babies Birth Centre  

  1. Hospital referral process including Hospital Referral Forms: Some are available as templates for MD and BP. Ask your practice staff to download into your clinical software. 

ANSC educational requirements – final year of triennium 

A reminder that 2019 is the final year of the current RACGP triennium and therefore the final year for ANSC GPs to fulfill their on-going educational requirements. 

GPs undertaking antenatal shared care are expected to maintain Recognition as an ANSC GP provider and be familiar with ANSC guidelines and protocols. This requires each ANSC GP to accrue at least 12 Category 2 points in antenatal or postnatal specific education over each RACGP triennium.

ANSC GPs that do not fulfill these educational requirements will no longer be able to participate in the ANSC Program with RPA Women and Babies and Canterbury Hospitals. 

CSPHN will be holding regular pregnancy-related educational events for 2019 ( calendar will be available shortly) and have listed a number of online educational activities available to all GPs. CESPHN educational activities are posted on the CESPHN website and included in the Sydney Health Weekly. Please contact the Lauren Thomas Maternal Health CPD Program Officer to clarify your CPD point status and to forward copies of completion certificates or RACGP CPD credit statement. 

What options are available for antenatal care at RPA Women and Babies and Canterbury Hospitals? 

Women may be unaware of the different models of antenatal care available at both RPA Women and Babies and Canterbury Hospital. Below is a brief outline of the various models. 

GP Antenatal Shared Care (ANSC)

This program enables a woman to be cared for by a general practitioner (GP) during her pregnancy. This GP will have gained specific training and recognition to provide shared care with the hospital clinics. 
 
GP ANSC provides regular and professional care throughout a pregnancy up until the time of baby birth and ongoing after the woman and baby leave hospital. Shared Care may be with the hospital Midwife Antenatal Care Clinic or Birth Centre (RPA only). 

Midwife Antenatal Care Clinic (MAC) RPA or Canterbury

A midwife provides care, education and advice during the woman’s pregnancy. The clinic aims to provide continuity of antenatal care by endeavouring to schedule appointments with the same midwife at each visit. The woman will only see a doctor if the midwives requires the woman to have a medical review. The delivery suite midwives will care for the woman in labour and childbirth.  

Birth Centre - RPA only

A team of midwives provides care education and advice during the woman’s pregnancy. It is an option of care for low risk women who want minimal intervention with their labour and birth. The Birth Centre staff will also care for the woman in labour, birth and the immediate postnatal period. Ph. 9515 6405 

Midwifery Group Practice (MGP) RPA or Canterbury

A team of midwives, each providing pregnancy, birthing, and early parenting support for a specified number of women per year. The nominated midwife acts in partnership with the women under her care to achieve a safe and rewarding pregnancy, birth, and early parenting experience. The nominated midwife will provide all antenatal clinic visits as well as care for her during labour. 
 
For women having MGP care at Canterbury Hospital, if risk factors develop during the pregnancy, their care will be collaborative between the high risk clinics and the MGP midwife. The woman may give birth at RPA. MGP RPA  ph 9515 8894 or Canterbury ph. 0467 721 622 

High Risk and Specialist Clinics

An obstetric team (obstetricians, obstetric registrar, and experienced midwives) provide care, education and advice for women with a complicated pregnancy. 
 
All high risk referrals should be referred to the antenatal clinic for triage. The hospital will determine the timing and clinic allocation. Referrals need to be faxed to relevant hospital: RPA Women and Babies: RPA Obstetric Referral Form – Fax 9515 3454. Canterbury Hospital : Canterbury Hospital Obstetric Referral Form – Fax 9787 0431  

Women with a high risk pregnancy will remain with the High Risk Clinic or Specialist Clinic. Other specialised clinics may also be involved in care. Women with medium risk are given a management plan and return to their general practitioner or midwife for shared antenatal care.

Depending on the risk, women will give birth at RPA Women and Babies or Canterbury Hospital. 

Aboriginal Liaison Midwife

Designated midwife who assists in providing care for Aboriginal and Torres Strait Islander women, or women who are pregnant with an Aboriginal or Torres Strait Islander baby. Care may also be shared with general practitioners or the Aboriginal Medical Service at Redfern. Referral to Clinics and other obstetric care is arranged as needed. Midwives provide care during pregnancy, labour, birth, and the postnatal period while in hospital. Ph. 9515 6586. 

Midwifery Discharge Support Program (MDSP)

Option available for women who have had a normal pregnancy and an uncomplicated vaginal or caesarean birth, have good supports and are coping well and wish to go home early.

The midwife will visit daily to check both mother and baby and to support establishment of infant feeding.


Private Care 
 
A number of private Obstetricians provide antenatal care at both RP Women and Babies and Canterbury Hospitals. Contact details can be found in the ANSC GP Resource Manual.  

  • All women, regardless of age, are eligible for the combined first trimester screening (cFTS) at RPA Women and Babies 
  • Women planning delivery at Canterbury Hospital are also eligible to attend RPA Women and Babies for combined first trimester screening (cTS), if prepared to travel. This service is provided at no cost to the patient.

For referral: 

  • Complete RPAH Ultrasound Referral Form (yellow or white form). 
  • Complete specific First Trimester Blood Collection form. Women can have their blood collected from 11 weeks up until 3 days prior to their ultrasound appointment. This should be collected at either RPAH or Canterbury Hospital Pathology Department (no external providers). This is to ensure results will be available at time of U/S appointment. This pathology form is also available as BP and MD templates
  • Provide Patient Information Sheet which outlines screening test procedure.
  • Provide relevant Patient Information Brochures cFTSNIPTCVS & Amniocentesis
  • Contact Fetal Medicine Unit on 9515 6042 for appointment. Women are advised to contact the service as soon as possible as appointments fill very quickly.
  • For urgent requests, please contact Clare Jordan, GP liaison midwife on 0425 230 662.