Mother, Daughter and Childs Daughter

Women and Newborn Health Service

Services A – Z

 

King Edward Memorial Hospital

PHR Why Woman Held Records?

References

Evidence Supporting Woman Held Records

There is significant evidence that women carrying their pregnancy care documentation is successful in promoting communication and increased satisfaction for women and care providers.

"Women-held antenatal records are one means by which women can feel better informed, more involved in, and exercise control over, their maternity care."[1]

"Carrying one's records during pregnancy was associated with an increased likelihood of feeling in control during pregnancy" [2, 3]. "Further, women reported that a woman-held record made it easier for them to talk to their doctors and midwives" [2].

In 1997 a Randomised Controlled Trial conducted at the St George Hospital, Sydney [4] reported that:

  • Women in the intervention group were significantly more likely to report feeling 'in control' during pregnancy.
  • Women (without the record) were more likely to feel anxious and helpless and less likely to have information explained by their caregiver.
  • Women did not lose their records more often than the hospital.
  • Nor are women more anxious with the additional information.
  • Most midwives were in favour of moving to a 'woman-held' record system.
  • Midwives felt the woman-held record would assist education, a sense of personal responsibility and provide access to a wider range of information.
  • 76% of midwives were positive about the woman-held record because it:
    • promotes responsibility
    • gives control back to the woman
    • provides greater access to information
    • women perceived to enjoy carrying their record
    • women perceived they were well cared for
  • Midwives generally felt there were benefits for women who carried their own antenatal records, that they were a good way to facilitate communication and the arrangement had benefits for the health care system.

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Other Woman Held Records in Australia

These documents have been introduced to a number of other hospitals in Australia and to the whole state of South Australia. Known document users are listed below and URL Links are provided where available:

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KEMH Inquiry Recommendations

A number of Recommendations from the report of the Inquiry into obstetric and gynaecological services at King Edward Memorial Hospital 1990 - 2004 were in the area of improved communication between health professionals, the woman and her family. In particular recommendation 5.20.56 is that a woman-held pregnancy record be introduced.

Number Recommendation
5.20.24 KEMH is to develop and implement guidelines to ensure that the standard of clinical care planning is improved. The guidelines are to include contingency planning and require statements of rationale for any unusual plan, or any change of plan.
5.20.25 All patients (except healthy women at low obstetric risk) are to have written care plans that have been approved by an experienced registrar or a consultant. Any changes to these care plans are to be approved by a consultant and the approval is to be documented.
5.20.35 Women are to be provided with written information concerning treatment options and, where possible, given sufficient time to review the information.
5.20.37 It needs to be recognised that when a woman withholds consent for an important and medically indicated treatment, this may represent a communication breakdown. The responsible consultant is to be informed and he or she is to review the circumstances with the woman and her family.
5.20.39 The Hospital is to take steps to enhance continuity of care for child-bearing women.
5.20.40

KEMH is to conduct regular workshops with medical, midwifery, nursing and allied health staff with particular emphasis on:

  • how to respond sensitively to women, including how to respond to their expression of subjective symptoms that do not match objective signs
  • how to involve women in decision-making
  • how to respond to women who have had poor outcomes
5.20.41 A woman is not to be discussed by clinicians in her presence or within her hearing without including the woman in the conversation.
5.20.48 KEMH is to develop and implement a policy to ensure that a woman and her family is included in clinical decision-making related to her or her baby. Changes to clinical status, along with options for care, are to be discussed with the woman.
5.20.50 KEMH is to improve its standard of documentation. Patient clinical files, in particular, are to be of sufficient quality and detail so that the documentation adequately informs other professionals taking over care of a woman and/or a baby.
5.20.52 The same standard of documentation and care planning is to be required from consultants as from other staff. This standard is to apply equally for public and private patients in KEMH.
5.20.53 KEMH is to develop and implement a standard organisational format for the patient clinical files used in the Hospital.
5.20.54 Integrated progress notes are to be used by clinicians and allied health professionals involved in the care of women and/or babies.
5.20.56 KEMH is to introduce a hand held (patient-held) antenatal record for public and private patients.

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References

  1. Homer C, E.L., Midwives' Attitudes to Shifting to 'Women-Held' Antenatal Records. 2000, New South Wales Health: Clinical Information Access Program (CIAP) website: Sydney.
  1. Elbourne D, R.M., Chalmers I, Waterhouse I, Holt E, The Newbury Maternity Care Study: a randomized controlled trial to assess a policy of women holding their own obstetric records. Br J Obstet Gynaecol, 1987. 94(7): p. 612-619.
  1. Lovell A, Z.L., James C, Foot S, Swan A, Reynolds A, The St Thomas's Maternity Case Notes study: a randomised controlled trial to assess the effects of giving expectant mothers their maternity case notes. Paedtr Perinat Epidemiol, 1987. 1(57-66).
  1. Homer C, D.G., Everitt L, The introduction of a woman-held record into a hospital antenatal clinic: The bring your own records study. Australian and New Zealand Journal of Obstetrics and Gynaecology, 1999. 39(1): p. 54-57.

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