We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. When you install the update, you will see that each toolkit has a small QR code icon the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.
You may need to actively install the update to install RDS app version 4.7.1 to see this improvement. Installing this update is also strongly recommended to get the full benefits of the new contingency arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits.
To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. To install latest updates:
On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.
On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.
Please get in touch with ann.wales3@nhs.scot with any questions.
The GGC Maternity services are committed to providing safe, effective and efficient, person centred care for all accessing the service, in keeping with Quality Everyone Everywhere NHSGGC’s Quality Strategy 2024-2029.
The purpose of this document is to provide a framework to support the planning of person centred, individualised care for women who are considering antenatal, intrapartum and/or postnatal care choices that are outwith NHSGGC recommended guidance, but is applicable to all women accessing maternity care.
This guide is informed by
There should be consideration of whether there are safeguarding concerns for every woman accessing NHSGGC Maternity services. Declining care does not, in itself, warrant any referrals to Blossom Team, Maternity and Neonatal Psychological Interventions (MNPI) Team or Public Protection.
However, it may be appropriate to exclude safeguarding concerns. These can be discussed with the Blossom Team and the Public Protection Team, and referrals made if indicated. Blossom Team referral criteria
All women should be able to access and discuss current reliable evidence based information with their midwife and obstetrician. Midwives should signpost women to reliable sources of information including:
Staff should ensure that they access reliable sources of information to support them in providing care to women asking for care outside guidance, including:
To support a woman requesting care or making choices outwith recommended GGC guidance, maternity staff should work in partnership with the woman to develop an individualised plan of care and to provide assurance through documentation of the discussions that choices and decisions are informed.
Building a trusting relationship is a key element of supporting women who are choosing care outside guidance and contributes to minimising risk. Advocating for a woman’s informed choices is an essential element of building a trusting relationship. Continuity of carer should be maximised for all appointments. If there are difficulties in continuing this development of a trusting relationship, women should be advised that they are able to request a different primary midwife.
Aspects of care may include:
It should be recognised that discussions to explore birth options and to develop an individualised plan of care require adequate time. Facilitating these conversations from early in pregnancy is best practice for all women, but particularly so for women considering choices outwith NHSGGC recommended guidance. Consideration should be given to additional or double appointments. Documentation of consultations and co-produced care plans should be shared to BadgerNet to allow visibility to all involved in the woman’s care, including the woman.
Birth choice discussions are the within the remit and responsibility of the primary midwife as part of the universal midwifery care pathway. Where the GGC recommended plan of care includes the wider maternity multidisciplinary team, that collaborative discussion should involve escalation or referral to the appropriate professional.
It is important that the primary midwife is confident to discuss the evidence around the particular choice being made. This should include sharing robust, clear evidence about potential risks and benefits of different choices in a format that is comprehensible for the woman and her family. The primary midwife should seek any support needed in accessing this evidence from their senior charge midwife, the service librarian for literature searches and obstetric and other specialist colleagues.
Common examples of requests for care out with recommended GGC guidance
These are examples, not a comprehensive list.
Midwives are encouraged to seek support from a senior/experienced midwife, usually the relevant Senior Charge Midwife, for case review/supervision. With a woman's agreement a group meeting with both the primary and senior charge midwife can be facilitated.
If a woman has already been counselled, and this is clearly and comprehensively documented, respect and honour her choices.
Women may choose to decline some aspects of maternity care offered to them, such as consultant obstetrician appointments, or choose not to engage with maternity services. In this situation the Lead Midwife for Community and Outpatients (Glasgow) or the Lead Midwife (Clyde) should be informed.
In the absence of safeguarding concerns, the next step is to communicate to the woman, both verbally and in writing, that maternity care remains accessible, and can recommence at any time during the antenatal, intrapartum or postnatal period. Advice should be shared around birth notification, the legality around acting as a midwife, and safety/what to do in an emergency (see appendix for suggested draft letter).
Supporting women who choose to make choices out with NHSGGC guidance may be emotionally and professionally challenging for maternity staff. Staff have access to:
Woman expresses desire to choose care outside NHSGGC guidance
Conversation facilitated by Primary midwife to discuss any concerns associated with choices, using evidence based information.
Care should be taken to ensure an unbiased approach is taken.
Documentation of conversation, including detail of topics discussed, with an outcome or plan included
[Management Plan, with use of critical alerts for appropriate dissemination of pertinent information]
Liaise with the MDT and action referrals if criteria are met.
Consider MNPI, Blossom Team, Public Protection helpline, named obstetrician.
Update/escalate to Senior Charge Midwife for support and case review/supervision
