The booking visit
Traditionally, the booking visit took place around 12 weeks. From a dietary and minor disorder of pregnancy point of view, contact with the midwife could be much earlier in the fi rst trimester in order to offer support, care and advice. The National Service Framework (NSF) (DH 2004) standard 11 for maternity services suggests that the midwife should be the fi rst port of call for the woman when she fi nds out she is pregnant. In future, women may well see their midwife earlier than the traditional 12 weeks as government propos- als stipulate that the midwife, rather than the GP, should be the fi rst contact a woman has when pregnant.
Case Notes
I was really looking forward to my booking appointment with my midwife. I was 12 weeks pregnant and had fi nally started to tell all my friends and family. I hate hospitals as my mum died last year and view them as places for ill people and death. My partner and I had read about and researched the area of homebirth and had decided that if all remained well in my pregnancy, I would have liked to give birth at home. I was excited about discussing this with the midwife and had practical ques- tions I wanted to ask her. When I brought this up at my booking appoint- ment, the midwife told me that having a homebirth was out of the question for my fi rst baby. I said that I had done my research and that this was my choice but the midwife was adamant that nobody would support me. I walked out of that appointment feeling disappointed, angry and let down.
Taking a comprehensive history from a woman relies on the midwife having excellent communication skills in order to elicit important information as well as gain the woman’s trust. For many, especially fi rst-time mothers, this will be the only time that a woman/
couple have met a midwife so this visit is an opportunity to explain the role. The booking visit will paint an overall picture of the woman’s physical, psychological and social needs. The woman can refer directly to the midwife and does not need to book in with her GP. National Institute for Health and Clinical Excellence (NICE) antenatal guidelines have endorsed the view that women should have access to antenatal services between 8 and 10 weeks of preg- nancy in order to plan care in partnership with the midwife as well as for early consideration of screening options (NICE 2003).
McCourt (2006) undertook a qualitative study examining the ante- natal booking interview and interactions between midwives and women using two models of care. It was found that case loading midwives who look after a group of women, giving continuity of care and being on call for their births, were less hierarchical, offered more choice and information than midwives who were delivering a more conventional model of care, such as having different midwives for different stages of pregnancy and birth. Table 2.1 provides a checklist for the booking visit.
Table 2.1 Booking visit: checklist prompt for midwives
• Be attentive
• Personal details (next of kin, phone numbers)
• Menstrual history, including last menstrual period or date of egg insertion if in vitro fertilisation pregnancy
• Medical history, including any psychiatric illnesses
• Family history
• Known allergies
• Lifestyle, including body mass index, smoking, alcohol and social drug use
• Previous birth history
• Her own mother’s birth history
• Physical examination
• Emotional issues, such as relationship diffi culties or previous pregnancy losses
• Diet and nutrition, including any eating disorders
Midwifery wisdom
Carry a notebook for prompts to help when you start booking women, ensuring that nothing is written that may breach confi dentiality
Opening questions
The opening questions in the booking visit may be related to this pregnancy. Asking the open question ‘How are you feeling?’ can elicit a variety of responses and information such as whether the
woman is experiencing nausea and vomiting, and if appropriate, information about her employment history and if this pregnancy has been planned. It is important to gain information and document it carefully, but not in such a way that a woman/couple feel that this is a box-ticking exercise. The important things to ask are:
• Has she has had any vaginal bleeding?
• Has she suffered from nausea and vomiting?
• Has she had any recent contact with rubella or any other infec- tious diseases?
• Does she suffer from varicose veins?
• Does she use any ‘social’ drugs?
• Is she a smoker or a recent smoker – if yes, what type of tobacco and how much?
• What is her weekly alcohol intake?
• How is her home life with regards to relationships and support?
• How is her work life and does her job impact on her preg- nancy?
• Does she have any religious and spiritual beliefs?
• Does she have any specifi c cultural issues and needs?
• Does she have any pets or live on a farm? If yes, advise on hygiene and avoidance of certain animals such as sheep in lambing season due to the risk of disease.
You may fi nd that as the conversation progresses you gain more information that you can use to plan the woman’s care and use in your documentation. Try to build on what she is telling you and listen carefully as this will help in your questioning as the consulta- tion continues. McCourt (2006) found that midwives had different styles of questioning during the booking visit. Some were authorita- tive; others were professional (information-giving) and yet other had a partnership style (offering choice). Midwives who had the partnership style demonstrated most empathy as well as employing a technique of open questioning.
Frye (1998) suggests that midwives observe the woman carefully throughout history-taking as well as using senses such as the sense of smell (for example, does she smell of alcohol or tobacco?), which may give clues as to her lifestyle. The woman should be observed to see if there any scars or bruises and if she displays antagonistic behaviour, in order to try to gain some insight as to why this may be. It is useful to explore diet when discussing body mass index.
James (2002) notes that eating disorders are within the spectrum of psychiatric disorders. If there is evidence of this, the woman may or may not need a team approach to care, perhaps including a dietician
or psychologist experienced in eating disorders. By providing edu- cation on nutrition in pregnancy the midwife may be a useful resource as well as reinforcing positive eating behaviours.
If the woman works, employment issues can be discussed and the woman may want to know her rights with regard to employment or self-employment. It is important that midwives give up to date and accurate information. Table 2.2 provides some hints and tips concerning effective communication.
Midwifery wisdom
Remember, choice is personal. We all have different preferences, and empathy starts with being non-judgemental.