Introduction

These Guidelines provide evidence-based recommendations to support high quality, safe pregnancy care and contribute to improved outcomes for all mothers and babies. The lengthy process of reviewing the evidence on the numerous aspects of antenatal care necessitated completion of the project in three stages, all of which are included in this document.

Australian Clinical Practice Guidelines on Antenatal Care were released in two stages in 2012 (Module I) Australian Health Ministers’ Advisory Council 2012 and 2014 (Module II) Australian Health Ministers’ Advisory Council 2014. The Modules were developed in collaboration with State and Territory governments and sponsored by the Maternity Services Inter-Jurisdictional Committee (MSIJC), a subcommittee of the Community Care Population Health Principal Committee (CCPHPC) of the Australian Health Ministers’ Advisory Council (AHMAC). In 2015–16, the MSIJC received funds through AHMAC to review certain topics in the Guidelines. The Australian Government Department of Health managed the review of the Guidelines on behalf of MSIJC and took responsibility for the project following the conclusion of MSIJC on 30 June 2016.

The development of this document has followed the key principles and processes outlined in Procedures and Requirements for Meeting the 2011 NHMRC Standard for Clinical Practice Guidelines NHMRC 2011. This involved convening a multidisciplinary committee, the membership of which included a range of health professionals with expertise in providing, developing and researching antenatal care, a consumer representative with experience of antenatal care and a methodology expert. Input was also sought from a Working Group for Aboriginal and Torres Strait Islander Women’s Antenatal Care and a Working Group for Migrant and Refugee Women’s Antenatal Care. The content of the Guidelines was developed by these groups and was not influenced by the funding body.

More detail on the guideline development process is included in the Administrative Report, published separately.

Application of the Guidelines

Objective of the Guidelines

The Guidelines aim to improve the health and experience of antenatal care of pregnant women and their babies by promoting consistency of care. They provide a summary of the current evidence on aspects of care. It is expected that implementation of these Guidelines will improve maternal and fetal outcomes in the short and longer terms.

Terminology used in the Guidelines

The Guidelines recognise that individuals have diverse gender identities. Terms such as pregnant person, childbearing people and parent can be used to avoid gendering birth, and those who give birth, as feminine. However, because women are also marginalised and oppressed in most places around the world, we have continued to use the terms woman, mother or maternity. When we use these words, it is not meant to exclude those who give birth and do not identify as female.

Scope

The Guidelines cover the antenatal care of healthy pregnant women (ie women who do not have identified pre-existing conditions and are not at higher risk of complications such as in multiple pregnancy). They are intended for use in all settings where antenatal care is provided, including primary care, obstetric and midwifery practice and public and private hospitals.

The Guidelines do not include:

• information on preconception or postnatal care
• advice on clinical management of women and babies when risks are identified through testing or clinical assessment (with the exception of syphilis, where a recommendation on treatment is included due to the current outbreak, deaths from congenital syphilis and rising prevalence nationally)
• discussion of specific topics where a practice is already established (eg testing of blood group) or where the topic was not considered a priority for inclusion in these Guidelines and advice is given by other organisations (eg vaginal discharge, backache).

Intended audience

The Guidelines are intended for all health professionals who contribute to antenatal care, including midwives, general practitioners (GPs), obstetricians, maternal and child health nurses, ^[7] Aboriginal and Torres Strait Islander Health Practitioners; Aboriginal and Torres Strait Islander Health Workers, multicultural health workers, practice nurses, allied health professionals and childbirth and parenting educators. The way in which different professionals use these Guidelines will vary depending on their knowledge, skills and role, as well as the setting in which care is provided.

These Guidelines will be of interest and relevance to pregnant women in Australia. In addition, it is expected that policy makers will be able to draw on the Guidelines in the development of policy and health services.

How to use the Guidelines

Part A of the Guidelines outlines the basics of providing woman-centred care and includes information on optimising antenatal care for specific groups of women: Aboriginal and Torres Strait Islander women, migrant and refugee women and women with serious mental health disorders, adolescent women and women in rural and remote settings.

Parts B to J of the Guidelines discuss lifestyle considerations, clinical assessments, social and emotional screening, maternal health testing, fetal chromosomal anomalies, common conditions during pregnancy and clinical assessments in late pregnancy. Within these parts, each chapter provides background information about the topic, discusses the available evidence and highlights points to include when discussing the topic with women. A practice summary is included for each topic. These provide information on when during pregnancy a topic is relevant and who may be involved in providing care and/or information.

The appendices include details on the membership of the working groups, terms of reference and topics under review.

Dissemination and review

A web-based approach has been taken to dissemination of the Guidelines. They are available in portable document format (PDF) from the Australian Government Department of Health website and accessible to health professionals and the broader community. The Guidelines are also listed on the NHMRC portal and accessible by searching the portal.

Due to the number of topics considered in the combined document, the EAC has prioritised topics for future reviews. Additional topics have also been identified for future consideration. It is anticipated that the online version of the Guidelines will be updated as revised or new chapters are developed and that most topics will be reviewed over the next 5 years.