Consultation & Referral Guidelines

Question 1

Describe what the referral and collaboration guidelines 2008 are

Answer 1

When a variance from the normal occurs or is identified in a pregnant woman by the midwife (occurring at booking in, antenatal, intrapartum and postnatal phases) it is recommended that utilizes the “discuss, consult and refer” tool to optimize woman and baby care and outcomes. The referral guideline may use discuss, consult or refer individually or a move across a spectrum i.e a situation may require a B + C escalation

Question 2

Explain the three-tiered approach

Give an example of each

Answer 2

A – Discuss: It is the midwife’s responsibility to initiate this phase when a variance from the normal occurs. Discussion with a colleague about the variance may occur with another midwife, medical doctor or other healthcare professional. Example: Symphysis pubis dysfunction – referral to physiotherapy

Question 3

Explain the three-tiered approach

Give an example of each

Answer 3

B – Consult: Consultation occurs when both the primary and secondary health care needs of the individual woman and her baby have been taken into consideration. An agreement will be made and clearly documented about the responsibility for maternity care. The woman will consent to consultation and will remain centre Does not mean an automatic transfer of care. Example: Anaemia (HB <90) at the commencement of care

Question 4

Explain the three-tiered approach

Give an example of each

Answer 4

C – Refer: Situation requiring medical care at a secondary or tertiary level for as long as the situation exists. The referral will be made in writing. Alteration in care will be made in writing to the midwife. Midwifery care may continue as appropriate. Example: Hepatitis B with positive serology (HBsAg+)

Question 5

Explain the three-tiered approach

Give an example of each

Answer 5

Combination examples include HSV

Intrapartum may include A = rupture of membrane B = Suspicious FHR C= prolapsed cord or presentation of cord PPH or IPH

Postnatal A/B/C – feeding problems or failure to thrive
A = failure to void or pass mec withing 24hrs
B = jaundice in the first 24hrs
C = Major congenital abnormality