Women with pre-existing medical and obstetric problems are at increased risk of complications in pregnancy. Such high-risk pregnancies result in increased maternal, fetal and neonatal morbidity and mortality. In 2008, the National Institute for Health and Clinical Excellence (NICE) issued guidelines for routine antenatal care of healthy pregnant women. Common medical conditions that confer a higher risk to the pregnancy but are often unrecognised at referral are obesity and mental health disorders. Integrated care pathways can be used as tools to incorporate local and national guidelines into everyday practice, manage clinical risk and meet the requirements of clinical governance. Training programmes for midwives, obstetricians, GPs and psychiatrists should include perinatal psychiatric disorders. The needs of the local population must be taken into account when planning a service in terms of providing the correct care, particularly in areas where there are large numbers of women from migrant and ethnic minority populations.

This chapter is based mainly on Pregnancy Loss and the Death of a Baby: Guidelines for Professionals. Women want to be cared for by skilled staff who show empathy and support for them and their partner, and who give them privacy and time. Several publications are available that provide guidance and set standards for the care of women and families experiencing pregnancy loss. Clear pathways between secondary care and the primary care team are essential to ensure that bereaved parents receive good care at all times. Staffing levels should ensure that parents receive continuity of carers. Carers must have training to enable them to support grieving parents, and must themselves be well supported. The bereavement service as a whole should be audited regularly to ensure that it provides comprehensive, culturally sensitive management and support for families who have experienced an early or mid-pregnancy loss, stillbirth or neonatal death.

This chapter provides guidance for clinicians, midwives, managers and commissioners as to the main aims and principles of postnatal care and how these should be delivered. Several national guidelines on postnatal care can be considered under: planning the content and delivery of care, maternal health, infant feeding and maintaining infant health. Coordinating services in the postnatal period is made more difficult by the transfer of care between health professionals and clinical settings. It is essential that staff involved have the necessary training and are competency tested in certain issues pertaining to the postnatal period. The postnatal environment should promote a healthy parent-infant relation ship and should support the wider family. Various neonatal screening tests are carried out in the postnatal period: newborn hearing tests, blood spot tests and newborn physical examination for developmental dislocation of the hip, congenital heart disease.

This chapter describes the level of service required from anaesthesia departments providing services for obstetric units. In addition to clinical duties, consultant anaesthetists are involved in teaching, training, administration, research and audit. The Obstetric Anaesthetists' Association (OAA) and the Association of Anaesthetists of Great Britain and Ireland (AAGBI) jointly published Guidelines for Obstetric Anaesthesia Services. These guidelines aim at developing national standards for maternity care. A clear line of communication from the duty anaesthetist to the on-call consultant should be assured at all times. All obstetric departments should provide and regularly update clinical protocols, which should be readily accessible. Obstetric units with an anaesthesia service should have a nominated consultant responsible for training in obstetric anaesthesia and there should be induction programmes for all new members of staff, including locums. There should be an audit programme in place to audit anaesthetic complication rates, such as accidental dural puncture.