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<pre>
 
 

Policy Classification: Public-I4-A2 

Policy No.: CD079 
 

 
 
 
 

SOUTH AUSTRALIAN 
GP OBSTETRIC SHARED 
CARE PROTOCOLS - 
CLINICAL DIRECTIVE 

 
 
 
 

A STATEWIDE MODEL 
 
 

 
April 2020 
 

 

 

 

 

 

 

Version No.: 4.2 

Approval date:   10/06/2020 

 
 
 
 
 
 
 

 
 



Page 2 of 35 

Policy Statement 

The South Australian GP Obstetric Shared Care Protocols - Clinical Directive 
will guide General Practitioners, Registered Midwives and health practitioners 
working within the South Australian public health system when caring for the 
woman who makes an informed choice to have her antenatal care provided 
within a shared care arrangement. 

 Shared Maternity Care represents an opportunity to practice collaborative 
holistic obstetric care by combining the varied skills of Midwife, General 
Practitioner and Obstetrician to the benefit of the community and mutual 
understanding between colleagues 1.  

Women wishing to attend a South Australian public hospital (in 
metropolitan Adelaide, and Gawler) for childbirth have the option of GP 
obstetric shared care if they meet the designated criteria. In this model, the 
General Practitioner (GP) provides most of the antenatal and postnatal care, 
while the public hospital staff provides the inpatient, intrapartum and some 
outpatient maternity care. 

It upholds the SA Health Strategic Plan 2017 - 2020 themes of Lead, Partner 
and Deliver through the use of evidence, translating research into practice and 
involving consumers in its development, ensuring safe and effective care for 
women planning shared antenatal care2. 

These protocols have been developed in accordance with contemporary 
professional standards of care and outline the minimum standards of clinical 
practice required by General Practitioners providing maternity services in South 
Australia. The SA Perinatal Practice Guidelines underpin the SA GP Obstetric 
Shared Care Protocols outlined within. 

Roles and Responsibility 

External Contract Provider 

SA Health has contracted GP Partners Australia as the co-ordinating body for 
the statewide GP OSC SA. GP Partners Australia is managing the statewide 
framework for the GP OSC SA. Contact details are listed below. 

GP Partners Australia manages the Statewide GP Obstetric Shared Care 
Program (GP OSC SA) in liaison with SA Health, within a governance 
framework that includes: 

? Clinical Governance Committee  

? GP Advisors 

? GP Obstetric Shared Care Program Manager 

? GP OSC Midwife Coordinators  

GP Partners Australia  
Postal | PO Box 7293 Hutt St Adelaide SA 5000   

Phone:    (08) 8112 1100 
Fax:        (08) 8227 2220 
Program Manager: 0418 803 844 
E-mail:  info@gppaustralia.org.au  
Website: www.gppaustralia.org.au 

A database of accredited GPs across South Australia is maintained by GP 
Partners Australia and is available to the GP OSC SA Midwife Coordinators 

Executive Officer 

The Executive Officer of the hospital providing access to the GP OSC SA must 
comply with the statutory obligations and guidance provided by the GP OSC 
SA Clinical Governance Committee. 




 
                                                                                                                                         Page 3 of 35 
 

 

Hospital Managers 

Hospital managers at units providing access to a GPOSC SA will ensure that 
health practitioners involved in the program: 

? have an understanding of the South Australian GP Obstetric Shared Care 
Protocols - Clinical Directive 

? recognises that the timely referral for support and assistance in the 
management of complex maternity care and psychosocial problems is 
entirely appropriate. 

? ensures the availability of a referral system that allows a the appointment 
of the pregnant woman who requires an antenatal appointment because 
her GPOSHC GP is on leave. 

General Practitioners 

A GP who is accredited for GP OSC SA can provide antenatal care in 
collaboration with the  booking  public hospital throughout the pregnancy in 
accordance with these protocols and the enclosed visit schedule. A shared 
care arrangement requires additional effort to be given to communication 
between all parties involved in the shared care arrangement, this should 
include the pregnant woman.  

The GP should ensure, the pregnant woman opting for GP OSC SA secures a 
reference number from the Pregnancy SA Referral Line (Ph: 1300 368 820) 
so she can be scheduled her first antenatal visit at  booking  public hospital. 

A GP who is accredited for GP OSC SA: 

? ensures the follow up of the pregnant woman they are managing who 
does not attend an antenatal appointment. 

? ensures the pregnant woman they are managing is referred to the 
 booking  hospital for any antenatal appointment that cannot be scheduled 
at his/her practice because of their leave 

? is aware that a pregnant woman who develops complications can be 
referred to the  booking  hospital for assessment at any time. 

It is essential that the GP accredited for GP OSC SA ensures that their current 
details are accurate and any changes are communicated to GP Partners 
Australia, www.gppaustralia.org.au/osc and are updated on the SA Health 
Provider Registry http://www.generalpracticesa.org.au/pages/hpry.html 

Registered Midwives 

The SA Health units providing access to the GP OSC SA will have a 
Registered Midwife work force (i.e. GP OSC SA Midwife Coordinator)allocated 
to support the GP OSC SA.  

The GP OSC SA Midwife Coordinator will facilitate and liaise with a range of 
health workers to support antenatal/postnatal activities for women and staff 
involved in the GP OSC SA, ensuring that relevant professional standards and 
appropriate documentation are maintained.   

The GP OSC SA Midwife Coordinator acts as an advocate, both for women 
and the GP involved in the GP OSHC SA and will assist with general maternal 
care information; this is not reliant upon the woman giving birth at a 
metropolitan hospital. 

  





 
                                                                                                                                         Page 4 of 35 
 

The following units support their antenatal clinics with a GP OSC SA Midwife 
Coordinator: 

? Women s and Children s Hospital 
? Flinders Medical Centre 

? Lyell McEwin Hospital 

? Modbury Hospital 

? Gawler Health Service 

The Registered Midwife involved in the GP OSC SA will support and guide the 
timely referral of the pregnant woman requiring more complex care to a 
 booking  hospital in accordance with the National Midwifery Guidelines for 
Consultation and Referral4. 

Contact details for the: 

 GP OSC SA MIDWIFE CO-ORDINATORS 

Women s and Children s Hospital 

72 King William Road NORTH ADELAIDE SA 5006 

Ph: (08) 8161 7000 pager 4259 

Fax: (08) 8161 8189 

Email: healthCYWHSSharedCare@sa.gov.au 

 

Lyell McEwin Hospital 

Haydown Road 

ELIZABETH VALE SA 5112 

PH: (08) 8182 9000 pager 6470 or 0417 840 062 (SMS only) 

Fax: (08) 8282 1612 

Email: Health.NALHNSharedcare@sa.gov.au 

Modbury Hospital  

Smart Road 

Modbury SA 5092 

PH: 81612593 

Fax: 81612227 

Email: NALHN.Sharedcare@sa.gov.au 

 

Flinders Medical Centre  

Flinders Drive BEDFORD PARK SA 5042 

Ph: (08) 8204 4650/ 8204 6894 

Fax: (08) 8204 5210 

Email: Health.FMCsharedcare@sa.gov.au  

 

Gawler Health Service  

21 Hutchinson Road  

GAWLER EAST SA 5118  

Ph: (08) 8521 2060 

Fax: (08) 8521 2069 

Email: Health: HEALTHCHSAGHSCommunityMidwives@sa.gov.au 

  








 
                                                                                                                                         Page 5 of 35 
 

Background 

The GP OSC SA was established in 2002 as a result of an initiative by SA 
Health, facilitated by the Healthy Start Clinical Reference Group (now known as 
the SA Maternity Neonatal Gynaecology Community of Practice - Clinical 
Reference Work Group). 

This document outlines the clinical protocols that support the GP OSC SA. 

These protocols have been developed in accordance with contemporary 
professional standards of care and outline the minimum standards of clinical 
practice required by General Practitioners providing maternity services in 
South Australia.  

The GP OSC SA protocols are updated every 5 years (or as required) and the 
clinical practices outlined in these protocols have been developed in 
accordance with the SA Perinatal Practice Guidelines (SA PPG), which 
provide perinatal care providers with evidence-based standards supporting 
clinical practice. The GP OSC SA Protocols are available on the website at:  
www.gppaustralia.org.au/osc and along with the SA PPGs on the SA Health 
website  www.sahealth.sa.gov.au/perinatal 

Policy Requirements 

An obstetric shared care arrangement should be recommended for all low risk 
women who have access to an accredited GP and a  booking  public hospital. 

Medical Indemnity 

In keeping with professional and community expectations, GP OSC SA 
providers should ensure they:  

? hold General or Specialist registration  without any conditions  under 
the Australian Health Practitioner Regulation Agency. 

? have and maintain current Medical Registration appropriate to their scope 
of practice.  

? prospectively ensure adequate medical indemnity cover for any 
consultations, procedures or related activities.  

? have a prospectively approved GP Obstetric Share Care Program 
accreditation with the program prior to commencement of his/her duties.  

? be responsible for the procedures he/she performs. 

? adhere to the GP Shared Care Protocols, the policies of the  booking  
hospital, SA Health Perinatal Practice Guidelines and the recognised 
referral system when managing  complex patient care.  

? ensure that he/she has a registered Provider Number for each location of 
employment5.  

Accreditation &amp; Continuing Professional Development (CPD) Requirements 

GP Partners Australia facilitates the management of the GP accreditation for 
the GP OSC SA.  

Initial Accreditation 

The GP undertaking obstetric shared care in South Australia m u s t  have 
maternity care training and experience or supervision and meet the 
accreditation requirements of the GP OSC Program SA. 

Approval for full accreditation within the GP OSC Program is subject to both: 

? Satisfactory obstetric experience, and 

? Completion of an Accreditation Seminar. 





 
                                                                                                                                         Page 6 of 35 
 

Provisional accreditation may be approved for a period of up to 12 months on 
the basis that the GP attends and fulfils the requirements for a Category 1 
Accreditation Seminar in that time. Provisional accreditation will usually be 
approved for GPs who have one of the following: 

? DRANZCOG with current recertification, or equivalent qualification; 

? Diploma Obstetrics RACOG, or CSCT in Women s Health, plus recent 
involvement in antenatal care provision; 

? GPs who can demonstrate recent significant obstetric experience such as 
having spent a minimum 3-month placement in obstetrics at a recognised 
teaching hospital.  

The GP who does not meet the GP OSC Program maternity care experience 
requirements may apply via GP Obstetric Shared Care Program Manager, to 
undertake a supervised obstetric clinical attachment at one of the public 
metropolitan maternity hospitals to secure this experience.  

Ongoing Accreditation 

The ongoing accreditation of the GP for the GP OSC SA Program is managed 
within a 3-year accreditation cycle, which is conducted in parallel with the 
Continuing Professional Development (CPD) triennium as defined by the 
RACGP and ACRRM. 

To maintain accreditation a GP must demonstrate over the 3 year period that 
they have engaged in CPD activities equivalent to a minimum of 12 CPD 
points specific to Obstetric Shared Care and must have attended at least one 
(1) Accreditation Seminar in the triennium.  

Assessment of CPD activities is a role undertaken by the GP Obstetric Shared 
Care Program Manager.  

The records management of CPD accreditation points will be managed by the 
GP Obstetric Shared Care Program Manager. 

CPD activities are strongly encouraged and could include: 

? GP OSC (SA) CPD events 

? RANZCOG Diplomats Days 

? DRANZCOG Revision course 

? Online CPD activities eg GP learning 

? Women s health activities and other events conducted by GP Networks 

? Other educational activities that can be demonstrated to be relevant to 
OSC ie part of a 40 point Active Learning Module 

The GP unable to meet any of the requirements should contact the GP 
Obstetric Shared Care Program Manager to discuss their options. 

Compliance - Accreditation 

The GP accredited to GPOSC SA program must ensure they remain current 
with maternity practice as per the SA Perinatal Practice Guidelines and the 
GPOSC SA protocols. 

The GP Obstetric Shared Care Program Manager facilitates the review of the 
accreditation status of the GP and supports the GP OSC SA accreditation 
process including their education/training. 

  

 

 



 
                                                                                                                                         Page 7 of 35 
 

Procedural Guidelines 

South Australian Pregnancy Record 

SA Health has endorsed the SA Pregnancy Record as the substantive record of 
a woman s pregnancy. The aim of the SA Pregnancy Record is to assist 
maintaining continuity of care, women s participation in the care and to promote 
early and appropriate use of antenatal services, particularly among 
disadvantaged groups. The SA Pregnancy Record must be used to 
document the care provided for all women involved in GP Obstetric 
Shared Care. 

The perinatal care provider must record at each visit all relevant antenatal 
information in the SA Pregnancy Record. Information must be sufficient to 
meet the provider s duty of care in diagnostic and treatment decisions. 

Information need not be duplicated, but clinicians may do so by choice. If 
duplication is required, it is recommended that the SA Pregnancy Record be 
photocopied. Pathology and ultrasound results are to be recorded in the SA 
Pregnancy Record. 

The SA Pregnancy Record should be given to the woman at her first 
antenatal visit after confirmation of pregnancy, with instruction to carry 
this with her to all appointments during her pregnancy, including those 
with other health professionals. The woman should be made aware that 
the SA Pregnancy Record is the ONLY complete medical record 
maintained for her antenatal care, and it is vital that it is used to 
record the care given to her at each visit. The woman should also be 
aware that the SA Pregnancy Record will become part of the hospital s 
medical records after the birth of her child. 

As the substantive record, the SA Pregnancy Record will be filed in the 
woman s medical record at the hospital where the birth occurs. The SA 
Pregnancy Record is not to be destroyed under any circumstances. 

The guidelines for their use can be accessed via: SA Pregnancy Record 
Guidelines 3.  

Relative Contraindications to GP Shared Care 

Although GP Obstetric shared care can be provided for most pregnant women, 
the GP should seek advice from the GP OSC Midwife Coordinator or an 
Obstetric Registrar / Consultant at the  booking  hospital to clarify the 
appropriate level of care for the mother or fetus. Relevant recognised risk 
factors may include, but are not restricted to: 

 Medical History 

? endocrine disease  

? cardiac disease 

? renal disease 

? hypertension, for example diastolic pressure 90-100 mm/Hg 

? respiratory disease 

? neurological disease including epilepsy on medication 

? thrombo-embolic disorders or antiphospholipid syndrome 

? illicit drug use 

? haematological disorders including haemoglobinopathy, thrombocytopenia, 
significant anaemia &lt; Hb110g/L &amp; MCV &lt; 80fl 

? significant mental health issues requiring medication  

? gastro-intestinal disease 

 





 
                                                                                                                                         Page 8 of 35 
 

 

? Obesity   BMI &gt; 40   44 kg/m  (requires consultant from Specialist 
Anesthetist and Obstetrician) 

? obesity   BMI &gt; 45 kg/m  (requires transfer of care to Obstetrician) 

From Obstetric History 

? severe pre-eclampsia 

? perinatal death 

? placental abruption 

? preterm birth at less than 34 weeks 

? fetal intrauterine growth restriction or small-for-gestational age 

? recurrent pregnancy loss 

? suspected cervical incompetence 

From Early Pregnancy Assessment 

? Rh or other blood group antibodies 

? multiple pregnancy 

? haemoglobinopathy 

Arising During Pregnancy (any of the above conditions and/or) 

? antepartum haemorrhage 

? fetal abnormality 

? extreme psychological issues / illness 

? hyperemesis gravidarum 

? hypertension and/or pre-eclampsia 

? suspected intra-uterine growth restriction 

? recurrent urinary tract infection 

? gestational diabetes requiring medication  

? deep vein thrombosis or embolism 

? abnormal placentation (including placenta praevia) 

? non-cephalic presentation after 36 weeks 

? gestational hypertension or pre-eclampsia 

? threatened preterm labour 

? cholestasis of pregnancy 

? pre-term rupture of membranes 

Booking the GP OSC SA Woman at the  Booking  Hospital 

The GP should ensure the GP OSC SA woman is referred to a  booking  

hospital as soon as possible to ensure her 1st antenatal visit is scheduled 

before 20 weeks gestation and preferably in the 1st trimester. 

SA Health has established a statewide antenatal telephone booking service 
(Pregnancy SA Referral Line) for women wishing to birth in a public hospital in 
metropolitan Adelaide (including Gawler, Mt Barker and South Coast District 
Hospitals), the pregnant woman opting for GP OSC SA is required to secure 
a reference number from the Pregnancy SA Referral Line before she can be 
scheduled her first antenatal visit. This coordinated approach aims to optimize 
the opportunity for women to birth as close to their home as possible. 

Women wishing to birth in a country maternity unit other than the Gawler, Mt 
Barker and South Coast District Hospitals should be directed to book at the 
local birthing hospital closest to where they live. 

The Pregnancy SA Referral telephone number is: 1300 368 820. The 
service is available 9am- 4pm Monday to Friday (excluding public holidays). 



 
                                                                                                                                         Page 9 of 35 
 

Obstetric Shared Care Antenatal Visit Schedule 

The GP OSC SA antenatal schedule of visits aligns with the SA Pregnancy 
Record; www.sahealth.sa.gov.au/pregnancyrecord 

Documentation 

The GP managing the woman in an obstetric shared care arrangement should 
commence documentation in the SA Pregnancy Record at the woman s 
first antenatal visit.  www.sahealth.sa.gov.au/pregnancyrecord 

First Appointment 

At the first appointment, the GP should: 

? ensure the pregnant woman opting for GP OSC SA secures a reference 
number from the Pregnancy SA Referral Line (Ph: 1300 368 820) so she 
can be scheduled for her first antenatal visit at the  booking  hospital  

? complete the  SA Pathology Family of Origin Questionnaire    for the 
Antenatal thalassaemia/haemoglobinopathy screening programme (form 
number: PUB-0588   order from SA Pathology). See Anaemia in 
Pregnancy PPG available at www.sahealth.sa.gov.au/perinatal.  

? request all required blood tests with a copy of results to be forwarded to 
the antenatal clinic at the  booking  hospital  

? explain the obstetric shared care protocols to the woman, including the 
timing and nature of the antenatal visits shared between the  booking  
hospital and GP  

? spend time early in the pregnancy discussing breastfeeding with the 
woman (see Breastfeeding PPG available at (www.sahealth.sa.gov/perinatal)  

The following areas must be addressed in the early antenatal appointments. 

History 

The GP should record the woman s personal details and medical and obstetric 
history in her SA Pregnancy Record. 

Family History of Genetic Condition 

An increasing number of genetic conditions can be screened for and/or 
diagnosed. If the woman has a relevant history, the GP should contact the 
Obstetric Registrar / Consultant at the  booking  hospital for advice before 
any testing. 

Examination 

A general examination must be performed in alignment with the South 
Australian Pregnancy Record. Blood pressure should be assessed (measured 
on the right arm with the woman seated, with appropriate size cuff (see 
Hypertension in Pregnancy PPG available at www.sahealth.sa.gov/perinatal). 
Weight (kg), height (cm) and BMI must be measured and calculated at the first 
visit with the woman s weight and BMI recorded each visit.  

The GP should refer to the SA Health Perinatal Practice Guidelines and Clinical 
Directives for advice regarding transfer of care; www.sahealth.sa.gov/perinatal   






 
                                                                                                                                         Page 10 of 35 
 

Subsequent Antenatal Appointments 

Routine Assessment 

All designated sections in the SA Pregnancy Record must be completed and 
documented at each antenatal visit, including the following: 

? gestation in completed weeks 

? symphysio-fundal  height  in  centimetres,  chart  in  SA  Pregnancy Record 

? blood pressure (measured on the right arm with the woman seated, with 
appropriate size at cessation of Korotkoff IV) 

? presentation and descent (fifths of fetal head palpable) after 30 weeks 
gestation 

? fetal heart and fetal movements 

? laboratory test results 

? smoking assessment 

? use of illicit drugs 

 Additional Assessment 

The GP should assess the need for additional targeted screening for pregnant 
woman such as: 

? Vitamin D level for women with identified risk factors (see Vitamin D Status in 
Pregnancy PPG available at www.sahealth.sa.gov.au/perinatal)  

? Cytomegalovirus for women who have frequent contact with large numbers of 
very young children 

? Chlamydia testing for all women &lt; 25 years and women with risk factors if aged 
25-29 years i.e having multiple sex partners, history of sexually transmitted 
infection). 

? Human papilloma virus for women who have never had a cervical screening 
test or have not had one within the last 5 years or with a low-grade abnormality 
without a follow-up cervical screening test 12 months afterwards 

? Trichomoniasis for women who have symptoms (genital itching, burning, 
redness or soreness, discomfort with urination, change in vaginal discharge) 

? Gonorrhoea for women with identified risk factors 

? Tuberculin skin test (TST) for women with a history of recent tuberculosis 
contact (e.g. Household) or are HIV positive (see Tuberculosis in pregnancy 
PPG available at www.sahealth.sa.gov.au/perinatal)  

? Thyroid function testing for women who have symptoms or high risk of thyroid 
dysfunction (see Thyroid Disorders in Pregnancy PPG available at 
www.sahealth.sa.gov.au/perinatal)  

AN Screening and Testing and Managing Abnormal Results 

Any investigations / tests / screening requested by the GP for the pregnant 
woman under his/her care must be followed up by the GP concerned. It is the 
GP s responsibility to follow up all abnormal results irrespective of whether a 
copy of the results has been sent to the  booking  hospital. 

If there are abnormal findings in any antenatal testing / screening, it is 
recommended that the GP should seek obstetric advice from and/or refer the 
woman to the  booking  hospital. 

 

 

 

 






 
                                                                                                                                         Page 11 of 35 
 

The GP ordering and requesting antenatal tests must: 

? comply with the antenatal screening and testing as outlined in the SA 
Pregnancy Record www.sahealth.sa.gov.au/pregnancyrecord 

? ensure that copies of the woman s results are available at the  booking  
hospital at the time of her first antenatal visit.  

? ensure they follow up all antenatal tests requested and that there is no 
expectation that these results will be followed up and acted upon by the 
 booking  hospital. 

Complete Blood Picture 

When a pregnant woman presents with a haemoglobin ?110 g/L in the first 
trimester and ? 105 g/L in the second and third trimesters, or particularly if red 
cell abnormalities are present, iron studies folate and B12 studies are 
recommended as follow up for the woman. 

The GP should also consider testing for thalassaemia (haemoglobin 
electrophoresis) where appropriate. Low white cell or platelet counts should 
prompt discussion with, and/or referral to the  booking  hospital. 
www.sahealth.sa.gov.au/perinatal. -Anaemia in pregnancy 

Blood Group and Antibody Screen 

When a pregnant woman presents with a positive test for red cell antibodies the 
GP should immediately refer the woman for consultant obstetric advice at 
 booking hospital .  

Rubella Titre 

In the instance that the pregnant woman shows a "non immune" level in a 
Rubella Titre, the GP should discuss with the woman the need for the 
measles, mumps, rubella (MMR) immunisation in the postnatal period. Under 
no circumstances should the MMR immunisation be given in 
pregnancy. The pregnant woman should be advised to avoid contact with 
rubella. 

Syphilis Serology 

The GP should request routine screening for Syphilis at the 1st antenatal visit. 

The GP should offer additional Syphilis screening for all Aboriginal women 
residing in high risk areas (or who have travelled through an outbreak area) as 
well as any woman (regardless of cultural background) with an Aboriginal 
partner residing in high risk areas (or who has travelled through an outbreak 
area).  

Additional screening required: 

? First antenatal visit (routine) 

? 28 weeks 

? 36 weeks  

? At birth 

? 6 week post-natal check 

The GP should offer screening for other sexually transmitted diseases (i.e. 
Chlamydia, Gonorrhoea, Human Immunodeficiency Virus (HIV), Hepatitis B and 
C Virus to the woman with a positive Syphilis serology. 

Further information: www.sahealth.sa.gov.au or via the SA Health 
Communicable Disease Control Branch direct on telephone:  1300 232 272 (24 
hours/7 days) 

In the instance that the pregnant woman presents with a positive Syphilis 
serology, the GP should immediately refer the woman for consultant obstetric 
advice at the  booking  hospital. 







 
                                                                                                                                         Page 12 of 35 
 

Hepatitis B and C and HIV  

The GP should request routine Hepatitis B, C or HIV serology at the 1st 
antenatal visit. 

In the presence of complications, a pregnant woman with a positive result to 
Hepatitis B, C or HIV may warrant referral to an Infectious Diseases 
Consultant and/or consultant obstetric advice at the  booking  hospital. 

Oral Glucose Tolerance Test 

The GP should assess the pregnant woman s risk factors for overt diabetes at 
the first antenatal visit to determine the need for additional screening. 

Risk factors: 

? Previous Gestational Diabetes Mellitus (GDM) 

? Previously elevated blood glucose level 

? Age ? 40 years 

? Family history of Diabetes Mellitus (DM) (i.e. 1st degree relative with 
diabetes or sister with GDM) 

? Pre-pregnancy BMI &gt;30 kg/m2 

? Previous macrosomic baby (birth weight &gt; 4500g or &gt; 90th centile) 

? Polycystic ovary syndrome 

? Medicated with corticosteroids or antipsychotics 

? Ethnicity (Asian, Indian subcontinent, Aboriginal, Torres Strait Islander, 
Pacific Islander, Maori, Middle Eastern, non-white African) 

If 1 or more risk factors are present the GP should request: 

? HbA1c or OGTT at 12-14 weeks gestation (or as soon as possible prior to 
20 weeks) 

If the results indicate normal BGL and/or OGTT the GP should follow up with a 
routine request for OGTT at 24-28 weeks gestation. 

Screening meets criteria for GDM: 

? Fasting BGL 5.1- 6.9mmol/L 

? 1 hour OGTT 10.0   11.0mmol/L 

? 2 hour OGTT 8.5   11.0mmol/L. 

Screening meets criteria for DM: 

? HbA1c ? 6.5% 

? A fasting BGL ? 7.0mmol/L 

? 2 hour OGTT ?11.1mmol/L. 

A diagnosis of GDM or DM does not necessarily preclude the woman from the 
Obstetric Shared Care Program. 

If the results indicate an abnormality in BGL or OGTT the GP should seek 
obstetric consultant advice from the  booking  hospital. 

For further information and alternative diagnostic tests refer to the SA 
Perinatal Practice Guideline www.sahealth.sa.gov.au/perinatal- Diabetes 
Mellitus and Gestational Diabetes. 

Combined First Trimester Screening 

Two request forms are required for the combined first trimester screening - one 
for the blood analysis 5-10 mLs clotted blood sample, taken 9 - 13w6d and one 
for the nuchal translucency ultrasound scan between 11   13w6d. 

A list of collection centres is provided on the reverse of the SA Maternal 
Serum Antenatal Screening (SAMSAS) request form. Telephone (08) 8161 
7285 to secure copies of the form. 

 

 




 
                                                                                                                                         Page 13 of 35 
 

Availability of first trimester screening 

Combined ultrasound and biochemistry screening is not currently offered 
through all hospitals/clinics. Check with the hospital/clinic concerned. The GP 
will be expected to organise the screening through private radiology services. 

Costs of first trimester screening 

SAMSAS continues its policy of accepting  Medicare only  for the serum 
biochemistry analyses, with no gap payment required for private or public 
patients. There may be a gap payment for the ultrasound measurement. 
Check with the practice providing this service and inform the woman. 

Use a SA Maternal Serum Antenatal Screening (SAMSAS) request form: 

The test request is for  first trimester screen    however, SAMSAS 
recommends ticking both the  first trimester screen  and the  second trimester 
screen  boxes on the request form. (This will assist with provision of the 
appropriate screen if the gestation on ultrasound scanning is different to 
expected gestation). The GP should: 

? Complete all information including the women s weight, ethnicity, 
estimated date of delivery, in-vitro fertilisation/egg donor. 

? Complete the gestational age information, the gestation must be 

between 9w0d   14wo for 1st trimester screening. 

? Specify the ultrasound practice performing the nuchal translucency scan. 

? Refer woman to the Privacy Disclosure on the SAMSAS request form and 
the SAMSAS pre-test information booklet. 

? Send the blood specimen to the Women s and Children s Hospital and 
request a copy of the results also to be sent to the  booking  hospital. 

For interstate or remote areas check with SAMSAS on what services are 
available. 

Ultrasound 

? Book a Nuchal Translucency scan with the medical imaging group of 
choice. The fetus must be between 11- 14 weeks gestation or crown rump 
length is 45-84mm at the time of the scan. 

? Complete an ultrasound request form, specifying  risk of fetal 
abnormality ; and  Copy to SAMSAS  and also request a copy of 
the results to be sent to the   booking  hospital. SAMSAS will 
coordinate the results with the ultrasound practice and you will receive a 
single report giving the risks calculated for the pregnancy. Post-test 
information booklets are provided with all reports issued by SAMSAS on 
pregnancies found at increased risk of fetal abnormality. 

A pregnant woman with an abnormal combined first trimester screening results 
must be promptly referred to the  booking  hospital for counselling with a view 
to offering CVS or Amniocentesis. www.sahealth.sa.gov.au/perinatal- PAPP-
A: Management of women with a low PAPP-A and normal chromosomes. 

Second trimester screening 

Second trimester screening for Down Syndrome should only be offered if the 

woman presents too late for 1st Trimester screening and should be 
undertaken between 14w0d and 20w6d. The GP should remember that If a 
pregnancy is screened in first trimester then any request in second trimester 
should be confined to neural tube defect (NTD) screening only. First 
trimester screening does not include a risk assessment for fetal NTDs. 

  







 
                                                                                                                                         Page 14 of 35 
 

Table: SAMSAS Prenatal Screening for Down syndrome 
 

Maternal Age 
in 
years at time 
of screen 

Maternal Age 
risk at
 12 
weeks1:n 

Maternal Age 
In years  at 
time of screen 

Maternal Age 
risk at 12 
weeks 1:n 

Maternal 
Age in 
years at 
time of 
screen 

Maternal Age 
Risk at 12 
weeks 1:n 

20 1131 30 719 40 94 

21 1118 31 636 41 72 

22 1102 32 552 42 55 

23 1081 33 468 43 42 

24 1054 34 390 44 31 

25 1020 35 318 45 28 

26 978 36 256   
27 926 37 203   
28 866 38 159   
29 796 39 123   

      Source: SAMSAS Program Update 15, www.wch.sa.gov.au/services/az/divisions/labs/geneticmed/samsas.html  
      (abridged version) 

Non Invasive Prenatal Testing 

Non-invasive prenatal testing (NIPT) is a screening test which uses free fetal 
DNA of placental origin in maternal serum to screen for fetal aneuploidy. NIPT 
is a screening test for early pregnancy to detect trisomy 21 (Down syndrome), 
trisomy 18 (Edward s syndrome) and trisomy 13 (Patau syndrome). Some 
laboratories offer testing for other chromosome conditions but this is not well 
validated. 

NIPT, like all prenatal tests is optional. All pregnant women should be made 
aware of the availability of NIPT screening. 

NIPT is available from 9 weeks gestation. There is no upper gestational limit. 
However, consideration needs to be given should the woman wish to proceed 
with a termination of pregnancy. 

Important Points 

? The test is safe and does not pose any risk to mother or baby 

? Currently only offered through specialist centres at a significant cost to the 
woman.   No Medicare rebate is available 

? The accuracy of NIPT tests is high for T21, T18 and T13 only- although not 
100% 

? A definitive diagnosis of a chromosome condition in the baby can only be 
made following an invasive prenatal diagnosis test like CVS or 
amniocentesis 

? The NIPT does not replace the 12 week first trimester screening. 

? Maternal weight &gt;120kgs may affect the results; due to insufficient fetal 
cells in the woman s blood sample.  

Morphology Ultrasound 

The GP should request a morphology ultrasound for when the woman is 18-20 
weeks gestation. 

The following women are at increased risk of fetal anomaly and the GP should 
consider referring the pregnant woman with one or more of these for a tertiary 
level morphology ultrasound: 

? Pre-existing diabetes type 1 or 2 

? Epilepsy  

? Multiple pregnancy 

? Maternal or paternal chromosome translocations 

? Known genetic disorders in parents or previous children/pregnancies 




 
                                                                                                                                         Page 15 of 35 
 

? Maternal cardiac conditions 

? Previous fetal anomaly/chromosomal condition 

? Previous severe early onset IUGR or confirmed maternal antiphospholipid 
syndrome 

? Maternal Anti Ro or Anti La antibodies 

? Known maternal substance misuse 

? Prescribed antipsychotic medication 

When women have a high BMI, visualisation of fetal structures is frequently 
more difficult, thus plan ultrasound for 19+ weeks gestation. For this group, it is 
important to note the following: 

? These women are at increased risk of diabetes and resultant fetal 
anomaly 

? If structures are not visualised, re-scheduling the ultrasound for later in 
pregnancy should not be done past 21+0 weeks gestation as this limits 
available time for referral and investigation prior to decision-making re 
possible termination of pregnancy 

In the instance that an abnormality is noted on the Morphology Ultrasound the 
GP should seek obstetric advice from and/or referral to the  booking  hospital. 

Chorionic Villus Sampling (CVS) 

CVS is performed as an outpatient procedure to detect whether the fetus has 
a chromosomal abnormality.  

CVS services are offered at FMC &amp; WCH. If a CVS is required the GP should 
promptly refer the woman to the  booking  hospital. 

Chorionic villus cells are obtained from the developing placenta (chorion). A 
small sample of chorionic villi is obtained in a syringe, via either the 
abdominal wall or the vagina under ultrasound guidance. 

The procedure can be uncomfortable and does not require fasting. After the 
procedure, women should be advised to rest for 48 hours, abstain from 
strenuous activity or exercise, including intercourse and contact their booking 
hospital if they experience any cramping pain, blood loss or loss of clear fluid. 
Women should be instructed to contact their  booking  hospital if they develop 
a fever, bleeding or loss of fluid. 

? Overall the risk of miscarriage after the procedure is approximately 1:100 
with chorionic villus sampling. 

? Chorionic villus sampling is performed between 10 weeks and 13w6d; 
amniocentesis after 15 weeks. 

? Results from chorionic villus sampling may not be available for up to 2 
weeks. 

? Because chorionic villus sampling detects an abnormality earlier than 
amniocentesis early termination of the pregnancy is possible. 

? Rhesus negative women require Anti-D at the time of chorionic villus 
sampling. 

Amniocentesis 

Amniocentesis is performed as an outpatient procedure after 15 weeks 
gestation to reduce the risk fetal malformations.  

Amniocentesis is undertaken to detect whether the fetus has a chromosomal 
abnormality cells. A sample of amniotic fluid is obtained via the abdominal 
route, under ultrasound guidance for chromosomal analysis.  

Amniocentesis is offered at all 3 metropolitan public maternity units. 

Page 25 



 
                                                                                                                                         Page 16 of 35 
 

Amniocentesis results may not be available for up to 2 weeks However, if a 
Fluorescence In Situ Hybridisation (FISH) has been performed, results may be 
available within 48 hours. 

The women may be required to cover the cost of a FISH. 

Sometimes the procedure may need to be postponed for up to a week if there 
is inadequate amniotic fluid. 

? Overall the risk of miscarriage after the procedure is approximately 1:200 
with amniocentesis. 

? Rhesus negative women require Anti-D at the time of amniocentesis. 

If an Amniocentesis is required the GP should promptly refer the woman to the 
 booking  hospital. 

Abnormal Findings/Symptoms and their Management 

While most women will have a normal pregnancy, it is imperative that thorough, 
comprehensive antenatal assessments are undertaken to ensure early and 
accurate detection of adverse clinical outcomes.  

In the instance that an abnormality is noted the GP should seek obstetric 
advice from the  booking  hospital. 

Large for Gestational Age (Fetal Growth Accelerated) 

Defined as a fetus with a recorded growth at the 90th percentile for 
that gestational age or has a noted accelerating growth. 

The management of the Fetal Growth Accelerated fetus can be complex. 

GPs should ensure they measure and  plot  the woman s symphysio-fundal 
height (SFH) measurement on the Symphysio-Fundal Chart in the SA 
Pregnancy Record.  

Further information can be sourced from the www.sahealth.sa.gov.au/perinatal-
Fetal Growth Accelerated. 

Intrauterine Growth Restriction (Fetal Growth Restricted) 

Defined as a fetus with a recorded growth that is below the 10th centile for 
gestational age. 

GPs should ensure they measure and  plot  the woman s SFH measurement on 
the Symphysio-Fundal Chart in the SA Pregnancy Record. 

If the SFH &lt;10th percentile or serial SFH measurements are flattening, then the 
GP should refer the woman for an ultrasound and request: 

? fetal biometry 

? Doppler of umbilical artery flow; and 

? amniotic fluid index  

The GP should ensure the ultrasound results are  plotted  on the appropriate 
graph in the SA Pregnancy Record. 

If any parameters are abnormal, the GP should seek obstetric advice from 
and/or referral to the  booking  hospital.  

Further information can be sourced from the www.sahealth.sa.gov.au/perinatal 
Fetal Growth Restricted. 

Abnormal Fetal Presentation 

If the woman presents at &gt;36 weeks gestation and has a suspected breech or 
transverse lie, the GP should seek obstetric advice from and/or referral to the 
 booking  hospital. 

Page 25 






 
                                                                                                                                         Page 17 of 35 
 

Reduced Fetal Movements 

The GP should: 

?  assess fetal movements at every antenatal visit  

?  ensure the pregnant woman is routinely provided with verbal and written 
information regarding normal fetal movements during the antenatal period. 
This information should include a description of the changing patterns of 
movement as the fetus develops and normal wake/sleep cycles  

? emphasize the importance of pregnant woman s awareness of her fetal 
movements at each antenatal visit 

If the woman is reporting DFM ? 28 weeks gestation, the GP should: 

? undertake abdominal palpation, assessing uterine tone and tenderness as 
well as fetal lie /presentation 

? ensure a minimum of 20 minute CTG is performed to exclude immediate 
fetal compromise  

? record maternal pulse rate and confirm different to the feta heart rate 

? measure the maternal temperature and blood pressure 

? undertake Kleihauer test  

? consider an ultrasound scan assessment including evaluation of fetal 
morphology (if this has not already been performed). 

If any parameters are abnormal, the GP should seek obstetric advice from 
and/or referral to the  booking  hospital. 

Further information can be sourced from the www.sahealth.sa.gov.au/perinatal 
Decreased Fetal Movements  

Hypertension 

Hypertension is defined as systolic BP is greater than or equal to 140 mm Hg 
and/or diastolic BP is greater than or equal to 90 mm Hg.  

All women with a systolic BP ? 160 mmHg or a diastolic BP ? 110 mmHg should 
be treated because of the risk of intracerebral haemorrhage and eclampsia. 

Hypertensive Disorders of Pregnancy are diagnosed after 20 weeks gestation 
(without pre-existing hypertension). Any woman presenting with new 
hypertension after 20 weeks gestation should be assessed for signs and 
symptoms of preeclampsia. 

Preeclampsia is diagnosed in the presence of hypertensive disorder of 
pregnancy that is also associated with any sign of a multi-system disorder 
including proteinuria and/or one of the following: 

? persistent cerebral symptoms (headache, visual disturbances, increased 
reflexes); 

? epigastric or right upper quadrant  pain; 

? intrauterine growth restriction; or 

? thrombocytopenia or abnormal liver function tests. 

The GP should complete a comprehensive history and clinical assessment of 
the pregnant woman at the first antenatal visit and then follow up with a 
thorough clinical assessment at every antennal visit to identify symptoms and 
signs of neurological and other systematic manifestation specific to pre-
eclampsia. 

  




 
                                                                                                                                         Page 18 of 35 
 

The GP should arrange the following laboratory investigations:  

? Ultrasound, 

? Urea &amp; Electrolytes  

? Complete Blood Examination  

? Liver Function Tests 

? Urate and  

? Urine Protein Creatinine Ratio. 

A diagnosis of preeclampsia dictates immediate referral to the  booking  
hospital The GP should seek obstetric advice from the  booking  hospital 
regarding these arrangements. 

Further information can be sourced from the www.sahealth.sa.gov.au/perinatal. 
Hypertensive Disorders in Pregnancy. 

Vaginal Bleeding 

Bleeding in pregnancy is recognised as a potential emergency.   

Per vaginum bleeding is the most common presentation to a care provider in 
early pregnancy and will affect an estimated 20-25% of women, the 
commonest cause of which is miscarriage (up to 20% of recognised 
pregnancies). Further information can be sourced from 
www.sahealth.sa.gov.au/perinatal Bleeding and Pain in Early Pregnancy 
(Ectopic Pregnancy, Miscarriage &amp;PUL)  

If the pregnant woman ? 20 weeks gestation presents with vaginal bleeding the 
GP should undertake a history and examination and seek obstetric advice and 
referral to the  booking  hospital. 

Further information can be sourced from the www.sahealth.sa.gov.au/perinatal. 
Antepartum Haemorrhage of bleeding in the second half of pregnancy. 

Rh D Negative 

Women with red cell antibodies including Rh D antibodies are not suitable 
for GP shared care. The following information therefore relates only to women 
who are Rh D negative and have no preexisting antibodies.  

Further information can be sourced from the www.sahealth.sa.gov.au/perinatal 
Anti-D Prophylaxis. 

Testing for Anti-D Antibodies 

The GP should test the woman for blood group antibodies at the first 
antenatal visit. If the woman is Rh negative and had no Rh D antibodies in 
early pregnancy, the GP should ensure she is tested again for the presence of 
antibodies at the end of the second trimester of pregnancy. 

Testing should precede administration of Anti-D. The GP should note that 
if antibody testing was undertaken at 26 or 27 weeks. There is no need to 
repeat this screening before Anti-D administration at 28 weeks.  

Prophylactic Anti-D Administration  

If the woman is Rh D negative and has no preexisting Anti-D antibodies, the GP 
should inform her about the need to prevent Rh D sensitisation. This includes: 

? Anti-D administration if a sensitising event occurs in pregnancy; 

? Routine prophylaxis at 28 and 34 weeks gestation; and 

? Further prophylaxis after birth if the baby is Rh D positive. 

If vaginal bleeding occurs, the GP should seek obstetric advice from and/or 
referral to the  booking  hospital before administering doses of Anti-D. 








 
                                                                                                                                         Page 19 of 35 
 

 
The GP should obtain informed consent for Anti D prophylaxis early in 
pregnancy. The woman s consent for Anti D prophylaxis must be 
documented in her South Australian Pregnancy Record. 

If the woman recommended for Anti D administration declines consent / 
administration, the GP should immediately refer her to the  booking  hospital. 

If concerned, the GP should seek obstetric advice from and/or referral to the 
 booking  hospital. 

Anti-D Prophylaxis for Potentially Sensitizing Events 

Potentially sensitising events are defined as any situation in which there is an 
increased likelihood of fetal red blood cells entering the maternal circulation.  

These include: 

? Miscarriage, termination of pregnancy, ectopic pregnancy, CVS in the 

first 12 weeks of pregnancy. Bleeding (threatened miscarriage) prior to 

12 weeks gestation does not necessitate anti-D, but if the woman goes 

on to miscarry, anti-D should then be given 

? any   uterine   bleeding   in   pregnancy   after 12 completed weeks 

gestation ranging   from   (threatened)   miscarriage   to antepartum 

haemorrhage; 

? any abdominal trauma in pregnancy; and 

? any uterine or intra-uterine intervention (such as external cephalic 
version, amniocentesis, etc).  

 
If a sensitising event occurs the GP should i m m e d i a t e l y  refer the woman 
to the  booking  hospital 

Further information can be sourced from the www.sahealth.sa.gov.au/perinatal 
Anti-D Prophylaxis.  

Routine Prophylaxis at 28 and 34 Weeks  

Rh D negative women without preexisting Anti-D antibodies should receive 
Rh D immunoglobulin at 28 weeks (after or simultaneously testing for 
preformed Rh D antibodies) and again at 34 weeks. 

If the woman has missed out on receiving Anti-D at 28 weeks (for example 
because they did not attend) Anti-D should be administered at the next visit 
(better late than never). In that case, the second injection should be planned 6 
weeks later, provided that the woman is still pregnant. 

If the woman has received Anti-D for a potentially sensitising event, e.g. 
antepartum haemorrhage or trauma, before 28 weeks, she should still receive 
Anti-D at 28 and 34 weeks as scheduled unless the Anti-D for the sensitizing 
event was administered less than 1 week before the prophylactic dose being 
due. 

Further information can be sourced from the www.sahealth.sa.gov.au/perinatal 
Anti-D Prophylaxis. 

Table: Summary of Dose Recommendations for Rh D Negative Women 

Sensitising events Dose of Rh D immunoglobulin 

Before 13 weeks 250 IU 

At or after 13 weeks 625 IU 

Routine prophylaxis  

At 28 and at 34 weeks 625 IU 

 

  





 
                                                                                                                                         Page 20 of 35 
 

Medications in Pregnancy 

The GP should advise the pregnant woman to: 

? only take medications that have been prescribed by a doctor  

? remain on any necessary medication without prior discussion with the 
doctor concerned  

? only use Paracetamol for the treatment of pain and fever,  

? refuse aspirin or other non-steroidal anti-inflammatory drugs, e.g. 
Ibuprofen 

The GP can seek advice from the Medicines and Drug Information Centre at 
the Women s and Children s Hospital Pharmacy (Phone (08) 8161 7222 
Monday- Friday 9 am   5 pm). 

Supplements in Pregnancy 

The GP should consider the following suggestions regarding advice given to 
the woman for the use of vitamins in pregnancy: 

? Calcium, vitamins and fluoride are not usually necessary. 

? Supplemental iron is recommended if haemoglobin is below 110g/L before 

12 weeks and if below 100g/L &gt; 12 weeks. NB Facilities and staff trained 
in management of anaphylaxis should be available when administering a 
Fe infusion. IV iron should not be administered to pregnant women 
outside a hospital setting 

? If Ferritin is less than 30mcg/L recommend a supplement 

? Folic Acid .5 mg ; although it is recommended to be taken at least one 
month prior to conception it is also recommended until 12 weeks 
gestation.  

If the woman: 

o Is at increased risk of neural tube defect,  

o Is on antiepileptic drugs,  

o has diabetes, or  

o has hyperhomocysteinaemia,  

a daily dose of Folic Acid 5 mg is recommended until 12 weeks gestation. 

? Vitamin D as per the SA Perinatal Practice Guidelines 
www.sahealth.sa.gov.au/perinatal - Vitamin D Status in Pregnancy 

? Iodine  150mcg(?g)/day  should  be  taken  during  pregnancy  and  
breastfeeding 

? Vitamin B12 during pregnancy and lactation for women who are vegetarian 
or vegan. 

Further information can be sourced from the www.sahealth.sa.gov.au/perinatal. 

? Vitamin and mineral supplementation in pregnancy. 

? Anaemia in Pregnancy 

? Vitamin D Status in Pregnancy 

Immunisations in Pregnancy 

The GP OSC SA antenatal schedule aligns with the SA Pregnancy Record; 
www.sahealth.sa.gov.au/pregnancyrecord 

The NHMRC recommends routine administration of 2 vaccines during 
pregnancy i.e influenza and pertussis.  

 

 







 
                                                                                                                                         Page 21 of 35 
 

The influenza vaccine is recommended as early as possible in pregnancy. A 
repeat dose of the influenza vaccination is suggested if the pregnancy endures 
over 2 flu seasons. 

The pertussis vaccine is recommended as a single dose from 20 weeks 
gestation. The optimal time for vaccination is between 20 and 32 weeks 
gestation, but the vaccine can be given at any time after the 20 week gestation 
up until birth. (Early vaccination is preferred because pertussis antibody levels 
do not peak until approximately 2 weeks after vaccination and active transport 
of maternal antibody to the fetus occurs predominantly from 20 weeks gestation 
onwards). 

Further information can be sourced from   www.sahealth.sa.gov.au/perinatal. 
Vaccines Recommended in Pregnancy. 

 

Perinatal Mental Health 

The recognition of depression and other mental health conditions in the 
antenatal period is important as it may require treatment during the 
pregnancy and is a strong predictor for postp artum depression.  

Screening for perinatal mood disorders, in the form of a psychosocial 
assessment or administration of a validated tool, such as the Edinburgh 
Postnatal Depression Scale (EPDS), should be considered part of routine 
antenatal and postpartum care. 

 Further information can be sourced from the www.sahealth.sa.gov.au/perinatal,  

? Anxiety and Depression in the Perinatal Period 

Referral Services 

There are a variety of services available for t h e  GP seeking assistance 
with managing perinatal mental health issues. Specific services available 
may depend on geographic location, but these include: 

? Emergency Mental Health Triage can undertake urgent assessments, 
telephone 13 14 65. The service is staffed by mental health clinicians who 
can provide advice and information in a mental health emergency or crisis 
situation. They will assess and refer to acute response teams where 
appropriate. 

? Mental health/perinatal mental health team at the  booking  hospital.  

? The Margaret Tobin Centre situated in close proximity to the Flinders 
Medical Centre can provide specialist psychiatric adult inpatient and 
intensive care. The GP in the first instance should call the Mental Health 
Triage on 131 465 who can advise on the best course of action. 

? Access to Allied Psychological Services.- The GP can establish a Mental 
health Care Plan  refer the woman with significant depression and anxiety. 

A private health provider can be an alternate referral the GP may wish to 
consider in this situation.  

? National Health Services Directory - available services at 
http://www.nhsd.com.au/ 

? Beyond Blue Infoline 1300 22 4636. Beyond blue is a national 
organisation working to address issues associated with depression &amp; 
anxiety in Australia.  www.beyondblue.org.au 

? The Post and Antenatal Depression Association (PANDA) National 
Helpline 1300 726 306 provides information, support and referral to 
anyone affected by depression and anxiety during pregnancy and after 
childbirth www.panda.org.au 

? Helen Mayo House (HMH) is a State-wide acute mother-baby unit which 
admits parents (usually mothers) and their children 3 years of age or 
younger, if the parent needs treatment for mental health problems such 








 
                                                                                                                                         Page 22 of 35 
 

as depression, anxiety or psychosis following childbirth. Inpatient, 
outreach day patient and group treatment programs are available, as 
well as brief telephone consultations for advice regarding patient care. 
Contact telephone (08) 7087 1030.  

Labour and Birth 

The care of the woman during labour and birth is the responsibility of the 
maternity team at the  booking  hospital. 

The  booking  hospital is expected to provide a discharge summary of the 
pregnancy and birth outcome for the GP at discharge of the woman.  

Postnatal Care 

Breastfeeding advice should be readily available during the immediate 
postnatal period whilst the woman is in hospital, and follow-up support post 
discharge is commonly arranged through the home visiting Midwifery Service. 

A universal contact visit by Child and Family Health Services will be facilitated 
with the woman s consent. 

Women will be advised by the  booking  hospital t o  secure follow-up postnatal 
visits with their GP at 2 and 6 weeks, unless needed prior to this. Some 
women may be required to return to the  booking  hospital if they have 
experienced particular problems during pregnancy or childbirth. This 
appointment should be made for the woman prior to discharge. 

Postnatal Visits 

At the 2 and 6 week postnatal visit the GP should assess both the mother and 
the baby. 

The GP shou ld  review the mother s obstetric and medical history and that 
of her baby including: 

Mother: 

? pregnancy, birth and delivery history including any complications 

? breasts /nipples/  breastfeeding 

? general physical assessment abdomen ? fundus, uterus involuted 

? perineum, vaginal examination, uterus involuted, Pap smear if due 

? examine perineum +/- abdominal wound (if caesarean section delivery) 

? lochial discharge 

? family and social supports 

? BP (if hypertension during pregnancy) 

? contraception 

? administer the Edinburgh Postnatal Depression Scale, if necessary  

? intercourse 

? urinary or faecal incontinence 

? follow-up on pregnancy complications i.e gestational diabetes, 
hypertension 

Discuss vaccination of the mother, and vaccinate as recommended. Ensure all 
family members are up to date with their vaccinations, particularly pertussis. Refer  
www.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook10-home 

Administer the Edinburgh Postnatal Depression Scale, if necessary.  

Discuss any questions or concerns the mother/father/carer may have. 

Discuss referral to the CYH contact/centre and ascertain need to refer to: 




 
                                                                                                                                         Page 23 of 35 
 

? Paediatrician 

? Community health centre 

? Lactation consultant 

? Australian Breastfeeding Association 

? Social worker. 

Baby: 

? examine the baby and review: 

o weight, length and head circumference including percentiles 

o head   shape, mobility, control 

o eyes   movement, conjunctiva, cornea 

o mouth   tongue, cheeks, ? thrush 

o CVS   colour, heart sounds, murmurs, pulses (femoral) 

o respiratory   effort, noises such as stridor or cough 

o GIT/GUT   umbilicus, abdomen, groin (hernias), perineum, genitalia 

o CNS   alertness/awareness, movement, tone 

o MSS   jaundice, skin rashes, hips, feet position 

? neonatal history, e.g. resuscitation needed, nursery admission 

? feeding   breast/bottle/mixed; frequency; any difficulties 

? feeding pattern   vomits/spills,  wind  colic, stools 

? behaviour between feeds. 

Discuss the six week immunisations as per the Child Immunisation Schedule. 

Discuss baby safety checks and SIDS advice, including sleeping (site, position), 
hygiene (bathing site, frequency), travel (pram, car). 

Observe parent s handling technique and attachment (confidence, interaction). 

The GP should document the visit, including examination findings, in the 
baby s My Health Record ( blue book ). 

At the six-week visit the GP should a l s o :  

? check if any parental concerns about baby s hearing or vision 

? recommend six week immunisations as per the Child Immunisation Schedule 

? developmental screen/guidelines 

? eyes   appearance, fixation, following 

 

Further Information for the GP 

Perinatal Practice Guidelines 

The SA Perinatal Practice Guidelines are available on the web at 
www.sahealth.sa.gov.au/perinatal, or via the web-based APP  Practice 
Guidelines  available at 
https://extapps2.sahealth.sa.gov.au/PracticeGuidelines/.  As they are 
continually being updated web access is the most appropriate means of 
accessing this information. The perinatal practice guidelines cover a broad 
range of topics that have not been repeated in these protocols. 

Patient Assistance Transport Scheme (PATS) 

The PATS is a subsidy program that provides money to pay for some travel, 
escort and accommodation costs when rural and remote South Australians 
travel over 100kms each way to see a specialist.  

 

? The scheme is intended to subsidise the unavoidable financial costs for 





 
                                                                                                                                         Page 24 of 35 
 

those residents of South Australia that have no option but to travel a long 
distance to receive essential medical specialist services from an approved 
medical specialist.  

? The scheme is not intended to support choice of specialists. Patients 
should be treated as close to home as possible without compromising the 
safety and quality of the care provided. The scheme will not support the 
additional costs of travel if a patient makes a choice to travel beyond their 
closest specialist services.  

Application forms are available online at www.sahealth.sa.gov.au/PATS 

The PATS Guidelines for Assessment is also available on the PATS website.  

To optimise safety and birth outcomes, women who live more than a two hour 
drive from their maternity hospital should be advised to temporarily relocate 
closer to the hospital from 36 weeks of pregnancy. A PATS subsidy may be 
available to assist the woman with the costs associated with this relocation.  

NB: GPs and Specialist medical practitioners must register and be 
certified by PATS for portal access. The GP must approve the online 
application or sign the paper based PATS form before the woman travels to see 
her specialist to ensure the woman can qualify to receive the reimbursement.  

Further Information:  

Contact: PATS, Rural Support Service, SA Health: 
Phone: 1300 341 684  
Visit www.sahealth.sa.gov.au/PATS 
Email: PATS@sa.gov.au or contact your local PATS office 

 
 
 
 
 
 
 
 
 
 
 
 
 






 
                                                                                                                                         Page 25 of 35 
 

 
Information Related to  Booking  Hospitals 

While the  booking  hospitals maintain the GP OSC Program in accordance 
with agreed standards and protocols, each unit has some specific services 
that the GP may wish to discuss with the pregnant woman and/or her family. 

 

 Flinders Medical Centre (FMC) 

The Flinders Medical Centre (FMC) provides a comprehensive perinatal 
service for women, neonates and their families. Services provided at FMC 
include: 

Obstetric Clinics 

Obstetric clinics are provided by Obstetricians/Registrars and Midwives on 
most mornings and some afternoons at FMC. Noarlunga Health Service holds 
obstetric clinics usually in the afternoons and evenings. 

Maternal Fetal Medicine (MFM) Unit 

MFM is a branch of obstetric medicine that focuses on managing the health 
concerns of the mother and fetus prior to, during, and shortly after conception. 
It manages ongoing surveillance and management for women whose 
pregnancies are significantly complicated by maternal and/or fetal conditions. 

Medical Complications of Pregnancy Clinics 

Obstetric medicine clinics are held on Monday, Wednesday and Friday 
mornings by Medical specialists in medical conditions that effect pregnancy. 

Women s Assessment Service (WAS) 

WAS operates Monday   Friday from 8am   4pm. This service predominately 
assesses women in early pregnancy for possible loss and surveillance and 
assessment in pregnancy such as blood pressure monitoring and decreased 
fetal movements.  

Childbirth and Parenting Education 

Antenatal, labour and breast feeding classes are provided at Flinders Medical 
Centre and Noarlunga Health Service upon request. 

Perinatal Mental Health Service 

A perinatal Menth Health Nurse is available by referral for primarily antenatal 
but available postnatal for support. A referral is required. 

Southern Midwifery Group Practice 

The Southern Midwifery Group Practice is a model of maternity care offered 
by a group of midwives that provide continuity of midwifery care to women 
during their pregnancy, childbirth and the postnatal period, to low risk women. 
Southern Midwifery Group Practice is referred after POB (Booking Visit) at 
FMC. 

Maternity Outreach Service 

Maternity Outreach Service is a home visiting service provided by Midwives to 
women postnatal after discharge. Midwives will provide two home visits with 
additional scheduled as required. 

Postnatal Support Service 

This service is conducted by a lactation consultant/midwife and is designed to 
help with unexpected feeding and settling difficulties that may arise in the 
early days after birth. 

Page 26 



 
                                                                                                                                         Page 26 of 35 
 

Multiple Birth Support Service 

A midwife is available to support and educate families with a multiple birth 
pregnancy in liaison with the Multiple Birth Association. 

Drug and Alcohol Support Service (DASSA) Clinic 

Flinders Medical Centre has a clinic managed by DASSA to support women 
with drug and alcohol dependence in the perinatal period. A referral is 
required. 

Baby-Friendly Hospital Initiative (BFHI) Accredited 

A World Health Organisation initiative to promote, support and encourage 
breastfeeding. FMC has been accredited as a BFHI hospital since 2003. 

Contact Numbers for the Flinders Medical Centre 
 

Women s Health Clinic (08) 8204 5197  Fax 8204 5120 

Birthing &amp; Assessment (BAS) Unit (08) 8204 5511   ask for BAS 

Women s Assessment Service (08) 0204 4645  

Maternity Outreach (08) 8204 4650  

Mental Health Nurse (08) 8204 5511 Pager:  38903 

Multiple Birth Co-ordinator (08) 8204 5511   

 

   Pager  48033 

Obstetric  

Bookings 

(08) 8204 5197  

Obstetric Clinic Appointments (08) 8204 5197  

Radiology (Ultrasound)  (08) 8204 5367  

Shared Care Midwife  (08) 8204 4650  

Noarlunga Health Service (08) 8384 2222  

Noarlunga Health Service Maternity 
Wome 

(08) 8384 9454 Fax 08 8384 9711 

   

Northern Adelaide Local Health Network (NALHN) 

NALHN offers a full range of obstetric, midwifery and paediatric services to 

mothers and babies. NALHN is one of South Australia s major teaching hospitals 
and has been accredited as a Baby Friendly Hospital (BFHI) since 2000.  

Antenatal Clinics 

NALHN has multiple obstetric and midwifery care pathways for pregnant women 

across numerous sites including: Northern Area Midwifery Group Practice 

(NAMGP), Birthing Centre, Northern Aboriginal Birthing Program (NABP), 

midwifery &amp; obstetric led care and GP Obstetric Shared Care.  These services are 

offered at multiple sites including: Lyell McEwin Hospital (LMH), Modbury Hospital 

(MH), GP Plus sites, community and outreach clinics.   

Women s Assessment Unit 

The Womens Assessment Unit provides specialist obstetric care, information and 
support to women who are pregnant and up to six weeks postnatal. This would 
include pain or bleeding at any gestation of pregnancy, unusual or offensive 
vaginal loss, headache and visual disturbances, labour assessment, a decrease 
or change in fetal movement, abnormal ultrasound results, iron infusion or any 
other obstetric concerns. Appointments are not necessary, however each woman 
is seen on the basis of clincial urgency, rather than order of arrival. 

 

 

 



 
                                                                                                                                         Page 27 of 35 
 

Obstetric clinics 

Women with medical conditions or complications of pregnancy can be seen in the 

antenatal clinic located at both the Lyell McEwin &amp; Modbury Hospitals. These 

clinics provide care with Consultant Obstetricians as well as Consultant 

Physicians, Midwives and Anaesthetists as required. The clinic is also staffed by 

training registrars and RMO s. Specialised Obstetric clinics with multidisciplinary 
health teams available include Diabetes Antenatal Care and Education (DANCE) 

and Antenatal Drugs Alcohol Service South Australia (DASSA) Clinic. 

Drugs and Alcohol Services South Australia (DASSA) Clinic 

This is a multidisciplinary clinic in partnership with women who have current 
and/or a recent history of substance and/or alcohol use, once a week at the LMH. 
The service provides support with reduction and quitting techniques and provides 
women, their partners and families with strategies to manage their addictions to 
promote the safety and wellbeing of their babies. The women are also seen by the 
obstetric and midwifery team and the Northern Aboriginal Birthing team if 
appropriate in order to provide holistic care.  

Shared Care with a General Practitioner  

A GP, accredited to provide Obstetric Share Care can provide antenatal care to 

women who have a low risk pregnancy. The GP will undertake the triage 

appointment and provide the woman with her pregnancy hand held record.  The 

pregnancy booking blood tests and the 1st trimester screening should be ordered 

by the GP. The woman would be required to attend the hospital for a booking 

visit, before 20 weeks gestation. To book an appointment for a woman requesting 

GP Shared Care, the GP should send a fax to the Family Clinic on (08) 8282 

1612 marked  Attention Shared Care ; or alternatively, the woman may ring the 
telephone appointment number (08) 8282 0255 Lyell McEwin Hospital or (08) 

8161 2154 Modbury Hospital and ask for an appointment with the GP Share Care 

Midwife.  Further appointments are made between 30-32 weeks if the woman 

wants to have her baby in the Birth Centre. All women having GP Share Care will 

require an appointment at 36 weeks and 40 weeks at the booking hospital.  

Birth Centre/Team Midwifery 

This is an option for women assessed as low risk of complications and who prefer 
a more natural approach to childbirth with little intervention. Women and their 
families are supported through pregnancy and birth by a team of midwives 
who support active birth in a relaxed, homely environment. 

Women wishing to use the birth centre and have shared care with their GP 
ideally should make their wishes known at the shared care booking visit. If 
undecided at this time, later bookings can be made by negotiation. An initial visit 
to the team midwives should be made at 30-32 weeks so that the woman can be 
allocated a birthing team. Women usually continue to see their GP until the 36 
week hospital visit then transfer to the team midwives for remaining visits. This 
plan is negotiable. 

Northern Area Midwifery Group Practice (NAMGP) 

NAMGP is an  all risk  midwifery model of care, with midwives working 
collaboratively with the medical teams at the LMH and Modbury Hospital. The 
woman may have her antenatal care in an outreach clinic in the community by a 
known midwife and the midwife will be the primary care provider throughout the 
pregnancy, birth and up to 4 weeks in the postnatal period. For further information 
8182900 page Midwifery Unit Manager of NAMGP. 

 



 
                                                                                                                                         Page 28 of 35 
 

Planned Homebirth 

Women can access planned homebirth services through NAMGP. Criteria as per 
the SA Health  Planned Birth at Home in SA  Clinical Directive. 

Northern Aboriginal Birthing Program (NABP) 

NABP provides culturally appropriate and holistic healthcare for Aboriginal and 
Torres Strait Islander (ATSI) women or women carrying ATSI babies throughout 
their pregnancy journey, within a continuity of care framework for up to 4-6 weeks 
following the birth of the baby.  Aboriginal Maternal Infant Care (AMIC) Workers 
work alongside midwives to provide culturally appropriate care. 

Continence Clinic 

Coordinated by a team of continence nurse advisors, to assess, educate and 
support women with continence issues (both faecal and urinary). All women who 

have had previous 3rd  or 4th  degree tears or significant perineal trauma are 
referred to this team during the antenatal period for support and advice 
regarding the mode of delivery for the current pregnancy. This clinic interlinks 
with the colorectal and urodynamic team.  

Perinatal Mental Health Team 

Pregnant women, at antenatal triage are offered screening via the ANRQ and 
EPDS for risk of depression and anxiety in the perinatal period. Referrals for the 
Perinatal Mental Health team are generated by the antenatal triage midwife. There 
are a limited range of supports including psychoeducation, referral to our perinatal 
psychiatrist, short intervention counselling and support. The perinatal team 
encourage utilization of mental health care plans and GP referral to other 
psychological services such as PANDA (perinatal and anxiety Australia) and 
COPE (Centre of perinatal excellence). When booked, LMH women can be 
enrolled in  Ready to cope  For further information: 82820794 

Northern Links: Antenatal psychosocial high risk triage meeting and Northern 
links monthly review meeting 

An antenatal psychosocial high risk meeting held with the aim to reduce the risk of 
harm to infants and their mothers who are receiving maternity care in NALHN by 
collecting and disseminating information within a multidisciplinary team to facilitate 
a holistic service response for women with complex psychosocial needs.  

Childbirth and Parenting Education 

A wide range of childbirth classes designed to meet the woman s needs, lifestyle 
and information preference are provided including a tour of the maternity unit. 
Modbury Hospital offer a dedicated breast-feeding education session that is held 
fortnightly on Friday afternoons. For bookings phone LMH (08)8182 9431 and 
Modbury (08) 8161 2154. 

Home Visiting Midwives 

Home Visiting Midwives provide community postnatal care for those women living 
in the NALHN catchment and not cared for through Northern Area Midwifery 
Group Practice. Visits are daily or second daily according to need and are 
generally completed within the first postnatal week. 

Mothercarer Program 

The LMH is the only metropolitan maternity service in Australia to offer the 
Mothercarer Program. Postnatal women discharged after a  short stay  are 
eligible for the program which provides a carer in the home for up to 5 hours 
per day, for up to 4 days.   

 

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                                                                                                                                         Page 29 of 35 
 

The Mothercarers work in conjunction with the visiting midwives and care of the 
baby and other children in the home, providing education for new parents, light 
home duties, emotional support, transport and connection with ongoing 
community services. 

Breastfeeding Day Assessment and Support Unit 

Available to all breastfeeding mothers of babies of up to 8 weeks. The unit is 
staffed by experienced midwives. The unit is operational Tuesday &amp; Friday by 
appointment only. Phone (08) 8182 9380 for an appointment.  

Contact Numbers for the Lyell McEwin Hospital (LMH)  
 

Hospital number (08) 8182 9000 

Obstetrics Department Office  (08) 8182 9306    Fax: (08) 8182 9337 

Birthing Centre  (08) 8182 9326 

Clinic Midwife (08) 8282 1613 

Clinic Receptionist (08) 8282 1611 

Continence Midwife (08) 8282 9000    Pager: 6187(Mon-Fri) 

High-risk pregnancies (08) 8182 1607 

Perinatal Mental Health Midwife (08) 8182 9000   Pager: 6006 (Mon-Fri) 

Phone appointments (08) 8282 0255 

Shared Care Midwife Coordinator (08)8182 9000      Pager: 6470 
Mobile 0417840062 

NALHN.Sharedcare@sa.gov.au 

Ultrasound appointments (08) 8182 9999 

Antenatal Educator (08) 8182 9431 

Birthing Assessment Unit High (08) 8182 9111 

Women s Assessment Unit (08) 82821301 

Home Visiting Midwifery Service (08) 8182 9252 

Modbury Hospital (MH) 

Contact Numbers for the Modbury site 

Hospital Number                       (08) 8161 2000   Fax (08) 8161 2227 
Antenatal Appointments             (08) 8161 2593 

Shared Care Midwife Coordinator  (08)8182 9000   Pager:6470 
               Mobile 0417840062 

NALHN.Sharedcare@sa.gov.au 

Antenatal Educator                     (08) 8182 9431 
 

 
 
 
 
 

  





 
                                                                                                                                         Page 30 of 35 
 

Women s and Children s Hospital (WCH) 

The Women s and Children s Hospital (WCH) provides a comprehensive obstetric 
service, providing all levels of care. The initial visit to the hospital, offered at 
approximately 12 weeks gestation is a 90 minute Triage appointment with a 
midwife who will assess the woman to determine the appropriate referral pathway 
and model of care. All models of care are discussed with woman at this visit. WCH 
has been accredited as a Baby-Friendly Hospital since 2012. 

Community Midwifery Outreach Clinics 

Midwifery care is delivered by the WCH midwives in 7 community based 
locations. Low risk woman will see the same midwife for most of the visits. The 
birth will occur in the hospital delivery suite, and care will be provided by the 
duty medical and midwifery team. 

Midwives Clinic 

Low risk women who attend the midwives clinic will see the same midwife 
for most visits. Women may ask to see a doctor at any time during their 
pregnancy. The birth will occur in the hospital delivery suite, and care will be 
provided by the duty medical and midwifery team. 

Midwifery Group Practice (MGP) 

Also known as "Caseload Midwifery", Midwifery Group Practice (MGP) enables 
women to be cared for by the same midwife (primary midwife) supported by a 
small team of midwives throughout their pregnancy, during childbirth and in the 
early weeks at home with a new baby. 

Home Birth 

Accredited MGP midwives can facilitate home birth for low risk women who meet 
the criteria. 

Aboriginal Family Birthing Program 

Aboriginal Family Birthing Program Any woman who identifies as Aboriginal and/or Torres 
Strait Islander or whose unborn baby identifies as Aboriginal and /or Torres Strait Islander 
can have their care provided in partnership with a designated Aboriginal Maternal Infant 
Care Practitioners (AMIC) and a Midwife. This decreases cultural and communication 
barriers in providing maternity health care. The AMIC program provides antenatal and 
postnatal service for Aboriginal woman and their babies for up to 4 weeks post birth 

Shared Antenatal Care with a General Practitioner 

Low risk woman can see their GP who is accredited with the GP Obstetric Shared Care 
Program. Women will need to visit the hospital as per this protocol. GPs may send a 
referral via fax to the midwife coordinator s office on (08) 81616246; or contact the 
Midwife Coordinator directly on (08) 8161-7000, pager 4259 to arrange an appointment. 
Antenatal clinic days are held on Tuesday, Wednesday, Thursday and Friday. 

Medical Antenatal Care (Public Patients) 

Women with medical conditions or complications of pregnancy can be seen in 
the public antenatal clinic by Consultant Obstetricians as well as Consultant 
Physicians and Anaesthetists as needed. The clinic is also staffed by training 
registrars and RMO s. 

Medical Antenatal Care (Private Patients) 

Women may be referred for private antenatal care at the WCH. Patients will 
require a letter of referral addressed to one of the  booking  obstetricians by name. 
Further information can be obtained by phoning (08) 8161 7633.  

 

Page 30 

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                                                                                                                                         Page 31 of 35 
 

Maternal Fetal Medicine Unit 

The Maternal Fetal Medicine Unit at the WCH in Adelaide provides a sub-
specialist referral centre to women who are experiencing complicated pregnancies 
and problems with their unborn babies. 

Drug and Alcohol Service SA (DASSA clinic) 

DASSA clinic is available to women who are drug dependent or have had 
previous problems with drugs and/or alcohol. The WCH can provide antenatal 
care for pregnant women attending the clinic if required. 

Parent Education 

Group education sessions on specific topics are available and offered in different 
languages as demand requires. 

Pregnancy to Parenting Group Antenatal Care 

Young women less than 20 years can have midwifery care provided in a group 
setting in partnership with the MY Health Community Liaison Midwife.  Antenatal 
care is provided together with pregnancy labour and birth education in multiple 
two hour group sessions during pregnancy. 

Diabetes education 

Women who develop Gestational Diabetes Mellitus are referred to the Diabetic 
Educator at WCH for an information session and ongoing monitoring.  

Strengthening Links Program and Perinatal Mental Health Program 

All women are screened using the Antenatal Risk Assessment Questionnaire and 
Edinburgh Postnatal Depression Scale.  Women with psychosocial needs are 
referred to the Woman Social Work team.  Perinatal Mental Health team accept 
referrals for assessment and coordination of services for women with significant 
Mental Health/ Psychiatric illness. 

Breast feeding Support 

Lactation consultants dedicated to breastfeeding support are available whist 
women and babies are inpatients. Support continues with LCs will visit at 
home as part of the domiciliary home visiting service or MGP. 

Domiciliary Midwife 

The postnatal domiciliary care service is offered to all women who live within a 
20km radius of the WCH, when they leave the Hospital after their baby is born. 
WCH provides a midwifery home visiting service for up to 5 days. 

Criteria Led discharge 

Women are likely to be discharged from hospital 4-24 hour after a normal birth, 
this is criteria led. Women are offered home visiting through the domiciliary 
service for the first week depending on clinical needs and the baby can be 
referred to the postnatal baby clinic if needed in the first 7 days. 

Neonatal Clinic 

Babies who have been admitted to the WCH nurseries or who have other 
complications will be seen in the neonatal outpatient clinic for up to 12 months. 

 

 

 

 

 



 
                                                                                                                                         Page 32 of 35 
 

Admissions (08) 8161 7508  

Antenatal Bookings (08) 8161 7590      Fax: (08) 8161 6246 

Antenatal/Gynaecology Ward (08) 8161 7726  

Core Laboratory (08) 8161 6704  

Cytogenetics (Amnio/CVS results) (08) 8161 7413  

Day Assessment Unit (08) 8161 7530  

Director of Obstetrics &amp; 
Gynaecology 

(08) 8161 7000  

Drug Information (08) 8161 7222  

Maternal Fetal Medicine (MFM) (08) 8161 9263 Fax: (08) 8161 9264 

Medical Genetics (08) 8161 6281  

Midwifery Group Practice (08) 8161 8406  

Multiple Births Co-ordinator (08) 8161 7520  

Parent Educator (08) 8161 7571  

Physiotherapy (08) 8161 7579  

Private Referrals (08) 8161 7633  

Shared Care Midwife Co-ordinator (08) 8161 7000 Pager 4259 

(8am-4.00pm M - F)  Fax: (08) 8161 8189 
 Social Work (08) 8161 7580  

South Australian Maternal Serum 
Antenatal Screening Program 
(SAMSAS) 

(08) 8161 7285 Fax: (08) 8161 8085 

Ultrasound Bookings  (08) 8161 6055  

Ultrasound Results (08) 8161 7391  

Women s Assessment Service 
(Emergency) 

(08) 81617530  

 

Contact Numbers for the Women s and Children s Hospital 

 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 

 

 
 

  



 
                                                                                                                                         Page 33 of 35 
 

Gawler Health Service (GHS) 

Gawler Health Service provides comprehensive care of women deemed to be 
 low risk , whereby the woman delivers her baby at a gestation greater than or 
equal (i.e. ?) to 37 weeks and the newborn weight is greater than or equal to 
(i.e. ?) 2500gms. 

Antenatal Service 

Midwives manage many low risk ante-natal women in  Zadow Suite . For GP 
Shared Care women, a triage appointment with a midwife is the woman s 
first contact. GP Shared Care clients may be seen by a consultant either at this 
visit or an additional appointment is made for this prior to 20 weeks gestation, if 
required. Obstetric clinics are held in Zadow Suite and the Women's Health 
Centre. GP clinical attachments are offered at these clinics as well. 

Midwifery Group Practice (One 2 One) 

This One 2 One midwifery service enables women to be cared for by the same 
midwife (primary midwife) supported by a small team of midwives throughout 
their pregnancy, during childbirth and in the early weeks postnatal at home. 

Postnatal Service 

For most normal births women are discharged within 3 days of admission. Each 
woman will be visited by a community midwife at least once, (and more if 
needed). 

Women who are experiencing difficulties with breastfeeding after discharge, or 
have any other concerns, are encouraged see their GP in the first instance. 

Baby Friendly Hospital Initiative (BFHI) Accredited 

A World Health Organisation (WHO) initiative to promote, support and encourage 
breastfeeding. GH has been accredited as a BFHI hospital since 2007. 

Childbirth and Parenting Education Sessions 

Various programs are available, including condensed sessions and 
breastfeeding sessions. Alternatively, 1:1 sessions are available through the 
community midwifery service. 

Community Midwifery Service 

A home visiting program operates Monday   Saturday, with women being visited 
in their homes for care and support. Breastfeeding is supported by this service. 

Postnatal Clinic 

This is run in the Zadow Suite and the Women's Health Centre on a weekly basis. 
All women who undergo caesarean section delivery are seen at 2 and 6 weeks. 
Women can choose to have their routine 6 week check with their GP, or at the 
health service. 

Booking Procedures 

GPs may send new patient referrals (indicate  shared care ) via fax to Zadow 
Suite on (08) 8521 2069. The referrals are reviewed by the midwife coordinator, 
a consultant and an appropriate appointment time arranged.  

Contact Numbers for GHS 

Hospital switchboard   (08) 8521 2000 

Antenatal Clinic (Zadow Suite) (08) 8521 2369  Fax: 8521 2069 

Forgie Ward (Inpatients)  (08) 8521 2060 

Community Midwives  (08) 8521 2011 



 
                                                                                                                                         Page 34 of 35 
 

Private Practice Lactation Consultants 

Details available through https://www.breastfeeding.asn.au/ 

References 

1. Royal Australian and New Zealand College Obstetricians and Gynaecologists 
statement: Shared maternity care obstetric patients; Cultural Competency WPI 
20; July 2016. 

2. SA Health Strategic Plan 2017-2020; www.sahealth.sa.gov.au 

3. SA Pregnancy Record Guidelines; 
https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+int
ernet/clinical+resources/clinical+programs/sa+pregnancy+record/sa+pregnanc
y+record+guidelines?contentIDR=6893fc804a00e370b8edfad925144668&amp;use
DefaultText=1&amp;useDefaultDesc=1 

4. National Midwifery Guidelines for Consultation and Referral 3rd Edition Issue 2; 
https://www.midwives.org.au/shop/national-midwifery-guidelines-consultation-
and-referral-3rd-edition-issue-2-book. 

5. Royal Australian and New Zealand College Obstetricians and Gynaecologists 
guideline; Guidelines for locum positions in specialist obstetric and 
gynaecological practice in Australia and New Zealand WPI 12; March 2017. 

Acknowledgements 

The GP Obstetric Shared Care SA Program was established in 2002 as a result 
of an initiative by SA Health, facilitated by the Healthy Start Clinical Reference 
Group (now known as the SA Maternity Neonatal Gynaecology Community of 
Practice - Clinical Reference Work Group). 

The members of the group that participated in the review of the GP OSC SA 
Protocols 2020 were: 

Name Role Unit 

Prof Jodie Dodd Director Women and Babies 
MFM Subspecialist 

Women s &amp; Children s Health 
Network 

Bonnie Fisher Principal Project Manager SA Maternity Neonatal Gynaecology 
Community of Practice 

Assoc Prof 
Rosalie Grivell 

Chair, SA Maternal Neonatal &amp; 
Gynaecology Community of Practice 

MFM Subspecialist &amp; Academic Head 
Department of Obstetrics &amp; 
Gynaecology 

Southern Adelaide Local Health 
Network 

Dr Jenni Goold General Practitioner GP Advisor SA GPOSHC 

Wendy Hermel Midwifery Clinical Service 
Coordinator 

Northern Adelaide Local Health 
Network    

Meredith  Hobbs Divisional Director Nursing &amp; 
Midwifery Women &amp; Children's 
Division  

Northern Adelaide Local Health 
Network    

Lucy King Midwifery Clinical Service 
Coordinator 

Northern Adelaide Local Health 
Network    

Leanne March Program Manager SA 
GPOSHC 

GP Partners Australia Australia 

Jo O Connor Co-Director, Operations, 

Women s and Children s Division 

Southern Adelaide Local Health 
Network 

Heather Purcell Midwifery Clinical Service Coordinator  
Women's Outpatients  

Women s &amp; Children s Health 
Network 

Lisa Walker Midwifery Clinical Service Coordinator 

Women s Outpatients 

Southern Adelaide Local Health 
Network 

Rachael Yates Midwife Manager Maternal &amp; Neonatal 
Services 

Rural Support Unit SA Health 





 
                                                                                                                                         Page 35 of 35 
 

Document Ownership &amp; History 

Developed by: SA Maternal, Neonatal &amp; Gynaecology Community of Practice  
Contact: HealthCYWHSPerintalProtocols@sa.gov.au  
Endorsed by: SA Health Commissioning and Performance Division 
Next review due: 24/04/2025  
ISBN: 978-1-76083-249-0 
PDS reference: CD079 
Policy History: Is this a new policy?   N 
 Does this policy amend or update an existing policy?  Y v4.1 
 Does this policy replace an existing policy?  Y 
 If so, which policies?  SA GP Obstetric Shared Care Protocols 2017 

  

Approval Date Version Who approved New/Revised Version Reason for Change 

10/06/2020 4.2 
Chair, SA Maternal, Neonatal and 
Gynaecology Community of Practice 

Form number added 

14/05/2020 4.1 
Chair, SA Maternal, Neonatal and 
Gynaecology Community of Practice 

Update to GHS contact 
number 

24/04/2020 4.0 
SA Health Commissioning and 
Performance Division 

Reviewed in line with 
scheduled review date 

03/11/2017 3.0 
SA Maternal, Neonatal &amp; Gynaecology 
Community of Practice 

Reviewed in line with 
scheduled review date 

30/06/2015 2.0 
SA Maternal, Neonatal Clinical 
Network 

Reviewed in line with 
scheduled review date 

05/06/2012 1.0 
SA Maternal, Neonatal Clinical 
Network 

Original version 

 


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