Women's health toolkit

Pregnancy and the postnatal period

Antenatal and intrapartum care have become much more the domain of secondary care over the last few decades. Only 2% of births take place at home and the concept of the ‘obstetric flying squad’ is now historical, with the understanding that it is safer to transport women who are having obstetric complications to a hospital, rather than trying to bring the hospital to the woman. We will however see pregnant women who present with new symptoms, or a worsening of existing medical conditions, some of whom will be at a high-risk of pregnancy-related complications. We also need to consider the risk:benefit balance when prescribing in pregnancy, as many medicines are not licensed for pregnant women. The cohort of women who are having babies is, on average, older than in the past - the number of women who are pregnant in their 40s has doubled since the 1990s. An increasing number of pregnant women have multimorbidities, with one registry study showing that nearly one-quarter of pregnant women had multimorbidities which were active in the year before delivery. Significant issues include obesity, mental health problems and pre-existing cardiac disease, which were relevant to 82%, 25% and 10% of maternal deaths in the last MBRRACE-UK report respectively

Management in the post-natal period is largely done in primary care – this is a risky time for a woman, with the risk of venous thromboembolism being higher in the early post-natal period than during pregnancy. 52% of maternal deaths occur between 1 and 41 days after delivery. Whilst the risk from physical health decreases significantly as time passes, the same cannot be said for mental health risks; the 2023 MBRRACE-UK report showed that nearly 40% of deaths from mental health related causes occurred between six weeks and one year after the end of pregnancy. The professional carrying out a woman’s post-natal check should always specifically enquire about mental health. We are also responsible for the 6-8 week baby check, which may pick up significant health issues and for prescribing to breastfeeding women, where drug licences are often also notable by their absence.

More information can be found in the following resources:

• NICE CKS pages on antenatal care in the uncomplicated pregnancy, depression in the antenatal and post-natal period and hypertension in pregnancy.

• NICE guidance on antenatal care, and weight management before, during and after pregnancy.

• RCPsych resources on postpartum psychosis for carers and perinatal mental health services; the second resource may be more useful for commissioning GPs.

• Resources on prescribing and vaccination in pregnancy – BUMPS (best use of medicines in pregnancy), UK teratology information service main page on exposure to medicines, vaccines, chemicals and radiation during pregnancy, RCOG information on the COVID-19 vaccine and pregnancy/breastfeeding, and information from the specialist pharmacy service.

• Resources on prescribing for breastfeeding women from the specialist pharmacy service and the breastfeeding network.

• A useful summary from the GP infant feeding network of how to approach a request to prescribe domperidone to improve breastmilk supply.

• RCGP eLearning and EKU resources on antenatal care, including on vaccination in pregnancy and the management of physical symptoms and nausea and vomiting during pregnancy.

• RCGP screencasts on lactational atrophic vulvovaginitis, perinatal mental health and nausea and vomiting in pregnancy.

• RCGP eLearning course on breastfeeding.

• FSRH guidance on contraception after pregnancy.