The Keeping Childbirth Natural and Dynamic (KCND) programme

KCND is a national programme established to ensure the implementation of maternity policy in practice. The programme aims to ensure all women have a robust assessment of their needs in early pregnancy; are offered the most appropriate care pathway for their need; and have care provided by the most appropriately skilled maternity professional. The programme promotes multi-professional working and is progressing in partnership with women’s representatives, professional Royal Colleges and NHS boards.

The objectives of the KCND programme are:

  1. Implementation of national multi-professional care pathways. These pathways are now in place across NHS Scotland, which will facilitate robust risk assessment in early pregnancy and timely intervention for women and families with additional medical or social need. The pathways identify the most appropriate care pathway for individual need and the most appropriately skilled professional to deliver that care.
  2. Implementation of the Lead maternity professional based on risk
    Normally a midwife has responsibility for the care of women experiencing a normal pregnancy and an obstetrician, supported by the maternity team, for those with factors that could adversely affect the outcome for mother and/or baby.  A woman’s general practitioner (GP) will continue to look after her general medical care and participate in antenatal care as desired.
  3. Implementation of the midwife to act as first point of professional contact in pregnancy
    To facilitate seamless access to maternity services, all pregnant women will be offered the option of seeing a midwife as their first contact from December 2009. This is in place in most NHS boards, however any women who wishes to continue to see her GP should be supported to do so.

It is important to note that women do not need to see a GP to seek confirmation of their pregnancy. If they have missed a period and a home pregnancy test has produced a positive result, no further confirmation is required. This has been standard practice for some time.

It should be recognised that for some vulnerable women self diagnosis of pregnancy using a home pregnancy kit may not be possible, therefore initial diagnosis will be required by the GP or family planning clinic.

To comply with the maternity care pathways, maternal history taking should begin with this first contact, with relevant information being documented in the Scottish Woman Held Maternity Record. In order to ensure the correct care pathway is identified, it is essential that accurate records are taken and there is a quality social needs assessment. Assessments require midwives to take information on sensitive issues such as gender-based violence and therefore it is essential that they receive the correct level of support and training to develop these skills. The Inequalities Sensitive Practice Initiative is a resource produced to support professionals to deliver quality social needs assessments.

Women will also be able to access the enhanced screening programmes through early contact with maternity services. Key public health messages should be delivered regarding first contact and women should be offered the most appropriate care pathway for their need. 

Communication between the midwife and GP is essential and therefore, where midwives undertake first contact, they will have a duty to communicate outcomes to the woman’s GP and refer women to GP services as required.

Women experiencing high risk pregnancies, who would therefore benefit most from early contact with maternity services, may be in contact with other services such as drug or alcohol addiction, housing or social work.  It is important that professionals working in these services signpost women to the support delivered by maternity services at the earliest possible stage.

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