Midwife Antenatal Assessment

Initial Assessment

• Aroha Campbell (NHI: ZXC4582), 34+2 weeks gestation.
• Aroha presented well and engaged throughout the visit.
• Routine antenatal appointment.
• Feeling well overall since last review, though experiencing mild nocturnal gastro-oesophageal reflux and occasional pelvic girdle discomfort.
• Attended with her partner, Liam Campbell.
• Enjoyed a family baby shower over the weekend in Taupō.
• Reviewed by maternity physiotherapy last week for pelvic girdle pain; pelvic support belt fitted with good effect.
• Has one dog named Kahu (Labrador) and a cat named Milo.

Physical Assessment

• BP: 116/72 mmHg.
• Urinalysis: NAD (protein negative, glucose negative, leukocytes negative).
• Palpation: Longitudinal lie, cephalic presentation, left occipito-anterior (LOA) position, head 4/5 palpable above pelvic brim. Fundal height 34 cm.
• FHR: 142 bpm via Doppler, regular rhythm, accelerations heard on auscultation.
• FM: Active and regular, consistent with normal diurnal pattern.
• GROW chart: Fundal height plotted at 34 cm, tracking consistently along the 50th customised centile.
• Mild postprandial reflux; no nausea or vomiting.
• Taking iodine and iron supplements.
• Nil symptoms of PET.
• Immunisations up to date for pregnancy.
• Nil headaches, visual disturbances, epigastric pain, or significant oedema (trace physiological ankle oedema only at end of day).

Blood and Scan Results

• Bloods (28/03/2025): Hb 118 g/L, Ferritin 32 µg/L, Blood group O Positive, antibodies negative. HbA1c 34 mmol/mol.
• Anatomy scan (20+1 weeks): Normal fetal morphology, anterior placenta clear of os. No subsequent growth scans required.

Medications

• Potassium iodate (Neurokare®) 150 mcg PO daily; ferrous fumarate (Ferro-tab®) 200 mg PO daily.
• Boostrix® (dTpa) given at 28 weeks; Influenza vaccine given at 30 weeks; COVID-19 booster declined as had recent infection 4 months ago.
• Commenced omeprazole (Losec®) 20 mg PO daily for symptomatic reflux.
• Prescription provided for omeprazole 20 mg PO daily (90 days supply).

Emotional/Social

• Coping well with pregnancy; feels well supported by midwifery and GP team with no concerns regarding care.
• Mood euthymic, Edinburgh Postnatal Depression Scale (EPDS) score 4.
• Excited and feeling strongly connected to baby, especially when feeling movements.
• Strong, supportive relationship with partner Liam and extended whānau living locally.
• Meeting friends regularly for coffee and attending weekly antenatal yoga classes.
• Works as a primary school teacher; finishing work at 36 weeks to commence 12 months parental leave.

Preparation for Baby

• Discussed colostrum harvesting; plans to commence at 37 weeks. Colostrum collection kit supplied.
• Pram, bassinet, and baby bath purchased.
• Capsule hired from Baby On The Move, installed in vehicle.
• Sufficient newborn and 0–3 month merino and cotton clothing washed and ready.
• Purchased two packs of disposable newborn nappies; intending to transition to cloth nappies at 4 weeks.
• Nursery set up completed, with bassinet placed in parents' bedroom for the first 6 months.
• Registered with Plunket for postnatal well-child care.
• Aroha's mother will stay for the first two weeks postpartum to assist with household tasks.

Education

• Discussed ongoing monitoring of fetal movements, safe sleep practices (SUDI prevention/PEPE principles), and perineal massage from 35 weeks.
• Provided Ministry of Health "Keep Your Baby Safe During Sleep" pamphlet and colostrum harvesting instruction sheet.

Referrals

• Ongoing care with Maternity Physiotherapy for pelvic girdle pain management.

Birth Plan

• Planning primary birthing unit or hospital birth at Auckland City Hospital.
• Environment: Dimmed lighting, own music playlist, freedom to mobilise, and use of birthing pool for immersion during first stage.
• Pain relief preferences: Non-pharmacological methods initially (water immersion, TENS machine hired privately), open to Entonox (nitrous oxide/oxygen). Prefers to avoid morphine; open to epidural only if labour is prolonged or augmented.
• Monitoring: Intermittent auscultation with Doppler if low risk continues; consents to continuous CTG if clinically indicated.
• Immediate postpartum: Immediate skin-to-skin contact with Aroha (or Liam if Aroha is unavailable).
• Cord management: Delayed cord clamping until pulsation ceases; Liam wishes to cut the cord.
• Third stage: Active management with oxytocin 10 IU IM consented.
• Placenta: To take home for burial (whenua ki te whenua); container prepared.
• Vitamin K: Consents to phytomenadione (Konakion MM®) 1 mg IM at birth.
• Feeding: Plans to exclusively breastfeed.
• Adverse outcomes: In the event of assisted delivery or Caesarean section, requests clear communication throughout, Liam present in theatre, immediate skin-to-skin in theatre if stable, and delayed cord clamping if safe.
• Advised to contact midwife on call if contractions are regular (every 5 minutes, lasting 45–60 seconds), upon spontaneous rupture of membranes (SROM), any vaginal bleeding, or reduced fetal movements.

Plan

• Routine 36-week bloods (FBC and group & screen) form provided to complete prior to next visit.
• Next appointment scheduled in 2 weeks at 36+2 weeks gestation (15/05/2025 at 10:00).
• Continue ferrous fumarate and potassium iodate; trial omeprazole for reflux and continue physiotherapy exercises.
• Review 36-week blood results, discuss Group B Streptococcus (GBS) screening options, and review postnatal care expectations at next visit.