The Royal Hospital for Women model of care – Sydney, Australia

The Royal Hospital for Women is a quaternary stand-alone Obstetric hospital in New South Wales (NSW), Australia, which offers a number of different models of care for pregnant women with asthma, depending on their asthma severity. 

  1. Those with mild asthma are managed in midwifery-led teams with support from both general practitioners and obstetricians. 
  2. Those with moderate symptoms are managed in a shared care setting by general practitioners, with support from hospital-based Obstetric Physicians, and
  3. Those with severe disease are managed in a high risk setting by obstetric physicians with close communication with, and input from, the woman’s personal respiratory physician. Within these clinics, care is optimised through a review of the current symptoms, the Asthma Management plan, inhaler technique and peak flow monitoring.  Should escalation of therapy be required, this is initiated by the Obstetric Physician and monitored accordingly.

Within these different models of care, emphasis is on regular review of symptoms (every 4-6 weeks depending on severity), and provision of clear advice on management.  Reassurance on the safety of medications in pregnancy is provided, along with the contact details of MotherSafe,  a medication-in-pregnancy safety advice line in NSW. Avoidance of triggers, smoking cessation and personal monitoring of symptoms is encouraged, and discussed at each visit. 

Should deterioration be identified, there are multiple pathways of escalation available, initially referral to the general practitioner, or if ongoing concerns, via a written referral to the Obstetric Physician team based at the Royal. 

Clear communication is facilitated through letters to the general practitioner and respiratory physician at each visit, along with documentation into our online maternity record, eMaternity at every midwifery, physician and obstetric review.