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Maternity Services

Just found out you're pregnant?

Here's what to do next...

Need to consider your pregnancy options?

If you are pregnant and worried, you are not alone, we are here to help.

We are a holistic service based at Lancashire Teaching Hospitals for women stressed by an unwanted pregnancy who wish to discuss their options.

We pride ourselves on providing high quality care before, during and after treatment and make sure that you have enough support to help you to make the decision that is best for you.

We will support you every step of the way.

Please see Termination of Pregnancy (Abortion) Service for more information.

 

Self-referral service for Lancashire Teaching Hospitals ( Includes Royal Preston Hospital and Chorley and South Ribble Hospital)

As soon as you find out you are pregnant you have the option to book your maternity care directly with Lancashire teaching Hospitals instead of seeing your GP; we encourage you to do this as soon as possible so you can see your midwife and have your early screening tests.

Note: Questions marked by * are mandatory

Please answer the questions as fully as possible as this will enable us to ensure you receive the most appropriate care.

When you submit the form our booking team will arrange your first booking appointment and also notify your GP of your pregnancy. Your first booking appointment will be sent to you via the email address you provide.

It is now routine practice for women to be seen on their own for the first 10 minutes of their appointment

Your booking appointment will between 9-11 weeks of pregnancy.

If you do not receive an appointment within three weeks then please call us on 01772 524726

 

Birth Location Preferences

Your option for birth*


About You

First Name*

Your Surname (family name)*

Previous Name*

Date of Birth*

Day

Month

Year

Address Line 1*

Address Line 2

Address Town*

Address County

Address Post Code*

Current contact phone number*

Is it ok to send you a text message?

Email Address*

Alternative email address (in case the above email address doesn't work)

Are you a smoker?

The risks of smoking during pregnancy are serious. To give your baby the best start in life we will refer you for support in stopping. Respond “No” if you do not agree for your details to be shared with the QuitSquad?

Do you need an interpreter/British Sign Language?*

If yes, what language

Do you have any mobility, sight, hearing or other particular needs that we should be aware of to help prepare for your appointment?

If yes, please provide details


GP Surgery Details

The name of your GP Doctor*

GP practice address*


Current Pregnancy Information

Date of last period (first day)*

Day

Month

Year


Previous Pregnancy Information

Have you been pregnant before?*

If yes how many times have you been pregnant? (Including this pregnancy)

How many children have you had?

Were any of your children born before 34 weeks gestation?

Have you had any miscarriages?

If yes, have you have experienced 3 or more miscarriages in a row?

Is there anything else you think we should know about your previous pregnancies?


Medical History

Do you have diabetes?

Do you have epilepsy?

Do you have mental health problems?

Have you experienced a blood clot in your leg or lungs e.g. DVT

Have you experienced ectopic pregnancy

Do you have Renal (kidney) disease?

Do you have a respiratory (breathing) disease such as severe asthma?

Do you have heart disease?

Do you have a blood disorder?

Do you have an auto-immune disease?

Do you have high blood pressure?

Do you have any other health conditions that we should know about you?

Is there anything else that you think we should know about you? (e.g. had care at another trust and want to transfer to LTHTr? Availability? Information given to you after a previous pregnancy regarding future pregnancies?)


BadgerNet and Maternity Notes

This is a mandatory field. Badger Notes: We use paperless notes with CleverMed's Badger Notes App through BadgerNet , this allows you to access your maternity records via your smart phone, tablet or PC. BadgerNet will send occasional emails, text message and push notifications (e.g. appointment reminders) through the maternity app. Please see here (https://www.lancsteachinghospitals.nhs.uk/badgernet) for more information about privacy and your data usage. Are you are happy with the information above regarding the maternity notes portal, to have emails, texts and push notifications from the app and consent to use the Maternity Notes app?*

Next steps: After you have submitted your referral, we will aim to have it processed within TWO WEEKS. You will receive an NHS email from us with your activation phrase and an email from CleverMed to sign up to Badger Notes (it will say you will get an activation phrase from your midwife - please ignore this, it will be sent in the previously mentioned NHS email). Your booking appointment will be arranged by your midwife before you are 13 weeks of pregnancy and will appear on the app.

Get in touch

Chorley and South Ribble Hospital

Preston Road

Chorley

PR7 1PP

01257 261222

Royal Preston Hospital

Sharoe Green Lane

Fulwood

Preston

PR2 9HT

01772 716565

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