My Maternity Passport

Patient and Carer Information

Easy Read Patient Information Leaflets on the trust website can be accessed via the link below:

https://www.wwl.nhs.uk/patient-information-leaflets?letter=E#

Or scan the QR Code.

Document Details

• Author ID: SH/ LT / KR
• Leaflet ref: ER 009
• Version: 2
• Leaflet title: My Maternity Passport – Easy Read
• Last review: September 2022
• Expiry Date: September 2024

About Me

My Personal Details

• My Name is:
• I like to be called:
• My Date of birth is:
• My age is:
• My Unit Number is:
• My NHS No. is:
• My address is:
• Post Code:
• Telephone number:
• My next of kin is:
• The people named below are available to help me in my pregnancy:
• My Care Package is:

Living Arrangements

• I live with … Family, Carers, Alone
• I live in a … House, Bungalow, Flat, Residential Home, Nursing Home, Other (please state)

Religious Information

• My religion is:
• My religious requests are:

My Medical Information

Doctor Details

• My Doctor is:
• Address:
• Post Code:
• Telephone number:

Health Checks

Do I access my Annual Health Check offered by my Doctor?

• Information on Annual Health Checks given: Yes / No

Medication and Medical History

• How Do I take my medication
• A Brief Medical History (including past procedures)

Current Medical Conditions and Allergies

• My Current Medical Conditions:
• My Allergies are:

Pain Management

• How do I tell you that I am in pain

Reasonable Adjustments

• What Reasonable adjustments do I need
• Does someone need to stay with me in hospital: Yes / No
• All of the time: Yes / No
• Overnight: Yes / No
• Details:

How Best to Support Me

• How to take my blood:
• How to give me injections:
• How to take my temperature:
• How to give me intravenous (IV) fluids (fluid through a drip)
• How to take my blood pressure (e.g. what size of cuff do I need, do I need some reassurance)
• How to give me an x-ray or scan:

My Likes and Dislikes

• Things I like, what is important to me:
• Things I don’t like, what anxieties do I have:

Sleep Pattern

• What is my sleep pattern /sleep routine

Understanding of Risk

• Would I take somebody else’s medication
• Would I wander from the ward and not know how to get back

Communication

• How do I communicate: I use sign language, I speak, I use pictures and timelines, Other (please state)

Hearing and Sight

• Are there any issues with my hearing: Yes / No
• Are there any issues with my eyesight: Yes / No

My Needs

Eating

• Do I have a special diet: Yes / No
• Does someone need to help me to be able to eat food: Yes / No
• Do I feel confident to collect my own meals on the ward or does someone need to bring my meals to my bed: Yes / No

Drinking

• Do I use a special cup: Yes / No
• Do I need supervision: Yes / No
• Other (please state):

Mobility

• Am I able to move around without any help: Yes / No
• Details:
• Do I need equipment to assist me to move around: Yes / No
• Details:

Personal Care

• What support do I need to have a wash?
• What support do I need to brush my teeth?
• What support do I need to wash my hair
• What help do I need to dress myself
• What help do I need with periods/bleeding:
• Do I need help with sanitary towels
• Do I need pain relief: Yes / No
• How do I show that I need to use the toilet
• Do I need help: Yes / No
• Do I need incontinence pads: Yes / No

Support for my Baby

• What support do I need to care for my baby?
• Easy read feeding guide: Yes / No
• 1-1 Help: Yes / No
• Tour of the ward before admission: Yes / No
• Someone to stay in hospital with me to help look after baby: Yes / No
• Help with washing and changing baby clothes: Yes / No
• Help with changing baby’s nappy: Yes / No
• Help with feeding baby: Yes / No

Additional Information

Useful phone numbers:

• Maternity ward: 01942 778506
• Delivery Suite: 01942 778505
• Safeguarding Team: 01942 778600
• Learning disability Liaison team: 01942 483061

Designed for pregnant women who may benefit from reasonable adjustments during pregnancy and birth. This document was created by WWL NHS Foundation Learning Disability Hospital Liaison Team/Named Midwife safeguarding, and the Accessible Communication Team. This document acknowledges the use of symbols provided by: Anthony Hobson (self-advocate), Pixabay and creativecommons.org

Contact Us

The Patient Relations/Patient Advice and Liaison Service (PALS) Department can give advice, information and support to patients, relatives, friends and carers.

Contact us by:

• Phone: 01942 822 376 (Monday to Friday 9am to 4pm)
• Post: The Patient Relations/PALS Manager, Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Royal Albert Edward Infirmary, Wigan Lane, Wigan WN1 2NN

Ask 3 Questions

You should try to be included in decisions about your healthcare. You might be asked to make choices about your treatment. To help you decide, you should get the answers to these 3 questions:

1. What are my options?
2. What are the good things and bad things about each option?
3. How do I get support to make the right decision for me?

How We Use Your Information

To find out how we collect, use and store your information, go to the Trust website: www.wwl.nhs.uk

Last modified 18th September 2025 04:24:28 am