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This article describes the implementation and evaluation of a programme of care at the Midwifery Development Unit, Glasgow Royal Maternity Hospital. This care programme is being provided as part of a ‘Choices for Care’ initiative.

Policy makers involved in planning maternity services should evaluate the effects on women receiving care as well as the implications for the NHS. This study considered the effect on women and their families receiving a new style of midwife-managed care in the antenatal period, in terms of both the cost to themselves and their satisfaction with the accessibility of care. This study was carried out as part of a randomized controlled trial to compare midwife-managed care with the traditional model of shared care. The setting for the randomized controlled trial was the Glasgow Royal Maternity Hospital, a major urban teaching hospital providing an integrated maternity service. The results demonstrated that decisions concerning the frequency and location of antenatal visits have significant cost implications for women and their families. The costs to women of attending antenatal clinics in different settings were found to vary widely. Women receiving midwife-managed antenatal care had slightly lower costs than women attending for shared care and higher levels of satisfaction with the accessibility of care.

The paucity of research examining effects of a known carer during labour has been highlighted by a number of authors. This paper compares clinical and psycho-social outcomes of women cared for by a known midwife during labour with those cared for by an unknown associate midwife. Economic implications are also discussed.