A randomised controlled trial of flexibility in routine antenatal care

Jewell, David; Sharp, Debbie; Sanders, Julia; Peters, Tim J.

doi:10.1111/j.1471-0528.2000.tb11614.x

Cited by 31 publications

(37 citation statements)

References 15 publications

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“…The characteristics of the sample are shown in the accompanying paper 1 . The data suggest that this was a predominantly privileged sample: the majority were living with their partners, were in employment and were nonsmokers.…”

Section: Resultsmentioning

confidence: 97%

“…Details of centres, inclusion, recruitment and randomisation are given in the accompanying paper 1 . Women participating in the trial were asked to complete a questionnaire within one week of recruitment.…”

Section: Methodsmentioning

confidence: 99%

“…The main purpose of the study was to measure the change in maternal satisfaction associated with a more flexible approach to antenatal care. Full details of the trial are given in the accompanying paper 1 .…”

Section: Introductionmentioning

confidence: 99%

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The views and anticipated needs of women in early pregnancy

Jewell

Sanders

Sharp

2000

BJOG

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Objective To assess the expectations of antenatal care of pregnant women at the outset of pregnancy.Design Questionnaire study within a randomised controlled trial, comparing traditional antenatal careSetting Eleven primary care centres providing midwifery care in Avon.Population Five hundred and ninety-three pregnant women at low risk of obstetric complications presenting for antenatal care.Methods A questionnaire was completed by women who agreed to participate in the trial shortly after antenatal booking. The questionnaire explored women's views on their attitudes to pregnancy and antenatal care, the locus of control related to pregnancy, the planning of the pregnancy and expectations of care.Main outcome measures Comparisons between nulliparous and multiparous women in terms of their views of antenatal care, and their stated preference for a particular package of care.Results There was no difference in their views of pregnancy as an event entailing risk. On a locus of control scale that measured women's perceptions of factors which might affect their babies' health, nulliparous women rated antenatal care higher than multiparous women ( P = 0.OOOl). However, this was not associated with any difference between the two groups in their stated preference for traditional or flexible care. Approximately half of the women expressed no preference, and of those who did 61% would opt for traditional care. Almost one-fifth of the whole sample welcomed the idea of flexible care.Discussion These data support the evidence of previous studies that there remains a strong desire among pregnant women to receive a 'traditional' pattern of care, even among those who have previously experienced normal pregnancy. However, a minority can be identified at the outset of pregnancy who may welcome a change to a more flexible pattern of care.with a more flexible schedule.

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Section: Resultsmentioning

confidence: 97%

Section: Methodsmentioning

confidence: 99%

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The views and anticipated needs of women in early pregnancy

Jewell

Sanders

Sharp

2000

BJOG

Self Cite

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“…Chronologically, they were quite close together (published 1996–2000). Women’s satisfaction levels were lower in three studies ([48–50]). Only one study showed a slight increase in satisfaction ([51]), although the sample size was very small ( n = 43 intervention, n = 38 control).…”

Section: Resultsmentioning

confidence: 99%

Antenatal care trial interventions: a systematic scoping review and taxonomy development of care models

Symon

Pringle

Downe

et al. 2017

BMC Pregnancy Childbirth

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BackgroundAntenatal care models vary widely around the world, reflecting local contexts, drivers and resources. Randomised controlled trials (RCTs) have tested the impact of multi-component antenatal care interventions on service delivery and outcomes in many countries since the 1980s. Some have applied entirely new schemes, while others have modified existing care delivery approaches. Systematic reviews (SRs) indicate that some specific antenatal interventions are more effective than others; however the causal mechanisms leading to better outcomes are poorly understood, limiting implementation and future research. As a first step in identifying what might be making the difference we conducted a scoping review of interventions tested in RCTs in order to establish a taxonomy of antenatal care models.MethodsA protocol-driven systematic search was undertaken of databases for RCTs and SRs reporting antenatal care interventions. Results were unrestricted by time or locality, but limited to English language. Key characteristics of both experimental and control interventions in the included trials were mapped using SPIO (Study design; Population; Intervention; Outcomes) criteria and the intervention and principal outcome measures were described. Commonalities and differences between the components that were being tested in each study were identified by consensus, resulting in a comprehensive description of emergent models for antenatal care interventions.ResultsOf 13,050 articles retrieved, we identified 153 eligible articles including 130 RCTs in 34 countries. The interventions tested in these trials varied from the number of visits to the location of care provision, and from the content of care to the professional/lay group providing that care. In most studies neither intervention nor control arm was well described. Our analysis of the identified trials of antenatal care interventions produced the following taxonomy: Universal provision model (for all women irrespective of health state or complications); Restricted ‘lower-risk’-based provision model (midwifery-led or reduced/flexible visit approach for healthy women); Augmented provision model (antenatal care as in Universal provision above but augmented by clinical, educational or behavioural intervention); Targeted ‘higher-risk’-based provision model (for woman with defined clinical or socio-demographic risk factors). The first category was most commonly tested in low-income countries (i.e. resource-poor settings), particularly in Asia. The other categories were tested around the world. The trials included a range of care providers, including midwives, nurses, doctors, and lay workers.ConclusionsInterventions can be defined and described in many ways. The intended antenatal care population group proved the simplest and most clinically relevant way of distinguishing trials which might otherwise be categorised together. Since our review excluded non-trial interventions, the taxonomy does not represent antenatal care provision worldwide. It offers a stable and reproduc...

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“…Maternal satisfaction is certainly one valid measure of outcome, but other consequences — maternal and paediatric, physical and psychological — must also be considered. Continuity of care is desirable from the maternal point of view, but it must be appropriate to the situation, and there must be understanding between all those participating, including women themselves, that sometimes transferring responsibility of care is in the best interests of the baby 24 . Within the hospital settings that most Australian women currently choose for the births of their babies, maternal satisfaction will be greatest, and outcomes for mothers and babies best, when midwives and obstetricians work in a complementary way, the first dealing largely with the normal, and the second largely with the abnormal.…”

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confidence: 99%

Throwing out the baby with the spa water?

Costa

Robson

2004

Medical Journal of Australia

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Australia is now one of the safest countries in the world in which to be born. This is largely a result of the many advances in obstetric and neonatal medicine of the past 50 years. However, the “medicalisation” of birth has tended to diminish women's satisfaction with their experience of childbirth. It has been shown that women are most satisfied by care from a single practitioner, and when they themselves have input into decision‐making. Although maternal satisfaction is important, it should not be promoted at the expense of the health of mothers and babies. More realistic antenatal education and preparation should be available for all pregnant women so that both maternal satisfaction and good perinatal outcomes can be achieved.

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A randomised controlled trial of flexibility in routine antenatal care

Cited by 31 publications

References 15 publications

The views and anticipated needs of women in early pregnancy

The views and anticipated needs of women in early pregnancy

Antenatal care trial interventions: a systematic scoping review and taxonomy development of care models

Throwing out the baby with the spa water?

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