title: Should obstetricians see women with normal pregnancies? A multicentre randomised controlled trial of routine antenatal care by general practitioners and midwives compared with shared care led by obstetricians.
abstract: OBJECTIVE
  To compare routine antenatal care provided by general practitioners and midwives with obstetrician led shared care.
  
  
  METHODS
  Multicentre randomised controlled trial.
  
  
  METHODS
  51 general practices linked to nine Scottish maternity hospitals.
  
  
  METHODS
  1765 women at low risk of antenatal complications.
  
  
  METHODS
  Routine antenatal care by general practitioners and midwives according to a care plan and protocols for managing complications.
  
  
  METHODS
  Comparisons of health service use, indicators of quality of care, and women's satisfaction.
  
  
  RESULTS
  Continuity of care was improved for the general practitioner and midwife group as the number of carers was less (median 5 carers v 7 for shared care group, P<0.0001) and the number of routine visits reduced (10.9 v 11.7, P<0.0001). Fewer women in the general practitioner and midwife group had antenatal admissions (27% (222/834) v 32% (266/840), P<0.05), non-attendances (7% (57) v 11% (89), P<0.01) and daycare (12% (102) v 7% (139), P<0.05) but more were referred (49% (406) v 36% (305), P<0.0001). Rates of antenatal diagnoses did not differ except that fewer women in the general practitioner and midwife group had hypertensive disorders (pregnancy induced hypertension, 5% (37) v 8% (70), P<0.01) and fewer had labour induced (18% (149) v 24% (201), P<0.01). Few failures to comply with the care protocol occurred, but more Rhesus negative women in the general practitioner and midwife group did not have an appropriate antibody check (2.5% (20) v 0.4% (3), P<0.0001). Both groups expressed high satisfaction with care (68% (453/663) v 65% (430/656), P=0.5) and acceptability of allocated style of care (93% (618) v 94% (624), P=0.6). Access to hospital support before labour was similar (45% (302) v 48% (312) visited labour rooms before giving birth, P=0.6).
  
  
  CONCLUSIONS
  Routine specialist visits for women initially at low risk of pregnancy complications offer little or no clinical or consumer benefit.
authors.affiliation: Department of Epidemiology and Public Health, University of Dundee, Ninewells Hospital and Medical School.
authors.forename: J S
authors.initials: JS
authors.lastname: Tucker
authors.forename: M H
authors.initials: MH
authors.lastname: Hall
authors.forename: P W
authors.initials: PW
authors.lastname: Howie
authors.forename: M E
authors.initials: ME
authors.lastname: Reid
authors.forename: R S
authors.initials: RS
authors.lastname: Barbour
authors.forename: C D
authors.initials: CD
authors.lastname: Florey
authors.forename: G M
authors.initials: GM
authors.lastname: McIlwaine
mesh_terms: D002985:Clinical Protocols; D005194:Family Practice; D005260:Female; D006176:Gynecology; D006771:Hospitals, Maternity; D006801:Humans; D008880:Midwifery; D010342:Patient Acceptance of Health Care; D010348:Patient Care Team; D017060:Patient Satisfaction; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000379:methods / Q000458:organization & administration* / Q000706:statistics & numerical data; D011787:Quality of Health Care; D012306:Risk; D012606:Scotland