title: The effectiveness of a Chinese midwives' antenatal clinic service on childbirth outcomes for primipare: a randomised controlled trial.
abstract: BACKGROUND
  Antenatal care is an important component of maternity care. In many parts of the world, midwives are the primary caregivers for childbearing women, providing a high level of continuity of care during a normal pregnancy. While in China, obstetricians are the primary providers of antenatal care for all childbearing women; and midwives only provide intrapartum care to labouring women. Today midwifery as a profession in China has been marginalised. Pregnant women usually lack individualised continuity of care from midwives during the perinatal period. There have been few randomised controlled trials of midwifery care practice in mainland China.
  
  
  OBJECTIVE
  (1) To develop and implement a model of Chinese midwives' antenatal clinic service and (2) to explore its effect on childbirth outcomes, psychological state and satisfaction, for primiparae.
  
  
  METHODS
  Two-group randomised controlled trial. One hundred and ten pregnant women were assessed for eligibility and invited to participate in either the intervention group (midwives' antenatal clinic service) or the control group (routine antenatal care) in the Obstetrics and Gynaecology Hospital of Fudan University from September 2011 to December 2011. Baseline data were collected, and then women were randomised to individual midwives' antenatal clinic care (intervention group) or regular antenatal clinic service by obstetricians and obstetric nurse (control group). The research hypothesis was that compared with regular obstetrician-led antenatal care, the midwives' antenatal clinic service would decrease the caesarean section rate, produce more favourable birth outcomes and women's greater satisfaction with care. Data were collected by retrospective review of case records and self-report questionnaires. The sample size of 110 was calculated to identify a decrease in caesarean birth from 70% to 40%. Birth outcomes, satisfaction and anxiety score in the two groups were compared.
  
  
  METHODS
  The midwives' antenatal clinic in the Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China.
  
  
  METHODS
  55 women, attending the midwives' antenatal clinic (the intervention group) and 55 women, entering the control group.
  
  
  RESULTS
  Women in the intervention group were more likely than women in the control group to have a vaginal birth (35 [66.04%] versus 23 [43.40%]; 95% CI for difference 3.69-41.60). Women in the intervention group had a higher perinatal satisfaction but lower anxiety score than those in the control group. No differences were seen in neonatal Apgar score and in the amount of bleeding 2h post partum.
  
  
  CONCLUSIONS
  The midwives' antenatal clinic can decrease the rate of caesarean section and enhance women's satisfaction with midwifery care. Further research needs to be conducted to implement this model of care more widely. We will attempt to make midwifery care a true choice for Chinese women.
authors.affiliation: Nursing Department, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China. Electronic address: guchunyi@hotmail.com.
authors.forename: Chunyi
authors.initials: C
authors.lastname: Gu
authors.forename: Xiaodan
authors.initials: X
authors.lastname: Wu
authors.forename: Yan
authors.initials: Y
authors.lastname: Ding
authors.forename: Xinli
authors.initials: X
authors.lastname: Zhu
authors.forename: Zheng
authors.initials: Z
authors.lastname: Zhang
mesh_terms: D002681:China; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D009721:Nurse Midwives; D010298:Parity; D011247:Pregnancy; D011256:Pregnancy Outcome
keywords: Antenatal clinic; Caesarean section; Maternal satisfaction; Midwife; Model of care