title: Evaluating midwife-led antenatal care: choice, experience, effectiveness, and preparation for pregnancy.
abstract: OBJECTIVE
  to evaluate midwife-led care (MLC) antenatal care compared with antenatal care provided in traditional obstetric-led hospital antenatal clinics (usual care).
  
  
  METHODS
  a mixed methods approach involving a chart audit, postal survey, focus group and in-depth interviews.
  
  
  METHODS
  data were collected at a large maternity hospital and satellite clinics in Dublin from women attending for antenatal care between June 2011 and May 2012.
  
  
  METHODS
  300 women with low-risk pregnancy who attended midwife-led antenatal care or usual clinics during the study period were randomly selected to participate.
  
  
  METHODS
  data were collected from 292 women׳s charts and from 186 survey participants (63% response rate). Nine women participated in in-depth interviews and a focus group.
  
  
  RESULTS
  MLC was as effective as usual care in relation to number of antenatal visits and ultrasound scans, referral to other clinicians, women׳s health in pregnancy, gestation at childbirth, and birth weight. Women attending MLC booked significantly earlier, fewer women attending MLC were admitted to hospital antenatally and more women breast fed their infant. Women attending MLC reported better choice and that shorter waiting times and having more time for discussion were important reasons for choosing MLC. Women attending MLC reported a better experience overall, and recorded better outcomes in relation to how they were treated, along with easier access to antenatal care and shorter waiting times to see a midwife. Although women attending MLC clinics reported higher satisfaction with the information that they received, they also identified that antenatal education could be improved in relation to labour, breast-feeding, depression and emotional well-being, and caring for the infant.
  
  
  CONCLUSIONS
  midwife-led antenatal care was as effective as usual care for women with low-risk pregnancy and better in relation to choice, breast feeding and women׳s experience of care.
authors.affiliation: Department of Family Practice, University of British Columbia, Vancouver, Canada. Electronic address: michelle.butler@midwifery.ubc.ca.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Butler
authors.affiliation: National Maternity Hospital, Dublin, Ireland.
authors.forename: Lucille
authors.initials: L
authors.lastname: Sheehy
authors.affiliation: National Maternity Hospital, Dublin, Ireland.
authors.forename: Mary Maureen
authors.initials: MM
authors.lastname: Kington
authors.affiliation: School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland.
authors.forename: Maura C
authors.initials: MC
authors.lastname: Walsh
authors.affiliation: National Maternity Hospital, Dublin, Ireland.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Brosnan
authors.affiliation: National Maternity Hospital, Dublin, Ireland.
authors.forename: Martina
authors.initials: M
authors.lastname: Murphy
authors.affiliation: Florence Nightingale School of Nursing and Midwifery, King׳s College London, UK.
authors.forename: Corina
authors.initials: C
authors.lastname: Naughton
authors.affiliation: Faculty of Health Sciences, University of Southampton, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Drennan
authors.affiliation: National Maternity Hospital, Dublin, Ireland.
authors.forename: Theresa
authors.initials: T
authors.lastname: Barry
mesh_terms: D000328:Adult; D002755:Choice Behavior; D003266:Continuity of Patient Care; D005260:Female; D006801:Humans; D008880:Midwifery / Q000379:methods / Q000592:standards*; D017060:Patient Satisfaction; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000379:methods / Q000592:standards*; D011795:Surveys and Questionnaires
keywords: Antenatal care; Midwife-led care; Midwifery; Outcome assessment