title: Midwifery-led antenatal care models: mapping a systematic review to an evidence-based quality framework to identify key components and characteristics of care.
abstract: Implementing effective antenatal care models is a key global policy goal. However, the mechanisms of action of these multi-faceted models that would allow widespread implementation are seldom examined and poorly understood. In existing care model analyses there is little distinction between what is done, how it is done, and who does it. A new evidence-informed quality maternal and newborn care (QMNC) framework identifies key characteristics of quality care. This offers the opportunity to identify systematically the characteristics of care delivery that may be generalizable across contexts, thereby enhancing implementation. Our objective was to map the characteristics of antenatal care models tested in Randomised Controlled Trials (RCTs) to a new evidence-based framework for quality maternal and newborn care; thus facilitating the identification of characteristics of effective care.
  
  
  
  A systematic review of RCTs of midwifery-led antenatal care models. Mapping and evaluation of these models' characteristics to the QMNC framework using data extraction and scoring forms derived from the five framework components. Paired team members independently extracted data and conducted quality assessment using the QMNC framework and standard RCT criteria.
  
  
  
  From 13,050 citations initially retrieved we identified 17 RCTs of midwifery-led antenatal care models from Australia (7), the UK (4), China (2), and Sweden, Ireland, Mexico and Canada (1 each). QMNC framework scores ranged from 9 to 25 (possible range 0-32), with most models reporting fewer than half the characteristics associated with quality maternity care. Description of care model characteristics was lacking in many studies, but was better reported for the intervention arms. Organisation of care was the best-described component. Underlying values and philosophy of care were poorly reported.
  
  
  
  The QMNC framework facilitates assessment of the characteristics of antenatal care models. It is vital to understand all the characteristics of multi-faceted interventions such as care models; not only what is done but why it is done, by whom, and how this differed from the standard care package. By applying the QMNC framework we have established a foundation for future reports of intervention studies so that the characteristics of individual models can be evaluated, and the impact of any differences appraised.
authors.affiliation: Mother and Infant Research Unit, University of Dundee, Dundee, DD1 4HJ, UK. a.g.symon@dundee.ac.uk.
authors.forename: Andrew
authors.identifier: 0000-0001-9269-940X
authors.initials: A
authors.lastname: Symon
authors.affiliation: School of Nursing & Health Sciences, University of Dundee, Dundee, DD1 4HJ, UK.
authors.forename: Jan
authors.initials: J
authors.lastname: Pringle
authors.affiliation: NMAHP Research Unit, University of Stirling, Stirling, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Cheyne
authors.affiliation: School of Health, Brook Building, University of Central Lancashire, Preston, PR1 2HE, UK.
authors.forename: Soo
authors.initials: S
authors.lastname: Downe
authors.affiliation: Centre for Midwifery, Maternal & Perinatal Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, BU1 3LH, UK.
authors.forename: Vanora
authors.initials: V
authors.lastname: Hundley
authors.affiliation: Mother and Infant Research Unit, University of Dundee, Dundee, DD1 4HJ, UK.
authors.forename: Elaine
authors.initials: E
authors.lastname: Lee
authors.affiliation: School of Nursing and Midwifery, Queens University Belfast, Belfast, BT9 7BL, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Lynn
authors.affiliation: Mother and Infant Research Unit, University of Dundee, Dundee, DD1 4HJ, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: McFadden
authors.affiliation: School of Nursing and Midwifery, Queens University Belfast, Belfast, BT9 7BL, UK.
authors.forename: Jenny
authors.initials: J
authors.lastname: McNeill
authors.affiliation: Mother and Infant Research Unit, University of Dundee, Dundee, DD1 4HJ, UK.
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Renfrew
authors.affiliation: Maternal and Child Health, NHS Education for Scotland, Edinburgh, EH3 9DN, UK.
authors.forename: Mary
authors.initials: M
authors.lastname: Ross-Davie
authors.affiliation: Centre for Midwifery, Maternal & Perinatal Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, BU1 3LH, UK.
authors.forename: Edwin
authors.initials: E
authors.lastname: van Teijlingen
authors.affiliation: Mother and Infant Research Unit, University of Dundee, Dundee, DD1 4HJ, UK.
authors.forename: Heather
authors.initials: H
authors.lastname: Whitford
authors.affiliation: School of Nursing and Midwifery, Queens University Belfast, Belfast, BT9 7BL, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Alderdice
mesh_terms: D001315:Australia; D002170:Canada; D002681:China; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007494:Ireland; D000068101:Maternal-Child Health Services / Q000592:standards*; D008800:Mexico; D008880:Midwifery / Q000379:methods* / Q000592:standards; D008962:Models, Theoretical; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods* / Q000592:standards; D011785:Quality Assurance, Health Care / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D013548:Sweden; D006113:United Kingdom
keywords: Care model; Characteristics of care; Maternity care; Midwifery-led; Outcomes; Pregnancy; Quality; Randomised controlled trial