SHOULD OBSTETRICIANS SEE WOMEN WITH NORMAL PREGNANCIES - A MULTICENTER RANDOMIZED CONTROLLED TRIAL OF ROUTINE ANTENATAL CARE BY GENERAL-PRACTITIONERS AND MIDWIVES COMPARED WITH SHARED CARE LED BY OBSTETRICIANS

Objective-To compare routine antenatal care provided by general practi tioners and midwives with obstetrician led shared care. Design-Multice ntre randomised controlled trial. Setting-51 general practices linked to nine Scottish maternity hospitals. Subjects-1765 women at low risk of antenatal complications. Intervention-Routine antenatal care by gen eral practitioners and midwives according to a care plan and protocols for managing complications. Main outcome measures-Comparisons of heal th service use, indicators of quality of care, and women's satisfactio n. Results-Continuity of carer was improved for the general practition er 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 visi ts reduced (10.9 v 11.7, P < 0.0001). Fewer women in the general pract itioner 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 n ot differ except that fewer women in the general practitioner and midw ife 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 o ccurred, but more Rhesus negative women in the general practitioner an d 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 alloc ated 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 labou r rooms before giving birth, P=0.6). Conclusion-Routine specialist vis its for women initially at low risk of pregnancy complications offer l ittle or no clinical or consumer benefit.