Effect of the Maternal Care Manual from the perinatal education programme on the quality of antenatal and intrapartum care rendered by midwives

Objectives. To assess changes in the quality of antenatal and intrapartum c are rendered by midwives following intervention with the Maternal Care Manu al from the Perinatal Education Programme (PEP). Design. A prospective controlled study. Setting. A study town and two control towns in the Eastern Cape. Subjects. Before the study a sample of files was drawn to provide baseline information. Subsequently all the midwives in the study town studied the ma nual, following which a second sample of files was drawn. Outcome measures. A check-list was used to assess antenatal cards and parto grams. Results. The mean score allocated to the four subunits evaluating the front page of the antenatal card in the study town improved significantly (P = 0 .000) from 58.5% (standard deviation (SD) 20.6) to 74.5% (SD 19.2). No chan ges occurred in the control towns (47.5% and 52.9%). the score obtained for the completion of the back page also improved significantly (P = 0.014), f rom 69% (SD 13.7) to 75.6% (SD 14.2), with no changes in the control towns. The mean score achieved for the completion of the partogram did not change in the study town or control towns. Conclusions. The improved scores obtained for the antenatal card in the stu dy town reflects improved quality of antenatal care. Documentation that imp roved significantly included important aspects of antenatal care, i.e. prev ious obstetric history, gestational age, special investigations and correct charting of fundal growth. Three of the four subunits that did not improve were already familiar to the midwives before the study. Documentation of t he partogram did not improve for reasons outside the control of the PEP.