Who should provide the antenatal care

A meta-analysis comparing pregnancy outcome in two groups of low-risk women, one with community-led antenatal care (midwife and general practitioner) and the other with hospital-led care did not show any differences in terms of preterm birth, Caesarean section, anaemia, antepartum haemorrhage, urinary tract infections and perinatal mortality. The first group had a lower rate of pregnancy-induced hypertension and pre-eclampsia which could reflect a lower incidence or lower detection [7]. Clear referral pathways need to be developed, however, that allow appropriate referral to specialists when either fetal or maternal problems are detected.

There is little evidence regarding women's views on who should provide antenatal care. Unfortunately, care is usually provided by a number of different professionals often in different settings. Studies evaluating the impact of continuity of care do not generally separate the antenatal period from labour. The studies consistently show that with fewer caregivers women are better informed and prepared for labour, attend more antenatal classes, have fewer antenatal admissions to hospital and have higher satisfaction rates. Differences in clinical end-points such as Caesarean section rates, post-partum haemorrhage, admission to the neonatal unit and perinatal mortality are generally insignificant [3]. While it would appear advantageous for women to be seen by the same midwife throughout pregnancy and childbirth there are practical and economic considerations that need to be taken into account. Nevertheless, where possible, care should be provided by a small group of professionals.

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