Survey of health visiting in antenatal care.

The range of the health visitor''s work is expanding. To find out what antenatal work health visitors actually carry out and what their attitudes towards such work are we surveyed general practitioners, midwives, and health visitors in three district health authorities. The results indicate that health visitors are qualified and willing to work with women in the antenatal period.     

An audit of antenatal care: the value of the first antenatal visit.

A critical analysis of the events recorded at the first antenatal visits in a city where all pregnant women are seen by specialist obstetricians for booking for antenatal care and confinement showed that many women attended too late for optimal care. The selection of women for their risk of complications was not very effective, partly because of failure to take account of information that was available, but mainly because many obstetric complications cannot be predicted, except by classifying large proportions of pregnant women as high risk. Even with the greatest care, inappropriate bookings are made at the first visit, and reappraisal of booking for continuing care and confinement is necessary during pregnancy.     

New programme of antenatal care in general practice.

The conclusions from recent analyses of the clinical worth of routine antenatal attendances have been used in the setting of a modern primary health care team. As a result the number of times a low risk nulliparous woman is seen by her general practitioner has been reduced from 15 to eight and a low risk multiparous woman from 15 to six. The number of consultations with a midwife has also been considerably reduced. The time saved is used in longer, more structured consultations and for more intensive care of high risk, usually socially deprived, women. Despite these reductions in consultations organised, well recorded care of this type renders antenatal attendances at a hospital virtually unnecessary for low risk women.     

A randomised controlled trial comparing two schedules of antenatal visits: the antenatal care project.

OBJECTIVE--To compare the clinical and psychological effectiveness of the traditional British antenatal visit schedule (traditional care) with a reduced schedule of visits (new style care) for low risk women, together with maternal and professional satisfaction with care. DESIGN--Randomised controlled trial. SETTING--Places in south east London providing antenatal care for women receiving shared care and planning to deliver in one of three hospitals or at home. SUBJECT--2794 women at low risk fulfilling the trial''s inclusion criteria between June 1993 and July 1994. MAIN OUTCOME MEASURES--Measures of fetal and maternal morbidity, health service use, psychosocial outcomes, and maternal and professional satisfaction. RESULTS--Pregnant women allocated to new style care had fewer day admissions (0.8 v 1.0; P=0.002) and ultrasound scans (1.6 v 1.7; P=0.003) and were less often suspected of carrying fetuses that were small for gestational age (odds ratio 0.73; 95% confidence interval 0.54 to 0.99). They also had some poorer psychosocial outcomes; for example, they were more worried about fetal wellbeing antenatally and coping with the baby postnatally, and they had more negative attitudes to their babies, both in pregnancy and postnatally. These women were also more dissatisfied with the number of visits they received (odds ratio 2.50; 2.00 to 3.11). CONCLUSIONS--Patterns of antenatal care involving fewer routine visits for women at low risk may lead to reduced psychosocial effectiveness and dissatisfaction with frequency of visits. The number of antenatal day admissions and ultrasound scans performed may also be reduced. For the variables reported, the visit schedules studied are similar in their clinical effectiveness. Uncertainty remains as to the clinical effectiveness of reduced visit schedules for rare pregnancy problems.