ANTENATAL CARE OF LOW-RISK OBSTETRIC PATIENTS BY MIDWIVES - A RANDOMIZED CONTROLLED TRIAL

Objectives: To assess the practicality, acceptability to patients and salary costs of the antenatal care of low risk obstetric patients by midwives. Design: A randomised controlled trial. Setting: The antenatal clinic at Westmead Hospital, a teaching hospital of the University of Sydney in western Sydney. Patients: From January 1989 until November 1990, 89 women booking for full antenatal care at Westmead Hospital and classified as low risk were randomly allocated to one of two groups. Group 1 (43 patients) had their antenatal care provided by registered midwives. Group 2 (46 patients) had their antenatal care provided by an obstetrician (either Visiting Medical Officer or Staff Specialist) in a routine hospital antenatal clinic. Interventions: Patients in the midwives' clinic were seen by an obstetrician at their first visit to the antenatal clinic and again at 30 weeks and at 40 weeks. Main outcome measures: These were the salary costs of each clinic and the patients' levels of satisfaction. Maternal and neonatal indicators, delivery details and analgesic requirements were also considered. These indicators were planned before data collection commenced. Results: The major differences found were a 28% to 68% salary cost saving and that patients cared for by midwives showed appreciation of the continuity of care and information given at the midwives' clinic. Conclusions: The care of low risk obstetric patients by midwives in a midwives' clinic showed salary cost savings and high patient acceptance.