Should obstetricians see women with normal pregnancies? A multicentre randomised controlled trial of routine antenatal care by general practitioners and midwives compared with shared care led by obstetricians

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Abstract
Objective: To compare routine antenatal care provided by general practitioners and midwives with obstetrician led shared care. Design: Multicentre 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 general practitioners and midwives according to a care plan and protocols for managing complications. Main outcome measures: Comparisons of health service use, indicators of quality of care, and women's satisfaction. Results: Continuity of carer was improved for the general practitioner and midwife group as the number of carers was less (median 5 carers v 7 for shared care group, PConclusion: Routine specialist visits for women initially at low risk of pregnancy complications offer little or no clinical or consumer benefit. Key messages Care by general practitioners and midwives improved continuity of care: there were fewer carers, non-attendances, and hospital admissions, and marginally fewer routine visits than with specialist led shared care; incidences of hypertension, proteinuria, pre-eclampsia, and induction of labour were also lower Overall there were few deviations from the care protocol, but a greater proportion of Rhesus negative women in the general practitioner and midwife group did not have an appropriate check for antibodies The women in both trial groups were equally highly satisfied with all aspects of their care; only a small minority of women in the general practitioner and midwife group said they would have liked to have seen a hospital doctor but did not Although there was no net benefit from routine specialist antenatal visits, over half of women developed some complication during their pregnancy; in the general practitioner and midwife model of care, low risk women see a specialist when required and not at predefined routine visits