The psychosocial outcomes of antenatal day care for three medical complications of pregnancy: a randomised controlled trial of 395 women

Abstract

Background: Although antenatal day care is becoming increasingly common, there is little evidence as to the psychosocial efficacy of this model of care.

Aim: We aimed to assess the broader psychosocial impact of antenatal day care compared with admission to hospital.

Methods: We carried out a randomised trial of 395 women, randomly assigned in a 2 : 1 ratio between day care and antenatal ward, stratified for major diagnostic categories (proteinuric hypertension, non-proteinuric hypertension and preterm premature rupture of membranes). Main outcome measures--self-report questionnaires (response rates ranging from 80 to 90%) were sent to women's homes four days after randomisation and seven weeks after delivery.

Results: Overall, there were statistically significant differences favouring day care in 12 of 28 items at four days post-randomisation, with no differences in the two groups for the other 16 items. At seven weeks postdelivery, we found differences in eight of 28 items favouring day care, with no differences in the two groups for the other 20 items. The types of items indicating a sustained difference covered a range of aspects of care and included satisfaction with staff, continuity of carer, information transfer, and social support. There were no differences in relation to infant feeding and relationship with the baby.

Conclusions: Day care has an effect on women's satisfaction with care but does not produce broader psychosocial outcomes.